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• W1996177986 abstract "Dear Sir, A 26-year old man with psychiatric diagnosis of simple schizophrenia had been treated with olanzapine for 2 years. He was given olanzapine initially in doses of 10 mg/day, which later titrated to 20 mg/day for further improvement in negative symptoms, i.e. asociality, amotivation and avolition. He was taking no other medications. He developed progressively increasing slate-gray pigmentation over the dorsal aspect of both hands over a period of 4 months for which skin consultation was sought. He had never had any previous skin disorders. Past medical history was insignificant. He has no known drug allergies. His family history was unremarkable. Physical examination revealed slate-gray hyperpigmentation of the skin over the dorsal aspect of the hands with clear demarcation from the forearms (Fig. 1). The lesions were asymptomatic. The nails, hair, sclera and teeth were normal. The remainder of the physical examination revealed no abnormalities. Laboratory studies found the complete blood cell count and the serum electrolytes and serum ferritin levels to be within normal limits. Hyperpigmentation of the skin and dorsal aspects of the hands The diagnosis of drug (olanzapine)-induced acral melanosis was made on the basis of the clinical and laboratory findings. Because of the temporal association, olanzapine was implicated as the offending agent. Drug-induced pigmentation represents 10–20% of all cases of acquired hyperpigmentation.1 Various medications have been reported to induce state-gray pigmentation. These include heavy metals,2 amiodarone,3–4 minocycline5 and tricyclic antidepressants including imipramine6–7 and desipramine.8 In 1964, Greiner and Berry described what is probably the first documented study of skin pigmentation caused by long-term antipsychotic, i.e. chlorpromazine use.9 Since then there have been several publications regarding conventional antipsychotic-induced skin pigmentation in the literature.10–13 Atypical antipsychotic agents were developed in an attempt to widen the therapeutic ratio between efficacy and adverse effects in comparison with an older generation of antipsychotic medication,14 while the older antipsychotic drugs have been associated with an adverse effect of abnormal skin pigmentation, there have been no reports to date describing its incidence in the newer generation of antipsychotic medication including olanzapine. This case report represents the first report of skin hyperpigmentation caused by a novel antipsychotic agent, olanzapine, with strong evidence. The exact mechanism by which drugs cause skin pigmentation is unknown. The proposed mechanisms include: (1) stimulation of melanin production, (2) deposition of non-melanin pigments derived from the causative agent itself or its metabolic products, and (3) the combination of increased melanin formation and drug/metabolite deposition.2 Clinical features are variable greatly according to the triggering molecule, with a large range of patterns and shades, which are sometimes more or less reminiscent of the culprit drug.1 We believe that the risk of developing abnormal skin pigmentation with newer generation antipsychotic agents is minimal compared with older generation antipsychotics. This is the first report of skin hyperpigmentation with olanzapine, a novel antipsychotic agent. This case suggests that olanzapine-induced melanosis may be similar to that associated with older generation antipsychotic medications. As the potential role of olanzapine therapy is increasing in the treatment of schizophrenia and related psychoses, clinicians should be aware of this rare complication of olanzapine therapy." @default.
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• W1996177986 date "2004-10-01" @default.
• W1996177986 modified "2023-10-12" @default.
• W1996177986 title "Skin hyperpigmentation induced by olanzapine, a novel antipsychotic agent" @default.
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• W1996177986 doi "https://doi.org/10.1111/j.1365-4632.2004.02255.x" @default.
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