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Cutaneous Pigmentation Secondary to Amiodarone Therapy

Cutaneous Pigmentation Secondary to Amiodarone Therapy Abstract • Amiodarone (Cordarone) is an iodinated cardiac antiarrhythmic drug that causes a slate-gray discoloration of the sun-exposed skin and a yellow-brown stippling of the cornea. Histopathologically, biopsy specimens of aminodarone pigmentation sites disclose yellow-brown refractile granules in the reticular dermis. These granules were characterized by transmission electron microscopy as being concentrically arranged intralysosomal inclusions ("myelinlike" bodies) in dermal endothelial cells and perivascular smooth-muscle cells. Electron probe x-ray analysis of these same inclusions disclosed definite peaks for iodine, evidence for the presence of amiodarone or a metabolite of the drug at these sites. Amiodarone, then, concentrates in lysosomes and causes an accumulation of lipids similar to what has been seen with other cationic amphiphilic compounds, such as the glycosphingolipid stored in Fabry's disease. Amiodarone must be recognized as a cause of a drug-induced lipid storage disease with cutaneous and corneal manifestations. (Arch Dermatol 1983;119:914-918) References 1. Zipes DP, Troup PJ: New antiarrhythmic agents . Am J Cardiol 1978;41:1005-1024.Crossref 2. Matheis HA: Amiodarone-pigmentierung . Dermatologica 1972;145:304-318.Crossref 3. Balouet G, Labouche F, Daoulas R, et al: Evolution clinique et histo-pathologique des depots pigmentaires cutanes, apparus au cours de traitements par chlorhydrate d'amiodarone . Arch Anat Pathol 1972;20:265-269. 4. Morand P, Benatre J, Viau G, et al: Etude clinique et histologique (ultrastructure) de la pigmentation par le chlorhydrate d'amiodarone . Sem Hop Paris 1972;48:553-563. 5. Vos AK, Van Ramshorst AGS, Grosfeld JCM, et al: A peculiar cutaneous pigmentation from Cordarone . Dermatologica 1972;145:297-303.Crossref 6. D'Amico DJ, Kenyon KR, Ruskin JN: Amiodarone keratopathy . Arch Ophthalmol 1981;99:257-261.Crossref 7. Faraggiana T, Churg J, Grishman E, et al: Light- and electron-microscopic histochemistry of Fabry's disease . Am J Pathol 1981;103:247-262. 8. Nakamura T, Kaneko H, Nishino I: Angiokeratoma corporis diffusum (Fabry disease): Ultrastructural studies of the skin . Acta Derm Venereol 1981;61:37-41. 9. Breathnach SM, Black MM, Wallace HJ: Anderson-Fabry disease: Characteristic ultrastructural features in cutaneous blood vessels in a 1-year-old boy . Br J Dermatol 1980;103:81-84.Crossref 10. Masters SK, Bell SW, Ingram P, et al: Preparative techniques for freezing and freeze-sectioning macrophages for energy dispersive x-ray microanalysis , in Johari O (ed): Scanning Electron Microscopy . AMF O'Hare, Ill, SEM Inc, 1979, vol 3, pp 97-110, 122. 11. Rosenbaum MB, Chiale PA, Halpern MS, et al: Clinical efficacy of amiodarone as an antiarrhythmic agent . Am J Cardiol 1976;38:934-944.Crossref 12. Lullmann H, Lullmann-Rauch R, Wassermann O: Lipidosis induced by amphiphilic cationic drugs . Biochem Pharmacol 1978;27:1103-1108.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1983.01650350042012
Publisher site
See Article on Publisher Site

Abstract

Abstract • Amiodarone (Cordarone) is an iodinated cardiac antiarrhythmic drug that causes a slate-gray discoloration of the sun-exposed skin and a yellow-brown stippling of the cornea. Histopathologically, biopsy specimens of aminodarone pigmentation sites disclose yellow-brown refractile granules in the reticular dermis. These granules were characterized by transmission electron microscopy as being concentrically arranged intralysosomal inclusions ("myelinlike" bodies) in dermal endothelial cells and perivascular smooth-muscle cells. Electron probe x-ray analysis of these same inclusions disclosed definite peaks for iodine, evidence for the presence of amiodarone or a metabolite of the drug at these sites. Amiodarone, then, concentrates in lysosomes and causes an accumulation of lipids similar to what has been seen with other cationic amphiphilic compounds, such as the glycosphingolipid stored in Fabry's disease. Amiodarone must be recognized as a cause of a drug-induced lipid storage disease with cutaneous and corneal manifestations. (Arch Dermatol 1983;119:914-918) References 1. Zipes DP, Troup PJ: New antiarrhythmic agents . Am J Cardiol 1978;41:1005-1024.Crossref 2. Matheis HA: Amiodarone-pigmentierung . Dermatologica 1972;145:304-318.Crossref 3. Balouet G, Labouche F, Daoulas R, et al: Evolution clinique et histo-pathologique des depots pigmentaires cutanes, apparus au cours de traitements par chlorhydrate d'amiodarone . Arch Anat Pathol 1972;20:265-269. 4. Morand P, Benatre J, Viau G, et al: Etude clinique et histologique (ultrastructure) de la pigmentation par le chlorhydrate d'amiodarone . Sem Hop Paris 1972;48:553-563. 5. Vos AK, Van Ramshorst AGS, Grosfeld JCM, et al: A peculiar cutaneous pigmentation from Cordarone . Dermatologica 1972;145:297-303.Crossref 6. D'Amico DJ, Kenyon KR, Ruskin JN: Amiodarone keratopathy . Arch Ophthalmol 1981;99:257-261.Crossref 7. Faraggiana T, Churg J, Grishman E, et al: Light- and electron-microscopic histochemistry of Fabry's disease . Am J Pathol 1981;103:247-262. 8. Nakamura T, Kaneko H, Nishino I: Angiokeratoma corporis diffusum (Fabry disease): Ultrastructural studies of the skin . Acta Derm Venereol 1981;61:37-41. 9. Breathnach SM, Black MM, Wallace HJ: Anderson-Fabry disease: Characteristic ultrastructural features in cutaneous blood vessels in a 1-year-old boy . Br J Dermatol 1980;103:81-84.Crossref 10. Masters SK, Bell SW, Ingram P, et al: Preparative techniques for freezing and freeze-sectioning macrophages for energy dispersive x-ray microanalysis , in Johari O (ed): Scanning Electron Microscopy . AMF O'Hare, Ill, SEM Inc, 1979, vol 3, pp 97-110, 122. 11. Rosenbaum MB, Chiale PA, Halpern MS, et al: Clinical efficacy of amiodarone as an antiarrhythmic agent . Am J Cardiol 1976;38:934-944.Crossref 12. Lullmann H, Lullmann-Rauch R, Wassermann O: Lipidosis induced by amphiphilic cationic drugs . Biochem Pharmacol 1978;27:1103-1108.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1983

References