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Related Experiment Videos

[Apomorphine hyperpigmentation].

R Loewe1, M Püspök-Schwarz, P Petzelbauer

  • 1Universitätsklinik für Dermatologie, Abteilung Allgemeine Dermatologie, Universität Wien, Vienna, Austria..

Der Hautarzt; Zeitschrift Fur Dermatologie, Venerologie, Und Verwandte Gebiete
|February 5, 2003
PubMed
Summary
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Blue nodules in a Parkinson's patient were not melanoma metastases, but pigment deposits. Apomorphine treatment caused these skin changes by forming tetrahydroisoquinoline-melanin.

Area of Science:

  • Dermatology
  • Pathology
  • Pharmacology

Background:

  • A 72-year-old male with Parkinson's disease presented with unexplained blue nodules.
  • Initial clinical suspicion was melanoma metastasis due to a concurrent forearm melanoma.

Observation:

  • The patient had received long-term subcutaneous apomorphine infusions for Parkinson's disease.
  • Biopsies of the nodules revealed histiocytic cells containing pigment granules, histochemically similar to melanin.
  • Melanocytes were notably absent in the affected skin areas.

Findings:

  • The pigment was identified as tetrahydroisoquinoline-melanin, a metabolite of apomorphine.
  • Apomorphine oxidation led to pigment deposition in the deep dermis and upper subcutis.
  • The blue nodules were a result of iatrogenic pigment accumulation, not malignancy.

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Implications:

  • This case highlights a rare side effect of apomorphine treatment.
  • It underscores the importance of reassessing patient history for atypical presentations.
  • Distinguishing drug-induced pigmentations from metastatic disease is crucial for accurate diagnosis and management.