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Facial hyperpigmentation caused by diltiazem hydrochloride
Nina Desai1, Andrew F Alexis, Vincent A DeLeo
1Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA.
Cutis
|October 6, 2010
Summary
Diltiazem can cause skin darkening, particularly in sun-exposed areas. This case suggests ultraviolet B (UVB) light may contribute to this reaction, challenging the common belief that only UVA is involved.
Area of Science:
- Dermatology
- Pharmacology
- Photobiology
Background:
- Diltiazem hydrochloride is a calcium channel blocker used for hypertension.
- Cutaneous reactions, including photodistributed hyperpigmentation, are known side effects of diltiazem.
- The role of different ultraviolet (UV) wavelengths in drug-induced photosensitivity is an area of ongoing research.
Observation:
- A 53-year-old Black woman developed facial hyperpigmentation 6 months after initiating diltiazem.
- Topical treatments were ineffective.
- Skin biopsy revealed postinflammatory pigment alteration and lichenoid dermatitis.
Findings:
- Laboratory and patch/photo-patch testing for diltiazem and other agents were negative.
- Phototesting showed a normal minimal erythema dose (MED) to UVA but a reduced MED to UVB.
- Discontinuation of diltiazem and initiation of hydralazine hydrochloride led to improvement.
Implications:
- This case highlights a potential role for UVB radiation in diltiazem-induced photodistributed hyperpigmentation.
- It suggests that photoprotection against both UVA and UVB may be important for patients taking diltiazem.
- Further research is warranted to elucidate the specific mechanisms of UVB-induced photosensitivity to diltiazem.
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