By Gary M. White, MD
Minocycline for 3 years for rosacea caused this bluish discoloration of the nails.
Pigmentation of the nail may occur with the administration of various drugs including minocycline, AZT (zidovudine), cyclophosphomide, adriamycin, hydroxyurea [JAAD 1996;35;275], bleomycin, doxorubicin, fluorouracil, methotrexate and melphalan. Transverse bands thought to correspond to administration of the cytotoxic agent, longitudinal bands, and rarely diffuse pigmentation may occur. Some of these drugs may cause skin or mucosal pigmentation as well.
Nail pigmentation from zidovudine is thought to be caused by activation of melanocytes in the nail matrix. It appears to be reversible and relatively dose dependent [Scand J Infect Dis 1992;24:557-61].
Endogenous causes of nail pigmentation will have a proximal border parallel to the lunula. External causes of discoloration, e.g. products applied to the nail, will cause a proximal border that is opposite to the arc of the lunula.
For exogenous causes of nail discoloration, see Nail Discoloration.
AZT-induced nail pigmentation. Courtesy of Steven H. Goldberg, MD
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