| Class | Drug or chemical | Clinical features |
| Chemotherapeutic agents | Bleomycin | - Linear, flagellate bands
- Hyperpigmentation over joints, striae, and/or palmar creases
|
| Busulfan, cyclophosphamide, procarbazine | - Diffuse hyperpigmentation of the skin and mucous membranes
- Pigment localized to the nails, palms/soles, or teeth
|
| Cisplatin, docetaxel, doxorubicin, idarubicin | - Hyperpigmentation overlying the small joints of the hands and involving the palmar creases, palms/soles, and oral mucosa including the tongue
|
| Fluorouracil | - Hyperpigmentation in sun-exposed areas
- Pigmentation along veins used for infusions*
|
| Hydroxyurea | - Hyperpigmentation over pressure points and on the back
|
| Methotrexate | - Hyperpigmentation in sun-exposed areas and hair
|
| Antimalarials | Aminoquinolines | - Gray-blue pigmentation on pretibial surfaces and also the face, hard palate, sclerae, and subungual areas
|
| Hormones | Oral contraceptives | - Hyperpigmentation of the nipples
- Increased pigmentation of nevi
- Hyperpigmented patches of the face (melasma)
|
| Heavy metals | Arsenic | - Areas of bronze hyperpigmentation
|
| Gold (chrysiasis) | - Permanent blue-gray pigmentation in sun-exposed areas, especially periorbital
|
| Iron | - Permanent brown pigment at injection or application sites
|
| Lead | - Pigmentation at gingival margin
|
| Mercury | - Slate-gray discoloration, especially in skin folds
|
| Silver (argyria) | - Generalized slate-gray discoloration, increased in sun-exposed areas, nails, sclerae, oral mucosa, or application sites
|
| Prostaglandin agonists | Bimatoprost, latanoprost, tafluprost, travoprost, unoprostone | - Increased brown pigmentation of iris, eyelids, eyelashes, and periorbital skin
|
| Smoking | Nicotine and other substances in tobacco smoke | - Brown hyperpigmented lesions of oral mucosa, lips, and gingiva (smoker's melanosis)
|
| Miscellaneous | Amiodarone | - Slate-gray discoloration in sun-exposed areas, especially face
|
| Clofazimine | - Diffuse red-brown discoloration of the skin
- Blue-brown to violaceous discoloration in lesional skin
|
| Diltiazem | - Slate-gray-brown pigmentation of sun-exposed areas, especially in darker skin types, may have perifollicular accentuation and reticulated pattern
|
| Ezogabine | - Blue-gray discoloration of skin, nails, conjunctivae, and oral mucosa
|
| Minocycline¶ | - Generalized "muddy" brown discoloration
- Blue-black discoloration in old acne scars or sites of inflammation as well as lower extremities
- Pigmentation may also involve the nails, sclerae, oral mucosa, bones, thyroid, and teeth
|
| Psoralens | - Increased skin pigmentation after exposure to ultraviolet A light
|
| Psychotropic drugs (amitriptyline, chlorpromazine, desipramine, imipramine, thioridazine) | - Slate-gray pigmentation in sun-exposed areas
|
| Tacrolimus, topical | - Brown pigmented macules at application sites
|
| Zidovudine | - Mucocutaneous hyperpigmentation that can be widespread/diffuse, acral, or on oral mucosa
|
