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Indian Journal of Dermatology, Venereology, Leprology, Vol. 71, No. 1, January-February, 2005, pp. 47-49 Letter To Editor Sparfloxacin induced blue/black discoloration of all nails: Report of three cases Guptha SDN, Sacchidanand S Departments of Dermatology and STD, Sri Sathya Sai General Hospital, Bangalore Medical College, Karnataka Code Number: dv05014 Sir, Discoloration of nails is usually seen as an adverse reaction to drugs.[1] Pigmentation can occur either in the nail plate or vascular nail bed. The term chromonychia indicates an abnormality in color of the substance and / or the surface of the nail plate and / or subungual tissues. When the cause is endogenous, discoloration often corresponds to the shape of the lunula. Melanonychia is increased melanogenesis in the nail matrix. Chloroquine produces blue-black nail bed,[2] silver induces dark blue nail bed (argyria), amodiaquine causes hyperpigmentation, phenolphthalein - dark blue discoloration, and zidovudine (AZT) produces brown-black longitudinal streaks in the nail plate.[3] Hyperpigmentation due to an increase of melanin pigment in nail and nail bed has been noted in children after six weeks′ treatment with doxorubicin.[4] Carbamazepine was reported to have produced yellow discoloration in the nails which cleared within 6 months after stopping therapy.[5] We report blue / black discoloration of nails in 3 patients due to sparfloxacin, which has not been reported so far in the literature to the best of our knowledge. Case 1 A 16 year old boy presented with recurrent boils on the scalp. He was prescribed sparfloxacin 400 mg as a loading dose, followed by 200 mg daily for 15 days. He followed up after 15 days with nail discoloration [Figure - 1]. The nails showed blue-black pigmentation involving the lunulae. Involvement of all 20 nails was noted. Sparfloxacin was stopped and patient was followed-up for 6 months. The discoloration gradually moved distally and disappeared [Figure - 2]. Case 2 A 22 year old male had grade III acne. He was started on sparfloxacin 400 mg as loading dose, followed by 200 mg daily once for 15 days with clindamycin cream topically. He came for review after 20 days and complained of bluish discoloration of nails in lunular area of all 20 nails. After stopping the drug the discoloration disappeared gradually moving distally in 6 months duration. Case 3 A 25 year old male patient, an agriculturist, presented with recurrent Bockhardt′s impetigo on the legs. Sparfloxacin and topical mupirocin were prescribed for 20 days. He came with recurrence after 45 days. We noticed black discoloration of the nails [Figure - 3]. After omission of the drug, the pigmentation gradually disappeared within 6-8 months. Sparfloxacin is a newer difluorinated quinolone antimicrobial agent. All fluoroquinolones act by inhibiting bacterial DNA gyrase enzyme, which is required for DNA replication. Sparfloxacin is known to be bactericidal against both Gram positive and Gram negative organisms. It is also known to be effective against M. tuberculosis, M. Leprae, Mycoplasma, Legionella and Chlamydia species. The commonly known adverse cutaneous reactions of sparfloxacin are photosensitivity, fixed drug reaction, toxic epidermal necrolysis and skin rashes.[6] The other adverse effects are abdominal pain, vomiting, diarrhea, and neurological disturbances like insomnia, confusion, paresthesia, and hallucinations. Nail pigmentation following sparfloxacin has hitherto not been reported. In our patients the blue-black nail pigmentation appeared two to three weeks following therapy and persisted for a long duration even after stopping the drug. However on follow-up of the patients over a period of 6-8 months, we noted gradual disappearance of the pigmentation. Nail discoloration is a benign condition and disappears with time but may prove of cosmetic discomfort to the patient. REFERENCES
Copyright 2005 - Indian Journal of Dermatology, Venereology, Leprology The following images related to this document are available:Photo images[dv05014f3.jpg] [dv05014f2.jpg] [dv05014f1.jpg] |
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