Nail Pigmentation May Be an Early Sign of Minocycline-Associated Cutaneous Pigmentation: A Systematic Review

This systematic review analyzed 98 studies involving 266 patients to investigate minocycline-associated pigmentation, revealing that nail pigmentation may be an early indicator of more widespread cutaneous pigmentation. The average onset of pigmentation occurred at approximately 1 year or a cumulative dose of 120 g of minocycline. Nail pigmentation alone was found to occur at significantly lower cumulative doses compared to combined skin and nail pigmentation. The review suggests limiting minocycline use to 3-4 months, monitoring cumulative doses, and conducting regular nail inspections, recommending discontinuation of the drug upon the first signs of nail pigmentation. Limitations include small sample sizes and study heterogeneity.