Hashimoto K, Joselow S A, Tye M J
Department of Dermatology, Wayne State University School of Medicine, Detroit, MI 48201.
J Am Acad Dermatol. 1991 Aug;25(2 Pt 2):357-61. doi: 10.1016/0190-9622(91)70204-f.
A 48-year-old white woman, skin type III, had a slate-gray discoloration of the face and dorsa of both hands after ingesting imipramine, 150 mg/day for 5 years. Her iris color was also darkened. One year after cessation of the therapy, the discoloration became lighter. Sun-protected skin showed no discoloration. Light microscopy revealed an accumulation of doubly refractile golden yellow granules in the papillary dermis, mostly scattered, with some concentration around the blood vessels but not in the endothelial cells. Electron micrographs showed numerous amorphous electron-dense inclusion bodies in histiocytes, phagocytes, fibroblasts, and dermal dendrocytes. Melanosomes were phagocytosed in the same cells but in separated locations. Imipramine is structurally related to chlorpromazine and can cause slate-gray discoloration. However, the color of the granules deposited in the papillary dermis is golden-yellow and they are not deposited in endothelial cells.
一名48岁的白人女性，皮肤类型为III型，在每天服用150毫克丙咪嗪，持续5年后，面部和双手背部出现蓝灰色色素沉着。她的虹膜颜色也变深了。停止治疗一年后，色素沉着变浅。防晒部位的皮肤未出现色素沉着。光学显微镜检查显示，乳头层真皮中有双折射的金黄色颗粒聚集，大多呈散在分布，部分集中在血管周围，但不在内皮细胞中。电子显微镜照片显示，组织细胞、吞噬细胞、成纤维细胞和真皮树突状细胞中有大量无定形电子致密包涵体。黑素小体在相同细胞中被吞噬，但位置不同。丙咪嗪在结构上与氯丙嗪相关，可导致蓝灰色色素沉着。然而，沉积在乳头层真皮中的颗粒颜色为金黄色，且它们不沉积在内皮细胞中。
