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proposed mechanisms for hyperpigmentation include: Indirect toxicity to the skin/melanocyte damage — eg, bleomycin and doxorubicin melanocyte damage Accumulation of drug/ drug metabolites in the skin — eg, chloroquine and hydroxychloroquine Immune mediation or an allergic reaction resulting in inflammation and pigment deposition — eg, gold (immune-mediated reaction) Stimulation of melanin production — eg, oral contraceptives and hormone replacement therapy (HRT) may stimulate melanin production Formation of drug-protein complexes causing inflammation and melanin deposition — amiodarone is proposed to cause pigmentation this way
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