Amiodaron-induced skin lesion: focus on blue man syndrome

Abstract

Amiodarone has been used in clinical practice since 1964. The 2020 European guidelines note that amiodarone is recommended for long-term rhythm control in all patients with atrial fibrillation. However, due to its extracardiac toxicity, other antiarrhythmic drugs should be considered first. Information databases were searched for descriptions of amiodarone-induced blue man syndrome. Its pathogenesis is associated with accelerated physiological aging of dermal cells, leading to the accumulation of lipofuscin in lysosomes, or occurs as a result of the direct accumulation of amiodarone and its metabolites in the skin. As part of the review, brief descriptions of the 32 clinical cases found of the blue man syndrome are given. Most publications refer to various countries in Europe and the United States, which suggests that this syndrome develops more often in Caucasians. This syndrome is more common in people over 60 years of age, males predominate among patients. The development of the blue man syndrome is preceded by long-term use of amiodarone and the achievement of a certain cumulative dose. After the abolition of amiodarone, a gradual improvement is noted for 1 year or more. Other side effects of amiodarone are often detected in the presence of the blue man syndrome. Most publications describing the blue man syndrome belong to cardiologists and dermatologists. Given the variety of side effects of amiodarone, pulmonologists, endocrinologists, neurologists, ophthalmologists, gastroenterologists and doctors of other specialties may encounter a blue-gray skin color change.