Nail Pigmentation due to Roxithromycin

Nail pigmentation Roxithromycin Dr. Amrinder J. Kanwar, Additional Professor Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India) Roxithromycin, the first of a new generation of macrolides, has an antibacterial spectrum similar to that of erythromycin for typical and atypical acute community-acquired infections. However, it has improved phar-macokinetics with proven efficacy, and better tolerance and compliance. The drug has been frequently used in infections of the upper and lower respiratory tract, ear, teeth, skin and soft tissue and genitourinary system [1–5]. The major adverse effects include nausea, abdominal pain and diarrhea. These are however, reduced in intensity and frequency as compared to other macrolides. Other side effects which may occasionally be seen are dyspepsia, flatulence, constipation, dizziness, pruritus, urticaria and skin rashes [4, 5]. We report a patient who developed nail pigmentation following roxithromycin. A 23-year-old male presented with pigmentation of finger nails of 2 months duration. The patient revealed that he had an episode of upper respiratory tract infection (URTI) 3 months before, for which roxithromycin, tablet 150 mg twice daily, was prescribed. He initially responded but as symptoms persisted, he continued the drug for another 2 weeks. On stopping the drug, he noticed a slight brownish discoloration of both thumb nails. He had a further episode of URTI for which he again took roxithromycin for 2 weeks. At that time, he noticed further darkening of pigmentation over both thumb