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These are: 1) the drug triggers accumulation of melanin 2) the triggering medication accumulates in the skin 3) the drug triggers synthesis of special pigments 4) the drug triggers deposition of iron Afrin et al 2022 Afrin et al reported an otherwise healthy 40-year-old male who experienced facial and dorsal hand hyperpigmentation within two weeks of beginning doxycycline monohydrate 100 milligrams twice daily for acne

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Note the pigment incontinence