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PEBC Theme of the Week: Blue/Purple

Continuing with the colour series, we are going to look at the colours blue and purple. Blue can be an indicator of lack of oxygen or circulation. For example, patients who overdose on opioids may present with blue nails and lips due to impaired breathing and slowed heart rate. Another example would be patients with chronic obstructive pulmonary disease who feel breathless due to the decline of their lung function. ------------------ Here are the top 4 medications you should know related to the colour “blue”.

1) Amiodarone: an antiarrhythmic which causes blue discolouration of the skin. This phenomenon is possibly linked to drug deposition in the skin, as well as a phototoxic reaction with the sun. It is more common in patients who have been taking high doses for long periods of time. Therefore, it is a good idea to counsel on proper sunscreen protection while on amiodarone. These patients often have what is called "blue man syndrome" or "smurf syndrome".

2) Minocycline: a tetracycline antibiotic which also causes blue discolouration of the skin. One of the possible mechanisms is the stimulation of melanin production, leading to darker skin in some areas.

3) Hydroxychloroquine and Chloroquine: an antimalarial/antirheumatic medication which causes blue skin discolouration after years of usage.

4) Amitriptyline: A tricyclic antidepressant which causes a harmless blue discolouration of urine. ------------------ As for purple, the one that comes to mind is gentian violet, but it is no longer on the market after a Health Canada advisory in 2019. Mothers used to use it as an antifungal topical agent to put on their nipple, or in the baby’s mouth to treat oral thrush. However, Health Canada states that there is evidence to suggest it could increase the risk of cancer, so it is no longer recommended or available for use.

Next time, we will be wrapping up the colour series!

Man with Amiodarone-Induced Blue Pigmentation

Baby With Gentian Violet in Mouth to Treat Oral Thrush

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