Treatment of imipramine-induced dyspigmentation with Q-switched alexandrite laser therapy.

The development of blue or gray cutaneous hyperpigmentation is a rare complication of chronic imipramine therapy. Treatment options for imipramine-induced hyperpigmentation are limited but include topical retinoids, bleaching agents, and laser therapy, with varying degrees of success. We report a case in which Q-switched alexandrite laser therapy alone led to nearly complete resolution of imipramine-induced dyspigmentation in a patient who had been taking this medication for 4 decades. Paradoxical darkening of imipramine-induced hyperpigmentation after combined Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) and Q-switched ruby laser therapy has recently been demonstrated. Here, we further report a similar pattern of focal paradoxical hyperpigmentation after treatment of imipramine-induced hyperpigmentation with Q-switched alexandrite laser therapy that resolved with additional treatment sessions.