A 66-year-old man suffering from atrial flutter developed cutaneous bl
ue-gray pigmentation while receiving 600 mg of amiodarone daily for 15
months. With reduction of the dose to 100 mg, skin discoloration disa
ppeared within 16 months, to reappear within 7 months after increasing
the dose to 400 mg. Finally, the discoloration disappeared within 13
months with a dose reduction to 200 mg daily. It seems that a tissue t
hreshold level for amiodarone exists in this patient, above which Skin
discoloration appears and below which it fades. Dose, duration, metab
olism, macrophage transfer. and spillover saturation-excretion may be
relevant in amiodarone-induced skin pigmentation.