A 63-year-old woman developed diffuse mucocutaneous hyperpigmentation post-hydroxyurea treatment for myelofibrosis. Hyperpigmentation appeared on eyelids, nasal ala, tongue, and palms without discomfort. Extensive investigations ruled out common causes; the patient had no prior dermatological conditions. Hydroxyurea was deemed causative due to temporal correlation. Counselling emphasized benign nature, recommending continued therapy with monitoring.

Hydroxyurea-induced skin changes include ulcerations, melanonychia, and hyperpigmentation.1 Mechanism involves photosensitization, toxicity, genetic factors, possibly increased melanin, and iron deposition.2–4 Management includes reassurance, differential evaluation, and discontinuation in severe cases.5 This case differs from typical singular-site presentations, presenting a rare, multifocal pattern.1,3–6Figures 1 and 2.

Figure 1.

Bilateral periorbital, nasal ala, and lingual pigmentation.

Figure 2.

Diffuse macular palmar pigmentation.