Drug-induced hyperpigmentation confounding clinical assessment and management for advanced chronic venous insufficiency.

Advanced chronic venous insufficiency (CVI) is commonly associated with lower extremity hyperpigmentation due to hemosiderin deposition. We present the case of a 56-year-old man with symptomatic bilateral CVI who underwent successful great saphenous vein radiofrequency ablation with resolution of pain and swelling but progressive ankle discoloration. Repeat duplex ultrasound examination confirmed durable vein closure without significant recurrent superficial disease. Dermatologic evaluation revealed chronic minocycline use, and biopsy demonstrated dermal pigment deposition positive for iron and Fontana-Masson stains, consistent with drug-induced hyperpigmentation. Discontinuation of minocycline led to partial improvement. This case highlights the importance of considering medication-related pigmentation in patients with skin discoloration and CVI.