A 32-year-old man on multibacillary multidrug therapy for 8 months reports progressive dark brownish-black discoloration of sun-exposed skin along with dryness and scaling. Which component of his regimen is responsible?

• A Rifampicin
• B Dapsone
• C Ofloxacin
• D Clofazimine ✓

Explanation

Clofazimine is a phenazine dye that accumulates in the reticuloendothelial system and skin, producing reversible reddish-brown to black pigmentation that is accentuated by sunlight, along with ichthyosis and dryness. These effects are dose dependent and resolve months after stopping the drug. Dapsone causes haemolysis and methaemoglobinaemia, rifampicin causes orange discolouration of body fluids and hepatotoxicity, and ofloxacin is not part of standard MDT.

Reference: Rook's Textbook of Dermatology, 9th ed.

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