Objective: To inform clinicians of the potential for severe and persistent facial hyperpigmentation with the long-term use of imipramine.
Case Summary: A 65-year-old white male veteran with a history of paranoid schizophrenia was referred to the psychiatry service by a dentist who thought that the patient was both cyanotic and psychotic. The history and biopsy results indicated the possibility of imipramine-associated hyperpigmentation, only the second reported case in a male patient.