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Eight months after the start of therapy, progressive bluish-purple to black cutaneous hyperpigmentation of his lower arms, back of his hands, and interdigital areas (figure 1A) developed since increasing the doxycycline dose (serum concentrations of 5.8 mg/ml)

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If you have any doubts about the integrity of the medication (for instance, if it changed color or appearance, or was inadvertently left out), err on the side of caution and consult your healthcare provider or pharmacist for advice