Amiodarone (Cordarone) is an iodinated compound widely used in the treatment of cardiac arrhythmias for more than a decade. A patient who developed a persistent blue-gray skin pigmentation of the light-exposed areas following long-term amiodarone hydrochloride administration is reported. The cutaneous signs and the ultrastructural findings are described. This rare iatrogenic hyperpigmentation is peculiarly due to lipofuscin and not melanin deposits. Its pathogenesis may be related to the basic action of the drug on the lysosome and to the extra phototoxic-induced lysosomal damage, which accounts for the specific location of the hyperpigmentation over the light-exposed areas.