One of the most popular comic book superheroes is the Hulk, whose mighty muscular physique is covered by strikingly green skin. Hulk also sports green eyes and greenish hair. Although the Hulk's verdant appearance was created by Stan Lee and Jack Kirby of Marvel Comics, his green skin does have its real-life counterparts. For example, a recent report described a 67-year-old jaundiced woman who developed intense green hyperpigmentation while receiving enteral tube feedings that contained FD&C blue No. 1. It was postulated that the blue dye in combination with the yellow jaundice produced the patient's greenish skin discoloration. Rarely, patients with hyperbilirubinemia may develop green skin changes caused by the cutaneous deposition of biliverdin.

A more common cause of green pigmentary changes in hair, nails, and skin is exogenous exposure to copper. Wearing copper jewelry can sometimes cause a localized greenish discoloration of the underlying skin. Green hair may result from swimming in pool water that contains a high copper level.

Perhaps the most memorable historical cause of a green skin tint in people was chlorosis, a condition associated with iron deficiency anemia, which was commonly observed during the 16th through the 19th centuries, particularly in young women. (...) Nowadays, chlorosis is no longer clinically seen, possibly because of the earlier diagnosis and treatment of iron deficiency disorders, among other factors.

Diagnosis - Acral green pigmentation (eccrine chromhidrosis)
(...)There are various causes of cutaneous green discoloration. Our patient presented with abrupt-onset green macules and patches on both palms and soles. Other causes of green-pigmented lesions, including pseudomonas infection and exogenous staining, were excluded by negative Gram stain result and the absence of greenish substance exposure, respectively. Green pigmentation on the palms and soles in patients with hyperbilirubinemia is a rare condition, with only 5 reported cases in the literature. Previous articles have reported that the green pigmentations are mainly along dermatoglyphic ridges where the eccrine sweat glands open as in our patient. In addition, all reported patients had cutaneous distribution only on palms and soles, the most abundant areas of sweat glands. Therefore, it was proposed as a variant of eccrine chromhidrosis. Eccrine chromhidrosis is a very rare condition in whichwater-soluble pigments from certain dyes or drugs are excreted via eccrine sweat glands. The evidence from clinical findings and dermatoscopic examination in our patient support that this condition is the variant of eccrine chromhidrosis.

Amiodarone hydrochloride (2-butyl-3-benzofuranyl 4-[2-(diethylamino)-ethoxy]-3,5-diiodophenyl ketone hydrochloride) is an iodinated compound that is widely used in the treatment of cardiac arrhythmias and is known to cause photosensitivity and cutaneous hyperpigmentation. Although amiodarone photosensitivity is quite common and occurs in more than 50% of treated patients, blue-gray cutaneous hyperpigmentation occurs in fewer than 10%.