Hyperpigmentation of hard palate induced by chloroquine therapy

Abstract

The antimalarials are one of the most commonly prescribed drugs for conditions such as lupus erythematosus and rheumatoid arthritis, and the side effects, though infrequent, are well known. The antimalarial agent chloroquine diphosphate usually causes pigmentary changes in the oral mucosa characterized by a bluish-grey to black discolorations mainly in the hard palate. Considering only the hard palate hyperpigmentation caused by chloroquine, to the best of our knowledge, only 13 cases have been reported in the English language literature. We described an additional case of palate hyperpigmentation related to the chronic use of chloroquine diphosphate in a 60-year-old Mexican woman. Although the diagnosis is usually made based on medication history and clinical presentation, a biopsy specimen may be helpful to confirm the diagnosis. Clinicians must be aware of these drugs and their adverse effects in order to make the correct diagnosis and decide on the optimal treatment for the condition. Key words:Oral cavity, hard palate, hyperpigmentation, chloroquine, antimalarials.

Hard Palate Hyperpigmentation Induced by Chloroquine: A Case Report

“…The literature reported that prolonged systemic administration of this drug can determine the deposition of hemosiderin in the tissues of the oral cavity. Chloroquine chelates iron and/or melanin; moreover, melanocytes are stimulated in melanin production [2,3].…”

Oral Manifestations of Chloroquine and Hydroxychloroquine: Differential Diagnoses

“…A detailed medical history with an accurate clinical examination is extremely important for elaboration of a diagnostic hypothesis. Due to the series of lesions presenting similar characteris-tics and yet different causes, the dentist can use an incisional biopsy for diagnostic confirmation [12] (ANDRADE et al 2017), consistently with the conduct of all authors of the studies in Table 1 [14].…”

“…Another important aspect is managingthe use of these drugs, which needs to beperformed by the doctor (and patient) responsible for the treatment, analyzing the benefits and costs of using chloroquine and hydroxychloroquine in the medical treatment proposed. Thus, in some cases, it is possible to opt for a reduction in the usual dose or for atemporaryor definitive interruption altogether [12] (ANDRADE et al 2017). The intensity of the effects and adverse reactions will dictate such maneuvers.…”

<p>Medication-Induced Oral Hyperpigmentation: A Systematic Review</p>

“…The majority of the included studies were case reports and case series, 4,5,[11][12][13][14][15][16][17][18][19][21][22][23][24][25][26][27][28][29][30][31][32][35][36][37][38][39][40][41][42][44][45][46]48,54,58,[62][63][64][65][66] most of which achieved a moderate quality level based on Murad et al's method. 9 The NOS was used for the assessment of bias in the included cohort and cross-sectional studies.…”