Hyperpigmentation of the skin due to hydroxychloroquine

Rood, M. J.; Vermeer, Maarten H.; Huizinga, T.

doi:10.1080/03009740701769735

Cited by 22 publications

(19 citation statements)

References 3 publications

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“…As in our patient, the most common presentations of leukaemia cutis are erythematous papules and nodules (2,3). Infiltrated hemorrhagic plaques and perifollicular acneiform papules are also seen.…”

Section: Diagnosis: Hydroxychloroquine-induced Skin and Nail Pigmentasupporting

confidence: 71%

“…Although mucocutaneous bluish grey hyperpigmentation induced by antimalarials was first reported in 1963 by Tuffanelli et al (1), hydroxychloroquine-induced skin pigmentation has been described in only a few papers in the recent literature (2)(3)(4)(5)(6). It usually presents as a macular pigmentation with symmetrical distribution on the forearms, thighs or shin.…”

Section: Diagnosis: Hydroxychloroquine-induced Skin and Nail Pigmentamentioning

confidence: 99%

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Hyperpigmented Forearms and Nail: A Quiz

Kalabalikis¹,

Patsatsi²,

Trakatelli³

et al. 2010

Acta Derm Venerol

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A 75-year-old woman with a history of hydroxychloroquinetreated cutaneous lupus erythematosus presented with a bilateral sharply demarcated macular hyperpigmentation on both forearms (Fig. 1) and a partial melanonychia of the right thumb nail. This pigmentation disorder developed gradually over a 6-month period. No retinal pigmentation and no systemic disorder were revealed. Dermoscopy of the nail plate and nail bed showed pigment deposition. Fig. /.Macular hyperpigmentation on both forearmsand partial melanonychia ofthc right thumb nail.Histological examination of a skin biopsy showed basal hyperpigmentation of the epidermis and a diffuse deposition of hemosiderin and melanin in the dermis. Abundant hemosiderin deposits were clearly indicated by iron staining (Fig. 2).A 66-year-oId male patient presented to our dermatology department with a 2-month history of a nodular eruption involving the face and the limbs, which was associated with lethargy.On clinical examination, the patient was found to have widespread papules over the face and multiple reddish nodules covering the arms and the forearms (Fig. la). Red-coloured infiltrated plaques were present on the upper part of the back. No gingival hyperplasia, adenopathy or splenomegaly was found.Pathological laboratory findings were as follows: white blood cell count 32,000/^1, macrocytic anaemia 10 g/dl, and thrombocytopaenia 125,000/|al. A skin biopsy from the arm revealed a dense and diffuse infiltrate of cells within collagen bundles (Fig.lb). These cells stained positively with lysozyme.

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Section: Diagnosis: Hydroxychloroquine-induced Skin and Nail Pigmentasupporting

confidence: 71%

Section: Diagnosis: Hydroxychloroquine-induced Skin and Nail Pigmentamentioning

confidence: 99%

Hyperpigmented Forearms and Nail: A Quiz

Kalabalikis¹,

Patsatsi²,

Trakatelli³

et al. 2010

Acta Derm Venerol

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show abstract

“…The granules stain positive for either melanin [15] or both melanin and hemosiderin [13, 16]. It has been postulated that this accumulation of melanin, hemosiderin, or both results in the pigmentation observed clinically [6, 12].…”

Section: Discussionmentioning

confidence: 99%

“…Hydroxychloroquine pigmentation can occur within 1 year after starting therapy [4, 12, 13, 17]. The skin discoloration has no systemic adverse sequelae.…”

Section: Discussionmentioning

confidence: 99%

Hydroxychloroquine-Associated Hyperpigmentation Mimicking Elder Abuse

Cohen

2013

Dermatol Ther (Heidelb)

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BackgroundHydroxychloroquine may result in cutaneous dyschromia. Older individuals who are the victims of elder abuse can present with bruising and resolving ecchymoses.PurposeThe features of hydroxychloroquine-associated hyperpigmentation are described, the mucosal and skin manifestations of elder abuse are reviewed, and the mucocutaneous mimickers of elder abuse are summarized.Case ReportAn elderly woman being treated with hydroxychloroquine for systemic lupus erythematosus developed drug-associated black and blue pigmentation of her skin. The dyschromia was misinterpreted by her clinician as elder abuse and Adult Protective Services was notified. The family was eventually cleared of suspected elder abuse. A skin biopsy of the patient’s dyschromia confirmed the diagnosis of hydroxychloroquine-associated hyperpigmentation.ConclusionHyperpigmentation of skin, mucosa, and nails can be observed in patients treated with antimalarials, including hydroxychloroquine. Elder abuse is a significant and underreported problem in seniors. Cutaneous findings can aid in the discovery of physical abuse, sexual abuse, and self-neglect in elderly individuals. However, medication-associated effects, systemic conditions, and accidental external injuries can mimic elder abuse. Therefore, a complete medical history and appropriate laboratory evaluation, including skin biopsy, should be conducted when the diagnosis of elder abuse is suspected.

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“…In our case, hyperpigmentation of the skin appeared about 1 year after initiating therapy. Treatment consisted of discontinuing HCQ, which led to the gradual decrease in hyperpigmentation of lesions within several months 5,6 . Although there is evidence that both melanin and iron deposits can be present within the dermis in hyperpigmented lesions induced by HCQ 1 , the exact mechanism of hyperpigmentation is unknown 7 .…”

Section: Of Rheumatologymentioning

confidence: 99%

Hydroxychloroquine-induced Hyperpigmentation of the Skin

Sawalha

2015

J Rheumatol

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Hyperpigmentation of the skin due to hydroxychloroquine

Cited by 22 publications

References 3 publications

Hyperpigmented Forearms and Nail: A Quiz

Hyperpigmented Forearms and Nail: A Quiz

Hydroxychloroquine-Associated Hyperpigmentation Mimicking Elder Abuse

Hydroxychloroquine-induced Hyperpigmentation of the Skin

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