Palate Hyperpigmentation Caused by Prolonged Use of the Anti-Malarial Chloroquine

Abstract

The side-effects of many drugs manifest in the oral mucosa. The anti-malarial agent chloroquine diphosphate, which is also used to treat immunological, dermatological, and rheumatological disorders, usually causes pigmentary changes in the oral mucosa. This report presents a case of palate pigmentation related to the prolonged use of chloroquine diphosphate caused by the deposition of drug metabolites in the mucosa. Healthcare professionals must be aware of these drugs and their adverse effects in order to make the correct diagnosis, decide on the optimal treatment for the condition, or refer the patient to an appropriate specialist.

Pathological pigmentation of the skin and palate caused by continuous use of chloroquine

“…Oral pigmentation caused by antimalarial drugs was reported for the first time in 1945 by soldiers who were in the South Pacific and had been treated with quinacrine hydrochloride 11 . Several subsequent clinical case reports were published reporting oral pigmentation induced by continuous use of antimalarial drugs, such as hydroxychloroquine sulfate and chloroquine diphosphate [4][5][6][7][8] .…”

“…The pigmentation of the oral mucosa caused by antimalarial drugs is usually asymptomatic, colored blue and gray, and exhibit a remarkable demarcation between the soft and hard palate. Even though the palatal mucosa is the site with greatest occurrence, the literature does not provide a plausible explanation for the appearance of pigmentation mainly in this region [4][5][6][7][8] . Often, this drug-induced pigmentation is more blackened and exhibits irregular edges, whose aspect is similar to that of melanomas 12 .…”

“…Individuals who require continuous use of this drug may exhibit pathological pigmentation of the face, upper and lower limbs, and also some mucous membranes, such as the oral mucosa. These are changes that evolve from isolated macules to major lesions that can appear on the lips and, mainly, in the palate [4][5][6][7][8] . In addition, patients may develop irreversible retinal damage 9,10 .…”

Pigmentation palatine due à la chloroquine persistant après plus de 50 ans ?

“…La pigmentation, allant du gris bleuté au noirâtre, se traduit par des macules de couleur assez homogène, à limites irrégulières, uniques ou multiples, plus ou moins étendues ; elle peut intéresser la peau, le lit unguéal et la muqueuse buccale. Dans la cavité buccale, la pigmentation siège le plus souvent sur la fibro-muqueuse palatine [1,2,[4][5][6][7] -les premiers cas de pigmentation palatine dus aux antipaludéens (quinacrine) ont été rapportés en 1945 chez 156 soldats américains stationnés dans le Pacifique Sud [in 5, in 6] -, plus rarement la gencive, les joues, la langue ou les lèvres. La pigmentation est due à la présence de mélanine [7] ou d'hémosidérine dans le chorion, les deux étant le plus souvent associées [3,5,6].…”

Extensive hard palate hyperpigmentation associated with chloroquine use

“…Pigmentary changes in the oral mucosa may be caused by many medications, including antimalarial drugs (chloroquine phosphate, hydroxychloroquine, quinidine and quinacrine), tranquilizers (chlorpromazine), chemotherapeutic drugs (doxorubicin, busulfan and cyclophosphamide), antiretroviral agents (AZT and ketoconazole), antibiotics (minocycline) and laxatives (phenolphthalein). 1 The pathogenesis underlying drug pigmentation can be categorized as arising from the deposition of metabolites or drugs in the dermis and epidermis, melanin deposition with or without melanocyte augmentation and drug-induced post-inflammatory mucosal changes. 2 Chloroquine phosphate, classified as an antimalarial agent due to its immunosuppressive potential and anti-inflammatory action, is also used for the treatment systemic lupus erythematosus and rheumatoid arthritis, in addition to other dermatological conditions.…”