Pigmentation From Antimalarial Therapy

Hydroxychloroquine-induced hyperpigmentation: a case report

“…It has been reported that the mucocutaneous discolouration tends to fade slowly over 2–6 months after drug withdrawal (7). Similar to other observations (6, 8), several months after HCQ withdrawal, the pigmentation decreased but resolution was incomplete in our patient. Antimalarial drug‐induced discolouration has also been suggested as a marker for patients at risk of ocular side effects, and regular ophthalmological examinations have been recommended for those patients (7, 8, 12).…”

Mepacrine pigmentation in systemic lupus erythematosus.

“…Other reports soon followed of other sites including the palate (Lippard & Kauer, 1945) and pretibial areas, and less commonly the conjunctivae, nares, epiglottis and trachea (Sugar & Waddell, 1946;Lutterloh & Schallenberger, 1946). Identical changes have been reported with other antimalarials-in particular chloroquine (Doll & Keane, 1959;Tuffanelli et al, 1963), hydroxychloroquine (TufFanelli et al, 1963) and amodiaquine (Campbell, i960;Young, 1958). In addition to the more common sites our patient has involvement of striae and atrophic skin lesions-features not hitherto described.…”

Hydroxychloroquine‐induced pigmentation in two patients with systemic lupus erythematosus

“…reviewed 25 patients on antimalarials who developed localized pigmentation; only one patient had had only hydroxychloroquine; others had had mepacrine, chloroquine, or a combination of both. The duration of time between the start of treatment and onset of pigmentation varied from 4 to 70 months with a mean of 18.5 months 4 as found in both our patients. Dosage varied greatly therefore it was not possible to correlate doses and appearance of pigment.…”

“…One of our patients had the typical pretibial distribution (fig. 1), frequently described with other antimalarials 4 . Our other patient had facial involvement, most prominent on the forehead, outer ears, chin and cheeks, suggesting a photodistribution; 4,5 in addition, she presented with similar pigmentation within atrophic scars of discoid lupus erythematosus, previously described in a patient with SLE, treated with mepacrine 2 …”

“…There was no involvement of the nails or oral mucosa. Hydroxychloroquine has rarely been reported to induce pigmentation; most reports being on oral pigmentation 4,7 . One of our patients had the typical pretibial distribution (fig.…”