A case of exogenous ochronosis associated with hydroxychloroquine

Abstract

Exogenous ochronosis is characterized by hyperpigmented skin lesions that arise in association with local suppression of homogentisic acid oxidase enzyme. Although it generally develops in association with topical application of chemical agents, it can occasionally develop in association with antimalarial drugs. Here we present the case of a patient with rheumatoid arthritis who developed hyperpigmentation on the face and neck regions during hydroxychloroquine treatment. Hydroxychloroquine is being widely used in rheumatology practice, and cutaneous hyperpigmentation may develop as an adverse effect. In the present case, we emphasize the potential underlying mechanisms through which it may cause cutaneous hyperpigmentation and determine the clinical and histopathological findings of exogenous ochronosis.

Hydroxychloroquine-induced hyperpigmentation in a 14-year-old female with systemic lupus erythematosus

“… 1 , 6 , 25 Non-cutaneous adverse effects of HCQ include nausea, diarrhea, prolongation of QT-interval, corneal lens opacity, retinopathy, ciliary body dysfunction, posterior subcapsular lens opacity, myopathy, and ochronosis. 5 , 11 , 26 , 27 Some authors suggest that HCQ-induced hyperpigmentation is a marker of increased risk of retinopathy. 16 , 20 , 27 …”

“…5 , 11 , 26 , 27 Some authors suggest that HCQ-induced hyperpigmentation is a marker of increased risk of retinopathy. 16 , 20 , 27 …”

Exogenous ochronosis: the failure of depigmenting creams

“…Se identifican como factores de riesgo para desarrollar OE el uso de productos que contengan hidroquinona durante largos períodos de tiempo (más de 6 meses), a concentraciones mayores del 2% y en solución alcohólica [1]. Junto a la hidroquinona, se han descrito casos de OE en relación al uso tópico de fenol, resorcinol, ácido pícrico y mercurio, así como casos asociados a antipalúdicos orales o quinina inyectable [1,2,6].…”

“…Esto provoca que el AHG se acumule y se polimerice formando pigmento ocronótico a nivel de la dermis [1,2]. En cuanto a los medicamentos sistémicos que causan OE, una hipótesis en su patogénesis es que la quinina podría tener una afinidad aumentada por el AHG y favorecer su acumulación en dermis [6].…”

Profile of melasma patients in dermatology and venerology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

“…12 If the lesion color is blue-black, it is necessary to consider other differential diagnoses such as exogenous ochronosis, especially if the patient has a history of using hydroquinone for a long time or using creams of unknown composition. 13 The size of the melasma lesion is the total area of the lesion on the face. This data is also in accordance with a previous study where the size of melasma lesions of 0.1-2 cm was the most common found in this research.…”