Early cutaneous eruptions after oral hydroxychloroquine in a lupus erythematosus patient: A case report and review of the published work

Abstract

Hydroxychloroquine (HCQ) is an effective treatment of lupus erythematosus. Although adverse effects, mainly gastrointestinal and cutaneous manifestations, are rare, they may result in the cessation of medication in some patients with severe reactions. Therefore, the evaluation of a patient's condition is important for a dermatologist to decide whether to cease or continue HCQ. We herein report a case of a 36-year-old Japanese woman with systemic lupus erythematosus and cutaneous eruptions caused by the p.o. administration of HCQ. Because she wanted to continue the medication and had only mild cutaneous eruptions without any adverse effects in other organs, we continued HCQ with careful monitoring. All cutaneous eruptions disappeared within 1 week. We also reviewed published case reports on skin lesions that developed after HCQ treatments, and propose strategies for early cutaneous eruptions after HCQ treatments. When the cutaneous reactions are mild without any reactions in other organs, withdrawal of the drug is not required. However, when cutaneous eruptions are accompanied by some common reactions, HCQ needs to be stopped for a period of time and may subsequently be carefully re-administrated.

Therapeutic efficacy and adverse events of hydroxychloroquine administration in Japanese systemic/cutaneous lupus erythematosus patients

“…6 Among our patients with AE, six patients could be re-administrated HCQ without the recurrence of AE. Similar to our cases, Matsuda et al 7 also reported that withdrawal of HCQ was not…”

Varied responses to and efficacies of hydroxychloroquine treatment according to cutaneous lupus erythematosus subtypes in Japanese patients

“…There were two patients with skin eruptions; however, one patient (with maculopapular type) restarted HCQ without further adverse events. Matsuda et al . reported that they continued HCQ therapy in a patient who developed a mild skin eruption, and her skin symptoms disappeared within 1 week under continuous HCQ treatment.…”

Hydroxychloroquine enhanced urticarial reaction in a patient with discoid lupus erythematosus

“…The ma jor i ty of the data comprise skin disorder and gas troin testinal disorders such as diarrhea, and there are 2 cases of urticaria. It is sometimes difficult to establish whether early cutaneous eruptions that appear after the initiation of oral HCQ are due to HCQ or a flare of disease [6] .…”