Generalized Skin Hyperpigmentation and Longitudinal Melanonychia Secondary to Treatment With Hydroxychloroquine in Systemic Lupus Erythematosus

Giraldo, Walter Alberto Sifuentes; Platero, Marta Grandal; Bujidos, Carlos de la Puente; Gámir, María Luz Gámir

doi:10.1016/j.reumae.2013.06.002

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…4 Recent published case reports concern essentially SLE patients. 8–10 In our study, only SLE patients had HQ-induced pigmentation. The difference of HQ-induced pigmentation in the group of SLE patients was significantly higher than the group of non-SLE patients ( p = 0.012).…”

Section: Discussionmentioning

confidence: 76%

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Hydroxychloroquine-induced hyperpigmentation in systemic diseases: prevalence, clinical features and risk factors: a cross-sectional study of 41 cases

Bahloul

Jallouli

Garbaa

et al. 2017

Lupus

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Introduction Hydroxychloroquine is an antimalarial agent widely prescribed in internal medicine, rheumatology and dermatology. Its use can be complicated by various side effects including skin pigmentation. Objectives The aim of the study is to review epidemiological, clinical features and risk factors of hydroxychloroquine-induced pigmentation. Materials and methods We performed a cross-sectional study conducted over a period of 5 months. During this period, patients who had been treated with hydroxychloroquine for over 6 months, in the internal medicine department, underwent a complete dermatological examination. All patients completed a structured questionnaire to collect demographic data, dosage and treatment duration of hydroxychloroquine, other drug intake, hydroxychloroquine indication, and presence of pigmentary changes on the skin, nail, hair, and mucosa. Results A total of 41 patients (38 women and 3 men) were included in the study. The mean age was 39.2 ± 15.4 years. The hydroxychloroquine was indicated for systemic lupus erythematosus in 73.2%, dermatomyositis in 12.2%, rheumatoid arthritis in 9.8%, actinic lichen and sarcoidosis each in 2.4%. Cutaneous pigmented lesions were found in 21 cases (51%), mucous pigmentation in 5 cases (12%) and nail pigmentation in 1 case (2.5%). In 12 of 41 (29%) of the hydroxychloroquine users, we conclude a hydroxychloroquine-induced pigmentation. There were 11 women and one man with a mean age of 43 years and all of them were systemic lupus erythematosus patients. Pigmented lesions were located on the lower limbs in seven cases, the face in two cases, lips in two cases and the gum in two cases. Pigmentation appeared after a median duration of hydroxychloroquine treatment of 32 months with a median cumulative dose of 361 g. Overall, two patients reported that the appearance of pigmented lesions was preceded by the occurrence of ecchymotic areas following microtrauma. Significant association was found between hydroxychloroquine-induced pigmentation and treatment with oral anticoagulants and/or antiplatelet agents ( p = 0.03). Conclusion Our systematic examination of patients demonstrated that hydroxychloroquine-induced pigmentation is not rare. The imputability of hydroxychloroquine in the genesis of this discoloration is difficult to establish. Our study supports the hypothesis that ecchymosis, platelet antiaggregants and oral anticoagulants may be the main predisposing factors to hydroxychloroquine-induced pigmentation.

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Section: Discussionmentioning

confidence: 76%

“…Melanonychia secondary to HQ was also described in literature. 9 In our study, although the systematic examination of 41 patient’s nails, we had only one case of melanonychia which wasn’t attributed to HQ.…”

Section: Discussionmentioning

confidence: 77%

Hydroxychloroquine-induced hyperpigmentation in systemic diseases: prevalence, clinical features and risk factors: a cross-sectional study of 41 cases

Bahloul

Jallouli

Garbaa

et al. 2017

Lupus

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“…In 2013, Sifuentes Giraldo et al reported that an Ecuadorian patient with SLE developed skin and nail hyperpigmentation after 12 months of HQ treatment. 2 This patient presented a generalized bluish-gray pigmentation on the face and back of the hands, and longitudinal bands on the nails of the second finger of the left hand and the third finger on both hands. In our case, no hyperpigmentation developed on the skin; however, the nail-banding alterations were typical for HQ-induced melanonychia after HQ treatment of 38 months with a cumulative dose of 198 g.…”

Section: Discussionmentioning

confidence: 97%

“…Although generally well tolerated, a variety of adverse effects in the skin, nails, and mucous have been reported. 2 The most common side effect is mucocutaneous hyperpigmentation, which develops in about 29% of patients receiving HQ therapy; however, most cases of mucocutaneous hyperpigmentation are generally mild and reversible. 3 Gray-blue to dark purple macules, or plaques, were most common on the skin, and generalized hyperpigmentation over the trunk and extremities was also reported.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

Zhang

Liu

Cai

et al. 2018

Lupus

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Hydroxychloroquine is an antimalarial agent, most commonly prescribed in the treatment of several rheumatic diseases. Although generally well tolerated, a variety of mucocutaneous adverse effects have been reported. Besides the familiar adverse effects, longitudinal melanonychia is rarely seen. Although the incidence is extremely low, systemic lupus erythematosus may also cause nail pigmentation in its own right. We report the case of a 55-year-old woman who was diagnosed with systemic lupus erythematosus and presented with longitudinal melanonychia of all 10 fingernails after 3 years of treatment with hydroxychloroquine, without mucocutaneous hyperpigmentation. The pigment of the nail lasted for more than 15 years. To the best of our knowledge, this is first published report of hydroxychloroquine-induced melanonychia without mucocutaneous hyperpigmentation. This case demonstrates that hydroxychloroquine treatment and the primary disease should be considered in the case of multiple nail changes in patients with systemic lupus erythematosus.

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“…Additionally, the symptoms are generally mild, which could be relieved after the withdrawal 89,90 . Skin and subcutaneous tissue SAEs of HCQ that were frequently reported in the literature were acute generalized exanthematous pustulosis (AGEP) [15][16][17][91][92][93][94] , pigmentation 18,20,[95][96][97][98][99][100][101] , Stevens-Johnson syndrome 22,102 , and toxic epidermal necrolysis 21,103,104 . One multinational case-control study suggested that HCQ or chloroquine was highly associated with AGEP 105 .…”

Section: Discussionmentioning

confidence: 99%

Is hydroxychloroquine safety for COVID-19? a systematic review and meta-analysis of randomized trials

Chen

Pan

et al.

Authorea

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Aim: Many concerns still existed about the safety of hydroxychloroquine (HCQ) in the treatment of Corona Virus Disease 2019 . The purpose of this study was to evaluate the safety of HCQ by performing a systematic review and meta-analysis. Methods: Randomized controlled trials reporting the safety of HCQ in PubMed, Embase, and Cochrane Library were retrieved from the establishment of the database to February 27, 2020. Literature screening, data extraction, and assessment of risk bias were performed independently by two reviewers. Results: We identified 34 eligible studies that involved 3,639 patients. The difference in the cumulative number of AEs between the HCQ and control group was statistically significant (P<0.0001). The pooled incidence of gastrointestinal AEs, which occurred most frequently in the HCQ group was higher than that in the control group (P<0.0001) according to the system organ class. In addition, the risks of skin and subcutaneous tissue AEs (P = 0.011), renal and urinary disorders (P=0.011), ear and labyrinth AEs (P = 0.045) and surgical and medical procedures AEs (P = 0.020) in HCQ group are also significantly increased compared with the control group. Meanwhile, the cumulative number of SAEs was similar between the two groups (P=0.222). Meta-analysis results indicated that the pooled incidences of all the AEs reported by two or more studies were similar except for the treatment discontinuation caused by AEs (RD 0.02, 95% CI: 0.00 to 0.06). Conclusion: HCQ was well tolerated and might be safe for clinical application under the outbreak of COVID-19.

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Generalized Skin Hyperpigmentation and Longitudinal Melanonychia Secondary to Treatment With Hydroxychloroquine in Systemic Lupus Erythematosus

Cited by 10 publications

References 8 publications

Hydroxychloroquine-induced hyperpigmentation in systemic diseases: prevalence, clinical features and risk factors: a cross-sectional study of 41 cases

Hydroxychloroquine-induced hyperpigmentation in systemic diseases: prevalence, clinical features and risk factors: a cross-sectional study of 41 cases

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

Is hydroxychloroquine safety for COVID-19? a systematic review and meta-analysis of randomized trials

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