Hard palate hyperpigmentation secondary to chronic chloroquine therapy: report of five cases

Andrade, Bruno Augusto Benevenuto de; Fonseca, Felipe Paiva; Pires, Fábio Ramôa; Mesquita, Ana Terezinha Marques; Falci, Saulo Gabriel Moreira; Santos‐Silva, Alan Roger; Vargas, Pablo Agustı́n; Jorge, Jacks; Almeida, Oslei Paes de

doi:10.1111/cup.12182

Cited by 22 publications

(40 citation statements)

References 14 publications

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Section: Gingival Pigmentationmentioning

confidence: 99%

“…Quinine derivatives such as quinolone, hydroxyquinolone, and amodiaquine are antimalarial drugs that cause bluish grey or black mucosal pigmentation occurring most frequently on the hard palate including the palatal gingiva. 113,114 Long-term use of minocycline is associated with pigmentation of the alveolar bone and teeth. When changes in bone are viewed through relatively thin overlying mucosa, the gingiva may appear grey and is seen primarily in the maxillary anterior region.…”

Section: Drug-induced Pigmentation (Dip)mentioning

confidence: 99%

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Non–plaque‐induced gingival diseases

Holmstrup

Plemons

Meyle

2018

J Clinic Periodontology

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While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non-plaque-induced gingival diseases are less common but often of major significance for patients. The non-plaque-induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. A classification is proposed, based on the etiology of the lesions and includes: Genetic/Developmental disorders; Specific infections; Inflammatory and immune conditions and lesions; Reactive processes; Neoplasms; Endocrine, Nutritional and metabolic diseases; Traumatic lesions; and Gingival pigmentation.

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Section: Gingival Pigmentationmentioning

confidence: 99%

Section: Drug-induced Pigmentation (Dip)mentioning

confidence: 99%

Non–plaque‐induced gingival diseases

Holmstrup

Plemons

Meyle

2018

J Clinic Periodontology

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“…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] .…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Introductionmentioning

confidence: 99%

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

Ferrazzo¹,

Payeras²,

Surkamp³

et al. 2017

J Oral Diag

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Introduction: Chloroquine diphosphate is an antimalarial drug commonly used in the treatment of autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis. Chronic use of this drug may cause toxicity and lead to irreversible visual loss. Objective: To report a case of pathological pigmentation of the skin and oral mucosa caused by the use of chloroquine diphosphate. Case report: A 40-year-old female patient used daily doses of chloroquine (250 mg) to treat rheumatoid arthritis. After using this antimalarial drug for two years, the patient exhibited pathological pigmentations in the hard palate and skin of the lower limbs. To prevent retinal damage, given the toxicity observed in the skin and mucous membranes, the medical team replaced this antimalarial drug. Conclusion: Pathological pigmentation is a sign of drug toxicity and may serve as a warning for health professionals in order to prevent macular diseases caused by antimalarial agents. We emphasize the importance of dental surgeons for the differential diagnosis of pathological pigmentation of the oral mucosa, as well as the importance of multidisciplinary work involving other health sectors to prevent the onset or worsening of clinical problems in these patients.

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“…61 Hyperpigmentation of the oral cavity is the most frequent finding, with several reported cases of hyperpigmentation of the oral mucosa due to hydroxychloroquine. 62,63 There are also cases of hyperpigmentation of the nails or nose due to quinacrine or quinidine 64 (Figure 6).…”

Section: Other Drugsmentioning

confidence: 99%

Drug-Induced Hyperpigmentation: Review and Case Series

García

Carrasco-Molina

2019

J Am Board Fam Med

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Background: Hyperpigmentation is a common dermatologic problem that may have substantial impact on the patient, since it affects the appearance and quality of life, and may influence treatment adherence. There are few studies of drug-induced hyperpigmentation. Methods: We studied drug-induced hyperpigmentation in patients attending an outpatient dermatology clinic in the Western Area of Valladolid (Spain) from August 1, 2017 to April 20, 2018. Results: The incidence of drug-induced hyperpigmentation was 1.31% in patients attending a first dermatology consultation in the study period. Of the 16 patients, 8 were taking more than 1 drug. The most frequent drugs identified were nonsteroidal anti-inflammatory agents (25%), antihypertensive agents (18.75%), antimalarials (12.5%), antibiotics, antineoplastic agents, psychoactive agents, simvastatin, allopurinol, amiodarone and mucolytic (6.25% each). Hyperpigmentation was found in the mucosa in 25% of patients and in photograph-exposed areas in 37.5%. Discussion: Diagnosing drug-induced hyperpigmentation is a dermatologic challenge. A differential diagnosis with hyperpigmentation caused by endocrine and metabolic disorders, the most closely-related disorders to drug-induced hyperpigmentation, and with hyperpigmentation of idiopathic origin, should be conducted. Drug-induced hyperpigmentation is a relatively frequent reason for consultation, especially in polypharmacy patients. The sample may have been biased as many patients receiving treatments frequently associated with drug-induced hyperpigmentation, such as antineoplastic drugs, are diagnosed and treated by other specialties, such as oncologists. Conclusion: Family physicians and specialists should consider drugs as a cause of hyperpigmentation to facilitate the correct diagnosis and treatment.

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Hard palate hyperpigmentation secondary to chronic chloroquine therapy: report of five cases

Cited by 22 publications

References 14 publications

Non–plaque‐induced gingival diseases

Non–plaque‐induced gingival diseases

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

Drug-Induced Hyperpigmentation: Review and Case Series

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