Hydroxychloroquine‐induced hyperpigmentation: the staining pattern

Puri, Puja K.; Lountzis, Nektarios; Tyler, William; Ferringer, Tammie

doi:10.1111/j.1600-0560.2008.01004.x

Cited by 53 publications

(41 citation statements)

References 13 publications

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“…Qu is associated with darker pigmentation compared to HCQ or CQ [1] or with lemon-yellow discoloration of the skin [55]. The pigmentation change is typically seen in the face, hard palate, forearms, and shins.…”

Section: Discussionmentioning

confidence: 99%

“…- Skin and mucosal pigmentation disorders with yellow-brown or blue-gray to slate-gray or black hyperpigmentation is observed in 10-30% of patients who receive long-term AM treatment with CQ therapy [55,56] but also with HCQ [57], Qud [58] or Qc [59,60]. Qu is associated with darker pigmentation compared to HCQ or CQ [1] or with lemon-yellow discoloration of the skin [55].…”

Section: Discussionmentioning

confidence: 99%

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Cutaneous Adverse Drug Reactions with Antimalarials and Allergological Skin Tests

et al. 2015

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Background: Currently used antimalarial drugs (AM) are hydroxychloroquine and chloroquine, which are prescribed for many autoimmune disorders. The value of skin tests on cutaneous adverse drug reactions (CADR) with AM remains unknown. Objective: The main objective of this retrospective study is to know whether skin tests for AM are useful and how to manage the recovery of AM therapy in these patients. Methods: All patients referred for suspected CADR secondary to AM between 2001 and 2014 in eight French dermatology centers were retrospectively reviewed. Results: We report herein a retrospective series of 20 patients with CADR and AM involvement. Skin tests, performed in 14/20 patients, were negative in all cases. Six patients had an oral provocation test with recurrence of CADR in 1 case. Conclusion: We encourage dermatologists to perform oral provocation tests in nonsevere CADR in order to allow AM rechallenge at progressive doses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cutaneous Adverse Drug Reactions with Antimalarials and Allergological Skin Tests

et al. 2015

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“…Olgumuzda hidroksiklorokin kullanımı olması sebebiyle ön tanılar arasında ilaca bağlı pigmentasyon da düşünülmüştür. Mikroskopik olarak ilaca bağlı pigmentasyonda üst dermiste kolajen demetler arasında ve makrofajlarda kaba, refraktil olmayan sarı-kahverengi granüler depolanmalar izlenir 6 . Bu granüllerin melanin ve/veya hemosiderin birikimine bağlı olduğu bildirilmiştir.…”

Section: Discussionunclassified

Melanotic lupus erythematosus: A rare variant of discoid lupus erythematosus

Kaçar¹,

Özuğuz²,

Yavaş³

et al. 2015

TURKDERM

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Discoid lupus erythematosus (DLE) is characterized by atrophic patches with peripheral hyperpigmentation on sun-exposed skin areas. It rarely presents with diffuse hyperpigmented patches without erythema, adherent scales and atrophy on the face and neck. This presentation is called melanotic lupus erythematosus and it has rarely been reported in the literature. Other conditions that cause facial pigmentation, such as melasma, Riehl melanosis, lichen planus pigmentosus, and drug-related pigmentation should be considered in the differential diagnosis. We herein, report a 66-year-old male patient with diffuse blue-brown pigmentations on his face who was diagnosed as having melanotic lupus erythematosus based on the clinical, histopathological and immunofluoresence findings. Summary Özet GirişYüzde yerleşen ve akkiz hiperpigmentasyonla seyreden lezyonların ayırıcı tanısında melazma, solar, lentigo, çiller, Riehl melanozu, liken planus pigmentozus (LPP), ilaca bağlı hiperpigmentasyon, ekzojen okronoz, argirya, Ota nevüs, Hori nevüs, Becker nevüs, fiks ilaç erüpsiyonu, akantozis nigrikans ve diskoid lupus eritematozus (DLE) gibi hastalıklar düşünülmelidir 1 . Bunlar arasında DLE sıklıkla güneş gören bölgelerde ortaları atrofik kenarları hiperpigmente plaklar şeklinde görülür. Nadir olarak yüz ve boyunda eşlik eden eritem, yapışık skuam ya da atrofi olmadan diffüz hiperpigmente plaklar şeklinde ortaya çıkabilir 2,3 .

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“…After the therapy is discontinued, the resolution of symptoms is slow and may be incomplete. In rare cases, long-term hydroxychloroquine treatment can also cause skin pigmentation [23]. In all reported cases, the main histological feature of hydroxychloroquine-induced pigmentation was the presence of iron and melanin deposits in the dermis [23].…”

Section: Discussionmentioning

confidence: 99%

Minocycline-associated rimmed vacuolar myopathy in a patient with rheumatoid arthritis

et al. 2012

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BackgroundThe autophagic vacuolar myopathies (AVM) are a group of inherited myopathies defined by the presence of autophagic vacuoles in pathological muscle specimens. AVM can be categorized into three groups: acid maltase deficiency, myopathies characterized by autophagic vacuoles with unique sarcolemmal features, and rimmed vacuolar myopathies (RVM). While the pathogeneses of these conditions are still being elucidated, some drugs (e.g., chloroquine, its analog, hydroxychloroquine, and colchicine) can also cause AVM. Minocycline is a disease-modifying anti-rheumatic drug that may be used in the treatment of rheumatoid arthritis (RA). Here, we describe the first case of minocycline-associated AVM with rimmed vacuole formation.Case presentationA 75-year-old woman suffering from RA has been continuously treated with minocycline (200 mg/day) for the past 7 years. During this time, she developed a myopathy that predominantly affected her lower limbs. Histological studies of biopsied muscle revealed scattered atrophic myofibers with rimmed vacuoles that contained pigment granules. Histochemical staining revealed that the pigment comprised both iron and melanin, which is consistent with type II minocycline-induced cutaneous pigmentation. Under electron microscopy, autophagic vacuoles were consistently observed in association with numerous collections of pigment granules.ConclusionsThis is the first report of minocycline-induced pigmentation in skeletal muscle. The strong association between autophagic vacuoles and the accumulation of minocycline-induced pigments suggest that long-term minocycline treatment induced pigment accumulation, leading to elevation of autophagic activity and RVM. It might also be possible that minocycline directly activated autophagy, as the observed pigments are known to form complexes containing minocycline and/or its metabolites. As long-term minocycline treatment is expected to be used more widely in the future, we must draw attention to this adverse effect.

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Hydroxychloroquine‐induced hyperpigmentation: the staining pattern

Abstract: To our knowledge, this is the first case of metastatic carcinoid tumor reported that has mimicked a poroid neoplasm.

Cited by 53 publications

References 13 publications

Cutaneous Adverse Drug Reactions with Antimalarials and Allergological Skin Tests

Cutaneous Adverse Drug Reactions with Antimalarials and Allergological Skin Tests

Melanotic lupus erythematosus: A rare variant of discoid lupus erythematosus

Minocycline-associated rimmed vacuolar myopathy in a patient with rheumatoid arthritis

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