Hydroxychloroquine-Induced Pigmentation in Patients With Systemic Lupus Erythematosus

Jallouli, M.; Françès, Camille; Piette, Jean‐Charles; Huong, D. Lê Thi; Moguelet, Philippe; Factor, Cécile; Zahr, Noël; Miyara, Makoto; Saadoun, David; Mathian, Alexis; Haroche, Julien; Gennes, C. De; Leroux, Gaëlle; Chapelon, C.; Wechsler, B.; Cacoub, Patrice; Amoura, Zahir; Costédoat-Chalumeau, Nathalie

doi:10.1001/jamadermatol.2013.709

Cited by 103 publications

(104 citation statements)

References 20 publications

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“…Although both the mean and maximum blood levels predict risk, we believe mean blood levels provide a better measure than maximum levels in the assessment of risk due to the issues of patient nonadherence and due to the variation we observed even when the patient was adherent. Correlation of HCQ blood levels with skin pigmentation and gastrointestinal side effects has been reported . Figure shows the large variance between HCQ blood levels and prescribed dosage.…”

Section: Discussionmentioning

confidence: 92%

Hydroxychloroquine Blood Levels Predict Hydroxychloroquine Retinopathy

Petri

Elkhalifa

et al. 2020

Arthritis & Rheumatology

117

113

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Objective In 2016, the American Academy of Ophthalmology (AAO) changed the recommended daily dose of hydroxychloroquine (HCQ) from 6.5 mg/kg to <5 mg/kg. However, it is not clear that the lower prescribed dose of HCQ will have the same efficacy for systemic lupus erythematosus (SLE) activity or the same role in protecting against cardiovascular risk factors and thrombosis. This study was undertaken to address the frequency of HCQ retinopathy and the role of HCQ blood levels in identifying those individuals who are at a greater future risk of retinopathy. Methods HCQ blood levels in 537 patients with SLE from a large clinical cohort were repeatedly measured, and patients were tested for HCQ retinopathy. We assessed the risk of retinopathy according to clinical characteristics and blood levels of HCQ. Results The overall frequency of retinopathy was 4.3% (23 of 537 patients). There was a 1% risk of retinopathy in the first 5 years of HCQ treatment, 1.8% from 6 to 10 years, 3.3% from 11 to 15 years, 11.5% from 16 to 20 years, and 8.0% after 21 years of use. We found that older age (P < 0.0001), higher body mass index (P for trend = 0.0160), and longer duration of HCQ intake (P = 0.0024 and P for trend = 0.0006) were associated with a higher risk of HCQ toxicity. Higher blood levels of HCQ predicted later HCQ retinopathy (P = 0.0124 and P = 0.0340 for mean and maximum HCQ blood levels, respectively). Conclusion Our data prove the utility of assessing blood levels of HCQ in the prediction of retinopathy. This would allow clinicians to either decrease the dose or increase monitoring in those patients with high HCQ blood levels.

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Section: Discussionmentioning

confidence: 92%

Hydroxychloroquine Blood Levels Predict Hydroxychloroquine Retinopathy

Petri

Elkhalifa

et al. 2020

Arthritis & Rheumatology

117

113

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“…- 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%

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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“…Hydroxychloroquine‐induced hyperpigmentation of the skin and mucosae has mainly been described in patients with systemic lupus erythematosus, affecting approximately 7% of cases . Discrete or diffuse areas of brown or blue‐grey discoloration are typical, often affecting the face, forearms and lower legs, with occasional involvement of the palate, gingiva and nails . Bruising may facilitate the process of hypermelanosis, with both haemosiderin and melanin being present in the dermis .…”

Section: Prescribing and Current Guidelinesmentioning

confidence: 99%

Hydroxychloroquine in dermatology: New perspectives on an old drug

et al. 2019

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Hydroxychloroquine is an age-old drug whose use as an immunomodulatory agent with a low side-effect profile continues to expand. We present a review of this drug including recently updated prescribing recommendations and a summary of its clinical application in dermatology. A maximum daily dose of 5.0 mg/kg based on actual body weight and no greater than 400 mg is advised in order to reduce the risk of retinopathy, which is potentially permanent and has an estimated prevalence of 7.5% at 5 years on standard dosing. Baseline ophthalmologic assessment followed by annual screening after 5 years is recommended; however, closer monitoring should be considered in the setting of existing retinopathy, a cumulative dose > 1000 g or renal dysfunction. Hydroxychloroquine is now considered to be safe in pregnancy, and routine glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is not required. Smoking can significantly decrease its efficacy although the reason is still uncertain. Hydroxychloroquine appears to also demonstrate antineoplastic and cardioprotective benefits.

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Hydroxychloroquine-Induced Pigmentation in Patients With Systemic Lupus Erythematosus

Abstract: Hydroxychloroquine-induced pigmentation is not a rare adverse effect of HCQ. Our data support the hypothesis that HCQ-induced pigmentation is secondary to ecchymosis or bruising.

Cited by 103 publications

References 20 publications

Hydroxychloroquine Blood Levels Predict Hydroxychloroquine Retinopathy

Hydroxychloroquine Blood Levels Predict Hydroxychloroquine Retinopathy

Cutaneous Adverse Drug Reactions with Antimalarials and Allergological Skin Tests

Hydroxychloroquine in dermatology: New perspectives on an old drug

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