Myopathy Induced by Antimalarial Agents: The Relevance of Screening Muscle Enzyme Levels

Abstract

Comment. Scalp dermoscopy or trichoscopy is a useful noninvasive adjunct to the pediatric scalp examination that allows the rapid capture of high-resolution images for in vivo evaluation. We describe a novel normal scalp finding in children and document the presence of dermoscopic patterns previously described in adults. Dirty dots, which present on the scalp as clumped and haphazardly arrayed particulate debris and loose fibers of various colors, were most commonly found in the intermediate age group (83% of those aged 9 months to 10 years; 10 of 12), and not at all in younger or older age groups. Two intermediate-aged subjects reevaluated 3 years after their initial examination demonstrated an improvement with age. The experience of 1 of us (A.T.) suggests that dirty dots are rarely if ever seen on the adult scalp. Bacterial and fungal cultures from the scalp of 2 subjects withdirtydotswerenegative.Dirtydotswerereadilyremoved by shampoo, but reaccumulated as early as 1 day afterwards. Unlike dirty dots, the yellow scale of seborrheic dermatitis was more common in younger and older children. We present dirty dots as a novel and unique dermoscopic finding of the normal scalp examination in prepubertal children. Dirty dots likely represent nonmicrobial environmental particles and should not be confused with cadaverized hairs or other abnormal trichoscopic structures. Given the negative correlation between the presence of dirty dots and seborrheic dermatitis in our series, we postulate that the relative decrease in sebaceous activity in prepubertal children may lead to an inability to repel particulate debris from exogenous environmental sources. Future studies to elucidate the potential relationship between dirty dots and sebaceous activity will be of interest.

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

“…All 15 patients with myopathy presented increased levels, mild to moderate, of CK or lactic dehydrogenase. By contrast, Kalajian and Callen [ 55 ] did not find an association between elevated serum muscle enzymes and underlying antimalarial-induced myopathy in patients taking CQ or HCQ.…”

Drug-related Myopathies of Which the Clinician Should Be Aware

“…A prospective study of myopathy induced by antimalarial agents previously conducted by Casado and colleagues [41] suggested serial muscle enzyme screening of patients on these therapies as a way to identify patients at risk. Dr. Jeffrey Callen has extensive experience with antimalarial use for dermatologic diseases and with the use of a prospective study, Callen and colleagues [42] did not find an association between elevated serum muscle enzymes and underlying antimalarial agent–related myopathy in patients taking chloroquine or hydroxychloroquine. Instead, this paper suggests empiric discontinuation of antimalarials in any patient with suspected antimalarial agent–related myopathy.…”

03 Low dose aspirin in aPL-positive patients: Are we treating the patient or the doctor?

“…Discuss optimal treatment options for thrombosis risk reduction in patients with aPL Type I interferons (IFNs), including IFN-a, IFN-b, IFN-w and IFN-k, represent an essential host defense mechanism stimulated by virus infection. [1][2][3][4] In that setting, type I IFN is tightly regulated with duration of expression limited to several days. When its production is sustained, its protean effects on immune cell function can be damaging.…”