Woman in grey: hydroxychloroquine-induced hyperpigmentation

Safety of hydroxychloroquine in COVID-19 and other diseases: a systematic review and meta-analysis of 53 randomized trials

“…Additionally, the symptoms were generally mild, which could be relieved after withdrawal of therapy [88,89]. The skin and subcutaneous tissue SAEs associated with HCQ that were frequently reported in the literature were acute generalized exanthematous pustulosis (AGEP) [12][13][14][90][91][92][93], pigmentation [15,17,[94][95][96][97][98][99][100], Stevens-Johnson syndrome [19,101], and toxic epidermal necrolysis [18,102,103]. One multinational case-control study suggested that HCQ or chloroquine was highly associated with AGEP [104].…”

“…Previous studies pointed out that the overall prevalence rate of patients receiving HCQ for more than 5 years is 7.5%, which may rise to roughly 20% 20 years later [7]. Other frequently reported SAEs mostly consisted of cardiotoxicities such as cardiomyopathy [8][9][10][11], and cutaneous toxicities such as acute generalized exanthematous pustulosis [12][13][14], pigmentation [15][16][17], and toxic epidermal necrolysis [18,19]. To date, a series of studies on HCQ use against COVID-19 have been published, but there Can Chen and Kunming Pan contributed equally to this work.…”

Hydroxychloroquine-induced hyperpigmentation in a 14-year-old female with systemic lupus erythematosus

“… 1 The hyperpigmentation may develop from a few months to a few years following the initiation of HCQ therapy. 2 , 3 To our knowledge, HCQ-induced hyperpigmentation has not been reported in the pediatric age group. Herein, we report on the case of a 14-year-old girl with systemic lupus erythematosus (SLE), who developed hyperpigmentation on her shins and dorsum of the left foot after treatment with HCQ for 3 years.…”

“…Cutaneous pigmentation occurs in 10–25% of patients after a few months to a few years of treatment with HCQ. 2 , 3 , 6 , 18 In one study of 41 patients treated with HCQ, pigmentation appeared after a median duration of HCQ treatment of 32 months (range 6–108 months). 2 There is no clear association with duration of treatment or cumulative dose of HCQ.…”

“… 6 Other predisposing factors include the use of oral anticoagulants or antiplatelet agents, long-term use of corticosteroids, and antiphospholipid syndrome. 2 , 3 , 13 , 18 , 19 HCQ-induced damage of dermal vessels with leakage of erythrocytes is another possibility. 1 Histopathological examination of the hyperpigmented lesion shows yellow–brown granules within macrophages in the dermis, melanin in reticular dermis, and perivascular iron/hemosiderin on special staining.…”