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KMID : 0363220120500060577
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Korean Journal of Dermatology
2012 Volume.50 No. 6 p.577 ~ p.578
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A Case of Hydroxychloroquine-Induced Cutaneous Hyperpigmentation
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Kim Jae-Kyung
Moon Hye-Rim
Won Chong-Hyun
Chang Sung-Eun
Lee Mi-Woo
Choi Jee-Ho
Moon Kee-Chan
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Abstract
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Antimalarial drugs (AM), such as chloroquine (CQ) and hydroxychloroquine (HCQ), are commonly prescribed drugs in dermatological practice. Many studies have evaluated the adverse effect and mucocutaneous hyperpigmentation is known to affect 10∼25% of patients with AM1. Most cases of hyperpigmentation have been reported from chloroquine, but rarely hydroxychroquine2,3. Herein, we report an additional case of cutaneous hyperpigmentation during therapy with HCQ. A 50-year-old woman was presented with skin discoloration. The patient had been taking 200 mg HCQ daily for SLE for 2 years. Six months after starting HCQ, cutaneous hyperpigmentation developed. Her past medical history was otherwise unremarkable, and there was no evidence of erythema or pruritus prior to the appearance of hyperpigmentation. She was not taking any other medications or supplements. Laboratory studies revealed a low platelet count (95; reference value 150∼350×103/uL), a positive antinuclear antibody (ANA) at 1：320 in a speckled pattern, and a positive anti-Ro antibody. Skin examination revealed mottled, reticulated, macular, brown pigmentation, involving her neck, trunk, and bilateral upper and lower extremities (Fig. 1). Histopathology findings demonstrated marked pigmentary incontinence, mild chronic inflammatory infiltrate, and basal cell degeneration. The pigments in the dermis stained with Fontana-Masson but we renegative for iron staining (Fig. 2). Based upon clinical, histopathologic, and laboratory findings, adiagnosis of HCQ-induced cutaneous hyperpigmentation was established. The mechanism of HCQ-induced hyperpigmentation is poorly understood; however, recent studies demonstrated the melanin pigment, hemosiderin, or both deposited in the lesional skin4. AM accumulates in melanin-rich tissues and triggers a phototoxic reaction5. Hemosiderin deposits in the dermis secondary to extravasation of red blood cells through damaged vessels1. Pigment changes associated with the use of AM can result in a limited-degree of morbidity; however, these changes may be very disturbing to patients, particularly to females. Explaining the benign nature of this reaction and offering cosmetic options to reduce the pigmentation may help reassure the patients.
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KEYWORD
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Antimalarial, Hydroxychloroquine, Hyperpigmentation
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