10.5826/dpc.1304a235
text/xml
2160-9381
3286
en
Laila Hamri
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Hyperpigmentation Induced by Hydroxychloroquine
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-23
2023-10-31
2024-01-15
e2023235
Dermatol Pract Concept
Laila Hamri
2023/10/31
10.5826/dpc.1304a235
e2023235
Department of internal medicine, provincial hospital center Sidi Hsein Bennacer, Ouarzazate, Morocco
2160-9381
en
e2023235
Tosios, Konstantinos I., Eleni-Marina Kalogirou, et Alexandra Sklavounou. « Drug-Associated Hyperpigmentation of the Oral Mucosa: Report of Four Cases ». Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 125, no 3 (mars 2018): e54 66. https://doi.org/10.1016/j.oooo.2017.10.006.
Hyperpigmentation Induced by Hydroxychloroquine
https://dpcj.org/index.php/dpc/article/download/3286/2379
Hyperpigmentation Induced by Hydroxychloroquine
                                                             Laila Hamri1


1 Department of internal medicine, provincial hospital center Sidi Hsein Bennacer, Ouarzazate, Morocco



Citation: Hamri L. Hyperpigmentation Induced by Hydroxychloroquine. Dermatol Pract Concept. 2023;13(4):e2023235.
DOI: https://doi.org/10.5826/dpc.1304a235
Accepted: April 15, 2023; Published: October 2023
Copyright: ©2023 Hamri. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial
License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and
reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Laila Hamri, Department of internal medicine, provincial hospital center Sidi Hsein Bennacer, Ouarzazate,
Morocco. Tel : 00212660834013 Mail : laila.medic@gmail.com




Case Presentation                                                        level, TSH, red blood cell sedimentation, C-reactive-protein,
                                                                         serum iron, ferritin, AST, ALT, bilirubin, gGT, PAL, urea,
A 52-year-old Moroccan woman, with a previous diagnosis                  creatinine, anti-phospholipid antibodies, 24-hour protein-
of Sjogren syndrome (SS), presented to our internal medicine             uria, blood and urine ionograms, virus serologies (HCV,
consultation with the appearance of hyperpigmented lesions               HIV, HBV), ceruleoplasmin, and vitamin B12 levels. A tho-
on lower lip and back of hands (Figure 1). She was medi-                 racic-abdominal-pelvic CT scan was also requested to rule
cated with hydroxychloroquine for 4 years at a dose of 400               out a neoplastic origin. As for the immunological workup,
mg/day. Clinical examination did not show any other local-               anti-SSA and anti-SSB were initially positive, but these same
izations. She did not present any other clinical systemic sign           antibodies were found when the immunological tests were
suggesting diagnosis of systemic lupus erythematosus. Con-               redone. Furthermore, biological and radiological investi-
sidering her age, clinical context and current medications,              gations came back normal, and the diagnosis of hyperpig-
the main diagnoses that were evoked were drug-induced                    mentation induced by hydroxychloroquine was retained. An
hyperpigmentation, metabolic disorders, endocrinopathies,                ophthalmological examination with a visual field was car-
other auto-immunities, and a paraneoplastic syndrome. We                 ried out, objective an enlargement of the blind spot, with-
performed biological tests: blood cell count, 8-hour cortisol            out other abnormality. Hydroxychloroquine was definitively




Image Letter | Dermatol Pract Concept. 2023;13(4):e2023235                                                                          1
 Figure 1. (A,B) Hyperpigmentation of lower lip (A) and back of hands (B) induced by hydroxychloroquine.




discontinued. Two months later, we noted a stability of the         other iatrogenic causes, endocrinopathies (Addison disease,
lesions, without appearance of other locations.                     Cushing syndrome, hyperthyroidism), metabolic disorders
                                                                    (hemochromatosis, Wilson disease), infections (HIV, Derma-
                                                                    tophytes), nutritional disorders [1].
Teaching Point
Antimalarials are responsible for hyperpigmentation in 25%
to 33% of cases [1]. This side effect is much more com-
                                                                    References
mon with chloroquine and quinacrine than with hydroxy-               1. Wang, Rebecca F., Dayoung Ko, Ben J. Friedman, Henry W. Lim,
chloroquine [1]. The most characterized locations are the               et Tasneem F. Mohammad. Disorders of Hyperpigmentation.
oral cavity, the neck and the front of the legs [1,2]. It ap-           Part I. Pathogenesis and Clinical Features of Common Pigmen-
                                                                        tary Disorders. J Am Acad Dermatol. 2023;88(2):271-288. DOI:
pears after months or years of use of the molecule, and it is
                                                                        10.1016/j.jaad.2022.01.051. PMID: 35151757.
dose-dependent [1]. Hydroxychloroquine-induced retinop-
                                                                     2. Tosios KI, Kalogirou EM, Sklavounou A. Drug-associated hyper-
athy is commonly associated. Discontinuation of the drug                pigmentation of the oral mucosa: report of four cases. Oral Surg
generally allows clearing of the lesions after a few months.            Oral Med Oral Pathol Oral Radiol. 2018;125(3):e54-e66. DOI:
It is important to rule out differential diagnoses, including           10.1016/j.oooo.2017.10.006. PMID: 29287748.




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