Hydroxychloroquine-induced hyperpigmentation: the staining pattern

J Cutan Pathol. 2008 Dec;35(12):1134-7. doi: 10.1111/j.1600-0560.2008.01004.x. Epub 2008 Aug 23.

Abstract

We report two cases of hydroxychloroquine-induced hyperpigmentation presenting in a 50-year-old Caucasian female (case 1) and a 78-year-old female (case 2), both receiving 400 mg per day. Case 1 had an arthritis predominant undifferentiated connective tissue disease, which was treated with hydroxychloroquine for 4-5 years. She presented with a mottled, reticulated macular gray pigmentation involving the upper back and shoulders. Case 2 had a history of systemic lupus erythematosus and rheumatoid arthritis, treated with hydroxychloroquine for 1.5 years. She presented to the hospital for treatment of constrictive cardiomyopathy and was noted to have a blue macular pigmentation involving the right temple. The biopsies from both patients showed superficial dermal, yellow-brown, non-refractile and coarsely granular pigment deposition. A Fontana-Masson stain highlighted some of these granules, while the Perl's iron stain was negative. Rare, previous reports of hyperpigmentation indicate the presence of both melanin and hemosiderin in patients being treated with antimalarial medication. To our knowledge, this staining pattern for hydroxychloroquine has not been previously reported in the literature and supports that hydroxychloroquine, in addition to chloroquine, binds to melanin.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antacids / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anti-Ulcer Agents / therapeutic use
  • Antirheumatic Agents / adverse effects*
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy
  • Aspirin / therapeutic use
  • Atorvastatin
  • Calcium Carbonate / therapeutic use
  • Cardiomyopathy, Restrictive / complications
  • Citalopram / therapeutic use
  • Connective Tissue Diseases / drug therapy
  • Diuretics / therapeutic use
  • Female
  • Furosemide / therapeutic use
  • Glucosamine / therapeutic use
  • Heptanoic Acids / therapeutic use
  • Humans
  • Hydroxychloroquine / adverse effects*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hyperpigmentation / chemically induced*
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / drug therapy
  • Magnesium / therapeutic use
  • Metolazone / therapeutic use
  • Middle Aged
  • Naproxen / therapeutic use
  • Omeprazole / therapeutic use
  • Potassium Chloride / therapeutic use
  • Prednisone / therapeutic use
  • Pyrroles / therapeutic use
  • Serotonin Uptake Inhibitors / therapeutic use
  • Spironolactone / therapeutic use

Substances

  • Antacids
  • Anti-Inflammatory Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anti-Ulcer Agents
  • Antirheumatic Agents
  • Diuretics
  • Heptanoic Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Pyrroles
  • Serotonin Uptake Inhibitors
  • Citalopram
  • magnesium carbonate
  • Spironolactone
  • Hydroxychloroquine
  • Naproxen
  • Potassium Chloride
  • Furosemide
  • Atorvastatin
  • Calcium Carbonate
  • Magnesium
  • Omeprazole
  • Glucosamine
  • Aspirin
  • Metolazone
  • Prednisone