title: Hydroxychloroquine-induced hyperpigmentation: the staining pattern.
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.
authors: Department of Dermatology/Dermatopathology, Geisinger Medical Center, Danville, PA 17822, USA. pkpuri@geisinger.edu
authors: Puja K
authors: PK
authors: Puri
authors: Nektarios I
authors: NI
authors: Lountzis
authors: William
authors: W
authors: Tyler
authors: Tammie
authors: T
authors: Ferringer
mesh_terms: D000368:Aged; D000863:Antacids / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D001241:Aspirin / Q000627:therapeutic use; D000069059:Atorvastatin; D002119:Calcium Carbonate / Q000627:therapeutic use; D002313:Cardiomyopathy, Restrictive / Q000150:complications; D015283:Citalopram / Q000627:therapeutic use; D003240:Connective Tissue Diseases / Q000188:drug therapy; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D005944:Glucosamine / Q000627:therapeutic use; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017495:Hyperpigmentation / Q000139:chemically induced*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy; D008274:Magnesium / Q000627:therapeutic use; D008788:Metolazone / Q000627:therapeutic use; D008875:Middle Aged; D009288:Naproxen / Q000627:therapeutic use; D009853:Omeprazole / Q000627:therapeutic use; D011189:Potassium Chloride / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013148:Spironolactone / Q000627:therapeutic use
chemical_list: D000863:Antacids; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D018501:Antirheumatic Agents; D001241:Aspirin; D000069059:Atorvastatin; D002119:Calcium Carbonate; D015283:Citalopram; D004232:Diuretics; D005665:Furosemide; D005944:Glucosamine; D006538:Heptanoic Acids; D006886:Hydroxychloroquine; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008274:Magnesium; D008788:Metolazone; D009288:Naproxen; D009853:Omeprazole; D011189:Potassium Chloride; D011241:Prednisone; D011758:Pyrroles; D017367:Selective Serotonin Reuptake Inhibitors; D013148:Spironolactone; C005479:magnesium carbonate