Prevalence and risk factors of hyperpigmentation induced by hydroxychloroquine in lupus patients


  • Nouf T. Mleeh Department of Dermatology, King Abdulaziz University Hospital, Jeddah



Hydroxychloroquine, Skin, Pigmentation, Systemic lupus erythematosus, Prevalence, Risk factors, Saudi Arabia


Background: Antimalarials including hydroxychloroquine (HCQ) have been used in the treatment of systemic lupus erythematosus (SLE) for more than 50 years. Few cases of hyperpigmentation attributed to HCQ have been reported in the literature from different geographical areas. However, no case reports or local studies from Saudi Arabia estimated the magnitude of HCQ adverse effect. This study aimed to estimate the prevalence of HCQ-induced hyperpigmentation and to investigate the possible risk factors related to this condition.

Methods: This retrospective study was conducted at King Abdulaziz University Hospital. All SLE patients on HCQ treatment, aged 18 years or above who visited Rheumatology and Dermatology Clinics were included. Those with the previous history of hyperpigmentation before starting HCQ treatment, or on chloroquine or quinacrine therapy were excluded. Medical records from September 2005 until June 2016 were reviewed.

Results: Out of 199 cases, 98 (49.2%) cases had hyperpigmentation, only 13 (13.3%) cases reported resolution. The main sites affected were the hands 46 (23.1%), followed by face 45 (22.6%), then feet 18 (9.0%), leg and whole body equally 12 (6.0%). There was a significant association between hyperpigmentation and receiving medications, history of ecchymosis, sun exposure, the presence of mucous membrane pigmentations (p<0.0001, p=0.012, p<0.0001, p=0.022 respectively).

Conclusions: HCQ-induced pigmentation is considered uncommon adverse effect of HCQ, with a prevalence rate of 49.2% indicated in this study. Furthermore, history of bruising, sun exposure, and the presence of mucous membrane pigmentation are possible predisposing factors.


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