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Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study.

Abstract：

IMPORTANCE:Hydroxychloroquine-induced pigmentation is not a rare adverse effect. Our data support the hypothesis that hydroxychloroquine-induced pigmentation is secondary to ecchymosis or bruising. OBJECTIVE:To describe the clinical features and outcome of hydroxychloroquine (HCQ)-induced pigmentation in patients with systemic lupus erythematosus (SLE). DESIGN, SETTING, AND PARTICIPANTS:In a case-control study conducted at a French referral center for SLE and antiphospholipid syndrome, 24 patients with SLE, with a diagnosis of HCQ-induced pigmentation, were compared with 517 SLE controls treated with HCQ. MAIN OUTCOMES AND MEASURES:The primary outcome was the clinical features of HCQ-induced pigmentation. Skin biopsies were performed on 5 patients, both in healthy skin and in the pigmented lesions. The statistical associations of HCQ-induced pigmentation with several variables were calculated using univariate and multivariate analyses. RESULTS:Among the 24 patients, skin pigmentation appeared after a median HCQ treatment duration of 6.1 years (range, 3 months-22 years). Twenty-two patients (92%) reported that the appearance of pigmented lesions was preceded by the occurrence of ecchymotic areas, which gave way to a localized blue-gray or brown pigmentation that persisted. Twenty-three patients (96%) had at least 1 condition predisposing them to easy bruising. Results from skin biopsies performed on 5 patients showed that the median concentration of iron was significantly higher in biopsy specimens of pigmented lesions compared with normal skin (4115 vs 413 nmol/g; P < .001). Using multivariate logistic regression, we found that HCQ-induced pigmentation was independently associated with previous treatment with oral anticoagulants and/or antiplatelet agents and with higher blood HCQ concentration. CONCLUSIONS AND RELEVANCE:Hydroxychloroquine-induced pigmentation is not a rare adverse effect of HCQ. Our data support the hypothesis that HCQ-induced pigmentation is secondary to ecchymosis or bruising.

journal_name

JAMA Dermatol

journal_title

JAMA dermatology

authors

Jallouli M,Francès C,Piette JC,Huong du LT,Moguelet P,Factor C,Zahr N,Miyara M,Saadoun D,Mathian A,Haroche J,De Gennes C,Leroux G,Chapelon C,Wechsler B,Cacoub P,Amoura Z,Costedoat-Chalumeau N,Plaquenil LUpus Systemic

doi

10.1001/jamadermatol.2013.709

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

935-40

issue

eissn

2168-6068

issn

2168-6084

pii

1708456

journal_volume

149

pub_type

杂志文章

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Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study.