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SLE patients experienced hydroxychloroquine-induced pigmentation as secondary effect
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Hydroxychloroquine-induced pigmentation was a secondary effect to ecchymosis in patients with systemic lupus erythematosus who were treated with the drug in a recent study.
Researchers conducted a retrospective, case-control study of 24 patients with systemic lupus erythematosus (SLE; mean age 34.2 years; 23 women) and hydroxychloroquine (HCQ)-induced pigmentation diagnoses confirmed by a dermatologist, along with 517 SLE controls who received HCQ for at least 6 months (mean age, 39.1 years; 91% women). Clinical features of HCQ-induced pigmentation were the primary outcome.
Five patients had biopsies performed on healthy skin and in pigmented lesions. Univariate and multivariate analyses were used to calculate statistical associations between HCQ-induced pigmentation and several variables.
Pigmentation appeared after a median HCQ treatment duration of 6.1 years in the 24 patients who received a median cumulative dose of 720 g HCQ. The occurrence of ecchymotic areas, which gave way to persistent, localized blue-gray or brown pigmentation, was reported by 22 patients. Patients reported the onset of pigmented lesions as “bruises that did not disappear.” At least one condition which predisposed patients to ecchymosis occurred in all but one patient. Median concentration of iron was significantly higher in biopsy specimens from pigmented lesions compared with normal skin in the patients who underwent biopsies (4,115 nmol/g vs. 413 nmol/g; P<.001).
“We found that HCQ-induced pigmentation was independently associated with previous treatments with oral anticoagulants and/or antiplatelet agents and with higher blood HCQ concentration,” the researchers reported.
“HCQ-induced pigmentation is not a rare adverse effect of HCQ, with a minimal incidence estimated at 7.3%,” the researchers concluded. “Its localization and association with factors facilitating bruising, interviews with patients and data from skin biopsies support the hypothesis that HCQ-induced pigmentation is secondary to ecchymosis or bruising.”
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