Hydroxychloroquine is associated with myriad adverse dermatologic effects, most of which are poorly characterized by the literature, with unknown frequencies and risk factors.
To conduct a systematic review of the adverse dermatologic effects and predisposing factors of hydroxychloroquine toxicity.
The review included 94 articles comprising 689 dermatologic adverse effects. A total of 21 unique dermatologic reactions were reported, most commonly drug eruption or rash (358 cases), cutaneous hyperpigmentation (116), pruritus (62), acute generalized exanthematous pustulosis (27), Stevens-Johnson syndrome or toxic epidermal necrolysis (26), hair loss (12), and stomatitis (11). Almost all underlying conditions were rheumatologic or autoimmune in nature, composed primarily of lupus erythematous (72% of all cases) and rheumatoid arthritis (14%). The range of reported mean cumulative dosages was wide, with some adverse reactions found after as little as 3 g or as much as 2500 g.
Dermatologic adverse events and primary diagnoses related to the use of hydroxychloroquine may be under-reported as only case reports and clinical trials that reported at least 1 dermatologic adverse effect were included.
Although hydroxychloroquine is generally well tolerated, dermatologic adverse effects involving the skin, hair, or nails are a frequent and significant complication. Most of these reactions occurred after treatment of autoimmune conditions, often manifesting on the skin after a wide range of cumulative dosages.Le texte complet de cet article est disponible en PDF.
Key words : adverse effect, adverse event, antimalarial, autoimmune, dermatomyositis, drug eruption, drug rash, hydroxychloroquine, hyperpigmentation, lupus, Plaquenil, rheumatology
Abbreviations used : AGEP, RA, SJS, TEN
| Funding sources: None.
| Conflicts of interest: None disclosed.
| IRB approval status: Exempt from review.
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