Skin pigmentation chloroquine

Quinoline antimalarials such as hydroxychloroquine (Fig. 5-6) and chloroquine have been found to have antiarthritic properties however, the onset of clinical improvement, as with penicillamine and gold, takes months. Irreversible retinopathy, including retinal opacity, can be encountered. Lesser toxicities include skin pigmentation and alopecia. Proposals to possible mechanisms of action are speculative at best. It should be emphasized that none of the slow-action antiarthritic agents discussed earlier should be considered as initial therapy in RA. The salicylates and other NSAIDs deserve this distinction. If results are unsatisfactory gold may be considered as the subsequent therapeutic step. Penicillamine would be a logical alternate, as would short-term steroids or cytotoxic agents. 

Amodiaquine (Camoquin) is another 4-aminoquinoline derivative whose antimalarial spectrum and adverse reactions are similar to those of chloroquine, although chloroquine-resistant parasites may not be amodi-aquine-resistant to the same degree. Prolonged treatment with amodiaquine may result in pigmentation of the palate, nail beds, and skin. There is a 1 2000 risk of agranulocytosis and hepatocellular dysfunction when the drug is used prophylactically. 

Abnormal pigmentation of the palate, nail beds, and the skin of the face and neck has been reported. The duration of such pigmentation after withdrawal is unknown. The effects on the nails resemble those seen with chloroquine (SEDA-12, 692) (SEDA-12, 241). 

Several patients seen with chloroquine retinopathy in Accra have been observed to present with depigmented patches in the skin of the face. This may be associated with a greyish pigmentation of the mucosa of the hard palate. Two such cases are reported here to illustrate the condition. Stomatitis with buccal ulceration has occasionally been mentioned (SEDA-11, 584). 

Answer C. Ocular toxicity is characteristic of chloroquine and hydroxychloroquine. Corneal deposits are reversible, but retinal pigmentation can ultimately lead to blindness. Patients will complain about GI distress, visual dysfunction, ringing in the ears (note that tinnitus aiso occurs in salicylism), and itchy skin. Hydroxychloroquine also promotes oxidative stress that can lead to hemolysis in G6PD deficiency. DMARDs include gold salts (e.g., auranofin), methotrexate, and etanercept, but thioridazine is a phenothiazine used as an antipsychotic it lacks anti-inflammatory effect, but does cause retinal pigmentation. 

Dizziness headache vomiting diarrhea yellow staining of skin toxic psychosis insomnia bizarre dreams blood dyscrasias urticaria blue and black nail pigmentation psoriasis-like rash acute hepatic necrosis convulsions severe exfoliative dermatitis ocular effects similar to those caused by chloroquine Quinine Dihydrochloride and Sulfate... 

Skin Chloroquine-induced hair hypo-pigmentation has been reported... 

A 65-year-old white woman developed diffuse blue-grey pigmentation on the hard palate mucosa and on the pretibial skin. She had taken chloroquine diphosphate for rheumatoid arthritis for 3 years. 

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