1Hiba Ibrahim Khogali
1Tawam Hospital
Introduction:
A retrospective observational study to assess the incidence of skin hyperpigmentation secondary to treatment with hydroxychloroquine (HCQ) in systemic lupus erythematous (SLE) Emirati patients attending a rheumatology clinic in Tawam hospital, Al Ain, UAE.
Method(s):
This study was conducted retrospectively using electric chart records at Tawam Hospital – Rheumatology service between January 2010 till June 2019. All patients fulfil the diagnostic criteria of ACR/ SILCC 2012(at least 6-7 out of 11 criteria) (table 1). Data was collected from patients who received HCQ (400 mg once daily for at least 3 months and had no other causes of hyperpigmentation, such as medications ,dermatological diseases ,nutrition deficiencies, or endocrinopathies). The reporting of skin hyperpigmentation was observed and documented by patient, family member or treating Physician and confirmed by treating Rheumatologist. Statistical analysis was performed using SPSS softword
Result(s):
A total of 120 cases of SLE patients (109 females and 11males) were observed over a period of 9 years, with 31 (25.83%) cases of HCQ-induced hyperpigmentation (30females and 1 male). All 31 (100%) patients were UAE nationals, with a mean age of 26 years (range: 16-36 years) and mean duration of treatment with HCQ of 16.5 (range: 3-24) months. Majority of the patients affected with hyperpigmentation 27 (87.09%) were dark-skinned. The overall disease activity score SLEDAI ranged from mild to moderate (5-7).
Most affected areas were the face predominantly (the front &cheeks), hands, upper back and submandibular area respectively (Table 2). HCQ therapy was withdrawn in 30 (96.77%) patients and the dose was reduced to 200 mg/day in 1 (3.22%) patient. Discontinuation of HCQ resulted in partial improvement of hyperpigmentation in 26 (83.87%) patients and complete resolution in 3 (9.67%) patients and non-resolution in 1 (3.22%) patient.
Conclusion(s):
In our study the incidence of skin hyperpigmentation in SLE patients on HCQ treatment was 25.83 % which is more frequent than other gulf countries. In our study hyperpigmentation affects proximal body parts sparing lower limbs The patient’s skin complexion should be taken into consideration while prescribing HCQ for SLE in future. Discontinuation or reduction of the dose doesn’t help hyperpigmentation in improvement.
Keywords: Antimalarials; hydroxychloroquine; systemic lupus erythematosus; skin hyperpigmentation; dark skin complexion, UAE.