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Pigmentation From Antimalarial Therapy: Its Possible Relationship to the Ocular Lesions

Pigmentation From Antimalarial Therapy: Its Possible Relationship to the Ocular Lesions Abstract Localized, cutaneous, blue-black pigmentation of a unique nature, involving the pretibial, palatal, facial, and subungual areas, was studied in 25 patients receiving antimalarial therapy. Histopathological findings on biopsies from 11 patients are discussed. Paired analysis for chloroquine in biopsies taken from pigmented and nonpigmented sites in three patients showed high concentration in all samples and a significantly greater concentration in the pigmented skin of only one patient. Four of these 25 patients had retinal damage, and eight had corneal depositions. A total of five patients has been observed in our clinic with retinopathy following antimalarial therapy; four have had cutaneous pigmentary disturbances prior to the retinal damage. In view of this, patients receiving antimalarial therapy who develop pigment abnormalities should have frequent ophthalmological examinations. References 1. Analyzed by E. W. McChesney, Sterling-Winthrop Research Institute, Rensselaer, NY. 2. Alving, A. S.; Eichelberger, L.; Craige, B., Jr.; Jones, R., Jr.; Whorton, C. M.; and Pullman, T. N.: Studies on the Chronic Toxicity of Chloroquine , J Clin Invest 27:60-65 ( (May) ) 1948.Crossref 3. Arden, G. B.; Friedmann, A.; and Kolb, H.: Anticipation of Chloroquine Retinopathy , Lancet 1:1164-1165 ( (June 2) ) 1962.Crossref 4. Bagby, J. W.: A Tropical Lichen Planus-like Disease , Arch Derm Syph 52:1-5 ( (July) ) 1945.Crossref 5. Barr, J. F.: Subungual Pigmentation Following Prolonged Atabrine Therapy , US Nav Med Bull 43:929 ( (Nov) ) 1944. 6. Butterworth, T., and German, J. E.: Discoid Lupus Erythematosus With Peculiar Pigmentation , Arch Derm 86:685-686 ( (Nov) ) 1962.Crossref 7. Cambiaggi, A.: Unusual Ocular Lesions in a Case of Systemic Lupus Erythematosus , AMA Arch Ophthal 57:451-453, 1957.Crossref 8. Campbell, C. H.: Pigmentation of the Nail-Beds, Palate, and Skin Occurring During Malarial Suppressive Therapy With ``Camoquin,'' Med J Aust 1:956-957 ( (June 18) ) 1960. 9. Doll, J. L. C., and Keane, J. A.: Disturbances of Pigmentation With Chloroquine , Brit Med J 1:1387-1389 ( (May 30) ) 1959.Crossref 10. Ellsworth, R. J., and Zeller, R. W.: Chloroquine (Aralen)-Induced Retinal Damage , Arch Ophthal 66:269-272 ( (Aug) ) 1961.Crossref 11. Hobbs, H. E.; Sorsby, A.; and Freedman, A.: Retinopathy Following Chloroquine Therapy , Lancet 2:478-480 ( (Oct 3) ) 1959.Crossref 12. Kierland, R. R.; Sheard, C.; Mason, H. L.; and Lobitz, W. C.: Fluorescence of Nails From Quinacrine Hydrochloride , JAMA 131:809-810 ( (July 6) ) 1946.Crossref 13. Kyle, R. A., and Bartholomew, L. G.: Variations in Pigmentation From Quinacrine: Report of a Case Mimicking Chronic Hepatic Disease , Arch Intern Med 109:458-462 ( (April) ) 1962.Crossref 14. Lippard, V. W., and Kauer, G. L., Jr.: Pigmentation of the Palate and Subungual Tissues Associated With Suppressive Quinacrine Hydrochloride Therapy , Amer J Trop Med 25:469-471 ( (Nov) ) 1945. 15. Lutterloh, C. H., and Shallenberger, P. L.: Unusual Pigmentation Developing After Prolonged Suppressive Therapy With Quinacrine Hydrochloride , Arch Derm Syph 53:349-354 ( (April) ) 1946.Crossref 16. Maguire, A.: Amodiaquine Hydrochloride: Corneal Deposits and Pigmented Palate and Nails After Treatment of Chronic Discoid Lupus Erythematosus , Lancet 1:667 ( (March 31) ) 1962.Crossref 17. Mann, I.: "Blue Halos" in Atabrine Workers , Brit J Ophthal 31:40-46 ( (Jan) ) 1947.Crossref 18. Merwin, C. F., and Winkelmann, R. K.: Dermatologic Clinics: 2. Antimalarial Drugs in the Therapy of Lupus Erythematosus , Proc Mayo Clin 37:253-268 ( (April) ) 1962. 19. Ormrod, J. N.: Two Cases of Chloroquine-Induced Retinal Damage , Brit Med J 5282:918-919 ( (March 31) ) 1962.Crossref 20. Pillsbury, D. M.; Shelly, W. B.; and Kligman, A. M.: Dermatology , Philadelphia: W. B. Saunders Company, 1956, p 881. 21. Rebello, D. J. A.: Ocular Reactions to Antimalarial Drugs , Arch Derm 83:785-789 ( (May) ) 1961.Crossref 22. Schmitt, C. L.; Alpins, O.; and Chambers, G.: Clinical Investigation of a New Cutaneous Entity , Arch Derm Syph 52:226-238 ( (Oct) ) 1945.Crossref 23. Sternberg, T. H., and Laden, E.: Discoid Lupus Erythematosus: Bilateral Macular Degeneration Due to Chloroquine , AMA Arch Derm 79: 116-118 ( (Jan) ) 1959.Crossref 24. Smith, J. L.: Chloroquine Macular Degeneration , Arch Ophthal 68:186-190 ( (Aug) ) 1962.Crossref 25. Sugar, H. S., and Waddell, W. W.: Ochronosis-like Pigmentation Associated With the Use of Atabrine , Illinois Med J 89:234-239 ( (May) ) 1946. 26. Winkelman, R. K.; Merwin, C. F.; and Brunsting, L. A.: Antimalarial Therapy of Lupus Erythematosus , Ann Intern Med 55:772-776 ( (Nov) ) 1961.Crossref 27. Wiselogle, F. Y., editor: A Survey of Antimalarial Drugs , Ann Arbor, Mich: J. W. Edwards Co., 1946, p 106. 28. Young, E.: Melanosis Caused by Camoquin , Dermatologica 116:389-395 ( (June) ) 1958.Crossref 29. Zvaifler, N. J.; Bernstein, H.; and Rubin, M.: Chloroquine Deposition in Ocular Tissue , Arthritis Rheum 5:667 ( (Dec) ) 1962.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Pigmentation From Antimalarial Therapy: Its Possible Relationship to the Ocular Lesions

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Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1963.01590220051006
Publisher site
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Abstract

Abstract Localized, cutaneous, blue-black pigmentation of a unique nature, involving the pretibial, palatal, facial, and subungual areas, was studied in 25 patients receiving antimalarial therapy. Histopathological findings on biopsies from 11 patients are discussed. Paired analysis for chloroquine in biopsies taken from pigmented and nonpigmented sites in three patients showed high concentration in all samples and a significantly greater concentration in the pigmented skin of only one patient. Four of these 25 patients had retinal damage, and eight had corneal depositions. A total of five patients has been observed in our clinic with retinopathy following antimalarial therapy; four have had cutaneous pigmentary disturbances prior to the retinal damage. In view of this, patients receiving antimalarial therapy who develop pigment abnormalities should have frequent ophthalmological examinations. References 1. Analyzed by E. W. McChesney, Sterling-Winthrop Research Institute, Rensselaer, NY. 2. Alving, A. S.; Eichelberger, L.; Craige, B., Jr.; Jones, R., Jr.; Whorton, C. M.; and Pullman, T. N.: Studies on the Chronic Toxicity of Chloroquine , J Clin Invest 27:60-65 ( (May) ) 1948.Crossref 3. Arden, G. B.; Friedmann, A.; and Kolb, H.: Anticipation of Chloroquine Retinopathy , Lancet 1:1164-1165 ( (June 2) ) 1962.Crossref 4. Bagby, J. W.: A Tropical Lichen Planus-like Disease , Arch Derm Syph 52:1-5 ( (July) ) 1945.Crossref 5. Barr, J. F.: Subungual Pigmentation Following Prolonged Atabrine Therapy , US Nav Med Bull 43:929 ( (Nov) ) 1944. 6. Butterworth, T., and German, J. E.: Discoid Lupus Erythematosus With Peculiar Pigmentation , Arch Derm 86:685-686 ( (Nov) ) 1962.Crossref 7. Cambiaggi, A.: Unusual Ocular Lesions in a Case of Systemic Lupus Erythematosus , AMA Arch Ophthal 57:451-453, 1957.Crossref 8. Campbell, C. H.: Pigmentation of the Nail-Beds, Palate, and Skin Occurring During Malarial Suppressive Therapy With ``Camoquin,'' Med J Aust 1:956-957 ( (June 18) ) 1960. 9. Doll, J. L. C., and Keane, J. A.: Disturbances of Pigmentation With Chloroquine , Brit Med J 1:1387-1389 ( (May 30) ) 1959.Crossref 10. Ellsworth, R. J., and Zeller, R. W.: Chloroquine (Aralen)-Induced Retinal Damage , Arch Ophthal 66:269-272 ( (Aug) ) 1961.Crossref 11. Hobbs, H. E.; Sorsby, A.; and Freedman, A.: Retinopathy Following Chloroquine Therapy , Lancet 2:478-480 ( (Oct 3) ) 1959.Crossref 12. Kierland, R. R.; Sheard, C.; Mason, H. L.; and Lobitz, W. C.: Fluorescence of Nails From Quinacrine Hydrochloride , JAMA 131:809-810 ( (July 6) ) 1946.Crossref 13. Kyle, R. A., and Bartholomew, L. G.: Variations in Pigmentation From Quinacrine: Report of a Case Mimicking Chronic Hepatic Disease , Arch Intern Med 109:458-462 ( (April) ) 1962.Crossref 14. Lippard, V. W., and Kauer, G. L., Jr.: Pigmentation of the Palate and Subungual Tissues Associated With Suppressive Quinacrine Hydrochloride Therapy , Amer J Trop Med 25:469-471 ( (Nov) ) 1945. 15. Lutterloh, C. H., and Shallenberger, P. L.: Unusual Pigmentation Developing After Prolonged Suppressive Therapy With Quinacrine Hydrochloride , Arch Derm Syph 53:349-354 ( (April) ) 1946.Crossref 16. Maguire, A.: Amodiaquine Hydrochloride: Corneal Deposits and Pigmented Palate and Nails After Treatment of Chronic Discoid Lupus Erythematosus , Lancet 1:667 ( (March 31) ) 1962.Crossref 17. Mann, I.: "Blue Halos" in Atabrine Workers , Brit J Ophthal 31:40-46 ( (Jan) ) 1947.Crossref 18. Merwin, C. F., and Winkelmann, R. K.: Dermatologic Clinics: 2. Antimalarial Drugs in the Therapy of Lupus Erythematosus , Proc Mayo Clin 37:253-268 ( (April) ) 1962. 19. Ormrod, J. N.: Two Cases of Chloroquine-Induced Retinal Damage , Brit Med J 5282:918-919 ( (March 31) ) 1962.Crossref 20. Pillsbury, D. M.; Shelly, W. B.; and Kligman, A. M.: Dermatology , Philadelphia: W. B. Saunders Company, 1956, p 881. 21. Rebello, D. J. A.: Ocular Reactions to Antimalarial Drugs , Arch Derm 83:785-789 ( (May) ) 1961.Crossref 22. Schmitt, C. L.; Alpins, O.; and Chambers, G.: Clinical Investigation of a New Cutaneous Entity , Arch Derm Syph 52:226-238 ( (Oct) ) 1945.Crossref 23. Sternberg, T. H., and Laden, E.: Discoid Lupus Erythematosus: Bilateral Macular Degeneration Due to Chloroquine , AMA Arch Derm 79: 116-118 ( (Jan) ) 1959.Crossref 24. Smith, J. L.: Chloroquine Macular Degeneration , Arch Ophthal 68:186-190 ( (Aug) ) 1962.Crossref 25. Sugar, H. S., and Waddell, W. W.: Ochronosis-like Pigmentation Associated With the Use of Atabrine , Illinois Med J 89:234-239 ( (May) ) 1946. 26. Winkelman, R. K.; Merwin, C. F.; and Brunsting, L. A.: Antimalarial Therapy of Lupus Erythematosus , Ann Intern Med 55:772-776 ( (Nov) ) 1961.Crossref 27. Wiselogle, F. Y., editor: A Survey of Antimalarial Drugs , Ann Arbor, Mich: J. W. Edwards Co., 1946, p 106. 28. Young, E.: Melanosis Caused by Camoquin , Dermatologica 116:389-395 ( (June) ) 1958.Crossref 29. Zvaifler, N. J.; Bernstein, H.; and Rubin, M.: Chloroquine Deposition in Ocular Tissue , Arthritis Rheum 5:667 ( (Dec) ) 1962.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Oct 1, 1963

References