By Gary M. White, MD

Prolonged administration of hydroxychloroquine can lead to cutaneous pigmentation. Biopsies have shown the presence of both melanin and hemosiderin in patients being treated with antimalarial medications. The pattern may be the same as that of minocycline, where a bruise from trauma gives way to a blue area. This is thought to result from the medication binding to iron in the dermis.


The pigmented lesions are often preceded by ecchymotic areas, which give way to a localized blue-gray or brown pigmentation that persists.


Persistent cutaneous hyperpigmentation due to hydroxychloroquine one year after therapy discontinuation. Dermatology Online Journal 15(12)

Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study JAMA Dermatol. 2013 Aug;149(8):935-40


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