ABSTRACT The antimalarials, chloroquine, hydroxychloroquine, and quinacrine, are used primarily for malaria; but they can be beneficial for cutaneous lupus erythematosus (LE), polymorphous light eruption, solar urticaria, and porphyria cutanea tarda. Antimalarials bind to deoxyribonucleic acid (DNA) which prevents DNA and ribonucleic acid (RNA) polymerase reactions and DNA heat inactivation; and they inhibit the LE cell phenomenon, antinuclear antibody reactions, and suppress lymphocyte transformation. By competing with calcium ion, they stabilize membranes and have an anesthetic effect. Their anti-inflammatory potential is due to their inhibition of hydrolytic enzymes, stabilization of lysosomes, interference with prostaglandin synthesis, blocking of chemotaxis, and antagonism of histamine responses. The antimalarials have no sunscreening properties. The most common toxic effects are cutaneous pigmentation, nausea, vomiting, diarrhea, mild ileus, and cycloplegia. There has been a reluctance to use chloroquine and hydroxychloroquine because of the possibility of retinopathy. However, if the "safe" daily dose limit of chloroquine, 2 mg per pound of body weight, and of hydroxychloroquine, 3.5 mg per pound of body weight, is followed, the chance of retinopathy is slight. Quinacrine does not cause retinopathy, but it has more cutaneous side effects than the other two agents.
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ABSTRACT: There are a multitude of diseases that commonly affect both the skin and the eye. Part II of this 2-part series reviews the oculocutaneous manifestations of neoplasms, both benign and malignant, and adverse drug reactions affecting the skin and the eye. Though rare, a number of neoplasms that primarily involve the skin, such as melanoma and basal cell carcinoma, can metastasize to the eye, leading to permanent damage if not properly treated. In addition, periocular neoplasms can irritate the conjunctiva and lid, reducing a patient's ability to see clearly. Neoplastic diseases, such as xeroderma pigmentosum, Sturge-Weber syndrome, and multiple myeloma, can also lead to permanent changes in the eye if not discovered and managed promptly. Furthermore, there are a multitude of drugs, including those commonly used by dermatologists, which can result in permanent damage to the eye. With proper knowledge of the ocular manifestations and treatment recommendations described in this 2-part series, dermatologists with the assistance of their ophthalmology colleagues can help avoid the complications, including permanent blindness, associated with infectious, inflammatory, genetic, neoplastic, and drug-related conditions.Journal of the American Academy of Dermatology 05/2014; 70(5):821.e1-821.e19. · 5.00 Impact Factor
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ABSTRACT: Hydroxychloroquine may result in cutaneous dyschromia. Older individuals who are the victims of elder abuse can present with bruising and resolving ecchymoses. The features of hydroxychloroquine-associated hyperpigmentation are described, the mucosal and skin manifestations of elder abuse are reviewed, and the mucocutaneous mimickers of elder abuse are summarized. An elderly woman being treated with hydroxychloroquine for systemic lupus erythematosus developed drug-associated black and blue pigmentation of her skin. The dyschromia was misinterpreted by her clinician as elder abuse and Adult Protective Services was notified. The family was eventually cleared of suspected elder abuse. A skin biopsy of the patient's dyschromia confirmed the diagnosis of hydroxychloroquine-associated hyperpigmentation. Hyperpigmentation of skin, mucosa, and nails can be observed in patients treated with antimalarials, including hydroxychloroquine. Elder abuse is a significant and underreported problem in seniors. Cutaneous findings can aid in the discovery of physical abuse, sexual abuse, and self-neglect in elderly individuals. However, medication-associated effects, systemic conditions, and accidental external injuries can mimic elder abuse. Therefore, a complete medical history and appropriate laboratory evaluation, including skin biopsy, should be conducted when the diagnosis of elder abuse is suspected.Dermatology and therapy. 08/2013;
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ABSTRACT: The evaluation and treatment of skin disease in patients of color has long presented a challenge to many dermatologists. From deep pigmentation masking erythema to a predilection for pilar structures, skin disease in African-Americans has many distinguishing factors that may not be observed in other populations. Most dermatologists have little formal training in examining skin of various levels of pigmentation, so it is necessary to identify common presentations of disease in this population. Pigment lability is a common concern among patients of deeply pigmented skin, and it is necessary to understand what is known about therapeutic options for dyschromia. Follicular prominence, granulomatous, and fibromatous changes are common presentations of disease in this population where differential diagnosis must be broadened to ensure correct diagnosis and effective treatment. For all these disorders there are options for treatment that should be enumerated to patients along with potential side effects of treatment. The goal of improving understanding of cutaneous disease in patients of color is to dispel myths that cultural impact is the primary variable causing reaction patterns in African-Americans and to report on the findings of skin disease in this group, which represents an intermixed population. As dermatologists broaden their view of potential disease presentation, patient satisfaction, treatment choices, and, potentially, access to care will be improved. This monograph provides an overview of the ultrastructure of the pigmentation system at the cellular level and what is understood about the role the pigmentation system may play in living patients in response to sun exposure, irritants, allergens, and trauma. Normal variants of skin seen in patients of color are described and what is known about the epidemiology of these normal states is reported. Diagnosis, treatment, and the psychosocial impact of vitiligo is reported as a representative disease of dyschromia. Pseudofolliculitis barbae is discussed as a prototypic disorder of the pilar apparatus and the approach to treatment is discussed. Special attention is given to children with the disorders discussed, and the need to amend therapy to fit a younger patient is explored. Finally, skin cancer in African-American patients is discussed. Reports of predisposing variables to the various forms of skin cancers including basal cell, squamous cell, Bowen's disease and melanoma are discussed. Pigmentation may play a role in protection but is clearly not the only factor protecting against the development of cutaneous malignancy. What is known about incidence, mortality, and response to treatment for cutaneous basal cell, squamous cell, Bowen's disease, and melanoma are discussed.Current Problems in Dermatology 05/1998; 10(3).