Article

Antimalarials

Journal of the American Academy of Dermatology (Impact Factor: 5). 07/1981; 4(6):650-5. DOI: 10.1016/S0190-9622(81)70065-3
Source: PubMed

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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    • "Hydroxychloroquine is an antimalarial medication that can cause hyperpigmentation of nails, mucosa, and skin [1–5]. Retrospective studies cite the incidence of drug-related hyperpigmentation from hydroxychloroquine to be as high as 33% of individuals [6]. "
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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.
    08/2013; 3(2). DOI:10.1007/s13555-013-0032-z
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    ABSTRACT: From 963 to the present, many reviews of antimalarials for use in dermatology have mentioned the special sensitivity of children to these drugs. Fatal reactions have been limited to accidental or intentional overdosage and two instances of IM injection. While 1 gm of chloroquine can produce fatal reaction in very young children, analysis of published and unpublished cases show that adults exhibit a similar sensitivity when compared on a mg/kg basis. This information should encourage a physician to use antimalarials where appropriate, but special precaution should be taken to prevent poisoning.
    Pediatric Dermatology 06/1983; 1(1):89 - 91. DOI:10.1111/j.1525-1470.1983.tb01097.x · 1.52 Impact Factor
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    [Show abstract] [Hide abstract]
    ABSTRACT: From 1963 to the present, many reviews of antimalarials for use in dermatology have mentioned the special sensitivity of children to these drugs. Fatal reactions have been limited to accidental or intentional overdosage and two instances of IM injection. While 1 gm of chloroquine can produce fatal reaction in very young children, analysis of published and unpublished cases show that adults exhibit a similar sensitivity when compared on a mg/kg basis. This information should encourage a physician to use antimalarials where appropriate, but special precaution should be taken to prevent poisoning.
    Pediatric Dermatology 08/1983; 1(1):89-91. · 1.52 Impact Factor
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