Department of Dermatology, University of California, Irvine, California.
Department of Dermatology, University of California, San Diego, La Jolla, California.
J Am Acad Dermatol. 2020 Aug;83(2):563-578. doi: 10.1016/j.jaad.2020.04.024. Epub 2020 Apr 11.
Hydroxychloroquine is associated with myriad adverse dermatologic effects, most of which are poorly characterized by the literature, with unknown frequencies and risk factors.
To conduct a systematic review of the adverse dermatologic effects and predisposing factors of hydroxychloroquine toxicity.
The review included 94 articles comprising 689 dermatologic adverse effects. A total of 21 unique dermatologic reactions were reported, most commonly drug eruption or rash (358 cases), cutaneous hyperpigmentation (116), pruritus (62), acute generalized exanthematous pustulosis (27), Stevens-Johnson syndrome or toxic epidermal necrolysis (26), hair loss (12), and stomatitis (11). Almost all underlying conditions were rheumatologic or autoimmune in nature, composed primarily of lupus erythematous (72% of all cases) and rheumatoid arthritis (14%). The range of reported mean cumulative dosages was wide, with some adverse reactions found after as little as 3 g or as much as 2500 g.
Dermatologic adverse events and primary diagnoses related to the use of hydroxychloroquine may be under-reported as only case reports and clinical trials that reported at least 1 dermatologic adverse effect were included.
Although hydroxychloroquine is generally well tolerated, dermatologic adverse effects involving the skin, hair, or nails are a frequent and significant complication. Most of these reactions occurred after treatment of autoimmune conditions, often manifesting on the skin after a wide range of cumulative dosages.
羟氯喹与众多不良皮肤效应相关，其中大多数在文献中描述得并不完善，其频率和风险因素未知。
对羟氯喹毒性的不良皮肤效应和易患因素进行系统回顾。
该综述纳入了 94 篇文章，共包含 689 例皮肤不良事件。共报告了 21 种独特的皮肤反应，最常见的是药物疹或皮疹（358 例）、皮肤色素沉着（116 例）、瘙痒（62 例）、急性泛发性发疹性脓疱病（27 例）、史蒂文斯-约翰逊综合征或中毒性表皮坏死松解症（26 例）、脱发（12 例）和口腔炎（11 例）。几乎所有的潜在疾病本质上都是风湿性或自身免疫性的，主要由红斑狼疮（所有病例的 72%）和类风湿性关节炎（14%）组成。报告的平均累积剂量范围很广，有些不良反应在累积剂量仅 3g 或多达 2500g 时就出现了。
与羟氯喹使用相关的皮肤不良事件和主要诊断可能报告不足，因为仅纳入了报告至少 1 种皮肤不良事件的病例报告和临床试验。
尽管羟氯喹通常具有良好的耐受性，但皮肤、毛发或指甲的皮肤不良效应是一种常见且严重的并发症。这些反应大多发生在治疗自身免疫性疾病之后，经常在累积剂量广泛的情况下在皮肤上表现出来。
