Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlandia, Uberlândia, Minas Gerais, Brazil,Department of Restorative Dentistry, Endodontics Division, School of Dentistry of Piracicaba, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil,Division of Pathology, School of Dentistry, Federal University of Uberlandia, Uberlândia, Minas Gerais, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil,Department of Dentistry, Faculdade São Leopoldo Mandic, Centro de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil,University of Saskatchewan, College of Dentistry, Saskatoon, SK, Canada,Division of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlandia, Uberlândia, Minas Gerais, Brazil.
Medicine (Baltimore). 2022 Mar 18;101(11). doi: 10.1097/MD.0000000000029044.
Chloroquine and hydroxychloroquine are 2 medications used to treat some systemic diseases.
The aim of this scoping review was to assess the occurrence of oral pigmentation induced by chloroquine or hydroxychloroquine and to understand the pathogenic mechanism behind this phenomenon.
The review was performed according to the list of PRISMA SrC recommendations and the JBI Manual for Evidence Synthesis for Scoping Reviews. MEDLINE (PubMed), Scopus, EMBASE, SciELO, Web of Science, Lilacs, and LIVIVO were primary sources, and "gray literature" was searched in OpenThesis and Open Access Thesis and Dissertations (OATD). Studies that screened the occurrence of oral pigmentation associated to the use of chloroquine or hydroxychloroquine were considered eligible. No restrictions of year and language of publication were applied. Study selection and data extraction were performed by 2 independent reviewers. The risk of bias was assessed through the JBI tool, depending on the design of the selected studies.
The initial search resulted in 2238 studies, of which 19 were eligible. Sixteen studies were case reports, 2 had case-control design and 1 was cross-sectional. Throughout the studies, 44 cases of oral pigmentation were reported. The hard palate was the anatomic region most affected with pigmentation (66%). According to the case reports, most of the lesions (44%) were bluish-gray. The minimum time from the beginning of treatment (chloroquine or hydroxychloroquine) to the occurrence of pigmentation was 6 months. The mean treatment time with the medications was 4.9 years, and the mean drug dosage was 244 mg. Most of the studies (63.1%) had low risk of bias (high methodological quality).
The outcomes of this study suggest that hyperpigmentation depend on drug dosage and treatment length. Hyperpigmentation was detected after a long period of treatment with chloroquine or hydroxychloroquine.
氯喹和羟氯喹是两种用于治疗某些系统性疾病的药物。
本范围综述的目的是评估氯喹或羟氯喹引起的口腔色素沉着的发生，并了解这种现象的发病机制。
本综述按照 PRISMA SrC 建议清单和 JBI 循证合成手册进行。MEDLINE（PubMed）、Scopus、EMBASE、SciELO、Web of Science、Lilacs 和 LIVIVO 是主要来源，并在 OpenThesis 和 Open Access Thesis and Dissertations (OATD) 中搜索“灰色文献”。筛选与氯喹或羟氯喹使用相关的口腔色素沉着发生情况的研究被认为是合格的。未对发表年份和语言进行限制。由 2 名独立审查员进行研究选择和数据提取。根据所选研究的设计，使用 JBI 工具评估偏倚风险。
最初的搜索产生了 2238 项研究，其中有 19 项符合条件。16 项研究为病例报告，2 项为病例对照设计，1 项为横断面研究。在所有研究中，共报告了 44 例口腔色素沉着病例。硬腭是受色素沉着影响最大的解剖区域（66%）。根据病例报告，大多数病变（44%）呈蓝灰色。从开始治疗（氯喹或羟氯喹）到出现色素沉着的最短时间为 6 个月。药物治疗的平均时间为 4.9 年，平均药物剂量为 244mg。大多数研究（63.1%）的偏倚风险较低（方法质量较高）。
本研究的结果表明，色素沉着取决于药物剂量和治疗时间。在氯喹或羟氯喹治疗很长一段时间后才发现色素沉着。
