Frequency and clinical characteristics of hydroxychloroquine-induced pigmentation in Japanese paediatric patients: a retrospective cohort study.

Authors

Reiko Yatabe, Keiji Akamine, Shogo Akahoshi, Satoru Mizumoto, Naoki Kimura, Naoaki Mikami, Riku Hamada

Published in

Rheumatology international. Volume 46. Issue 7. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

To investigate the frequency and characteristics of HCQ-induced pigmentation in Japanese paediatric patients. This retrospective cohort study enrolled Japanese children who received HCQ for ≥ 3 months. Data were collected from medical records, caregiver or patient questionnaires on awareness of pigmentation, and physical examination findings. The primary outcome was the frequency of HCQ-induced pigmentation. Twenty-six patients were included. Of these, 25 (96.2%) were female (median age: 15 years; first to third quartiles [Q1-Q3]: 12.0-16.8). Eleven patients had pigmentation (42.3%). Kaplan-Meier analysis demonstrated that the median time to the onset of pigmentation was 42 months (95% confidence interval: 30-not reached), and no new cases occurred after 48 months. The median observation period in the pigmentation and non-pigmentation group was 46 months (Q1-Q3: 27-51) and 24 months (Q1-Q3: 6-54), respectively. The cumulative HCQ dose per body weight was 4.0 g/kg (Q1-Q3: 2.7-5.4) in the pigmentation group and 3.0 g/kg (Q1-Q3: 0.6-5.5) in the non-pigmentation group. The Fitzpatrick skin types in the pigmentation group vs. non-pigmentation group were: type II (18.2% vs. 60%), type III (36.4% vs. 20%), type IV (36.4% vs. 20%), and type V (9.1% vs. 0%). Six of the 11 patients with pigmentation discontinued HCQ, as a result of which three experienced improvement in their pigmentation. All the improvements were noticeable within 2-6 months after discontinuing the therapy. HCQ-induced pigmentation may not be a rare adverse effect in children. Although the pigmentation may improve after discontinuing HCQ, treatment continuation or discontinuation should be carefully considered according to the activity of the underlying disease.

PMID:
42400606
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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