Case for Diagnosis
Hypopigmentation of the Eyelashes
Hipopigmentación de las pestañas
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In October 2009 the daily dose of chloroquine was increased to 500<span class="elsevierStyleHsp" style=""></span>mg due to poor control of the symptoms of the underlying disease. The patient came to the outpatient clinic for hypopigmentation of the eyelashes present since February 2010.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient had chestnut hair and skin phototype II but presented white eyelashes on the upper and lower eyelids of both eyes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No hypopigmentation of the scalp hair was observed due to the use of hair dye, or of terminal hair on other parts of the body at the time of examination. Examination of the remaining skin surface revealed no associated hypopigmented macules.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Light microscope examination of the hair showed an almost complete absence of melanin granules. Depigmentation affected the entire length of some eyelashes and only the distal portion of others, with a progressive increase in the number of granules to almost normal levels in the proximal portions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The blood count, biochemistry, and autoimmunity studies showed results typical of the underlying rheumatoid arthritis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Chloroquine-induced depigmentation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical suspicion of hypopigmentation due to the use of high doses of chloroquine prompted a change in treatment to leflunomide 10 mg/d with the prednisone maintained at the previous dosage.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Chloroquine induced hypopigmentation was first described in 1948<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but only 50 new cases have been published since.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In most of those cases the patients had received high doses of chloroquine (between 300 and 400 mg/d) and presented hypopigmentation with a preference for the eyebrows, eyelashes, moustache, and body hair.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Hypopigmentation was more common in patients with light hair than dark hair.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Most of the published cases show that depigmentation is reversible on interruption of treatment with chloroquine, dose reduction, or even substitution of chloroquine by hydroxychloroquine.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The mechanism of action of chloroquine-induced depigmentation is not fully understood. Chloroquine-melanin interaction allows us to suggest that this drug may interfere with melanogenesis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The condition shows a preference for tissues rich in melanin, which is found in highest concentrations in the skin and eyes. In chloroquine-induced retinopathy there is irreversible fixation of the drug to the pigmentary epithelium, but the process is reversible over time in the skin as the chloroquine deposited in the melanocytes transfers to the keratinocytes and is later eliminated by desquamation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> As the drug builds up in pigmented epithelia, the accumulation of melanin in the melanosomes in the prolongations of the hair bulb is partially or completely inhibited. This indicates that chloroquine exerts a toxic effect on melanocytes that blocks melanin production.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Several authors have shown that chloroquine has a tendency to accumulate in the skin and that the amount of the drug detected is directly proportional to the dose administered and the duration of treatment. Depigmentation of fair or red hair is far more common than that of darker hair, suggesting the possibility of a greater interaction between chloroquine and pheomelanin than between chloroquine and eumelanin.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, chloroquine-induced hypopigmentation is similar to vitiligo, and although it is a rare collateral effect it represents one end of the spectrum of chloroquine-induced pigmentary disorders.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gómez-Vázquez M, et al. Hipopigmentación de las pestañas. Actas Dermosifiliogr.2011;102:463-464.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 614 "Ancho" => 818 "Tamanyo" => 82719 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 749 "Ancho" => 998 "Tamanyo" => 71389 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Studies on the chronic toxicity of chloroquine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.S. 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Nico" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0961203308097473" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "264" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19213866" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decrease in human hair color and feather pigment of fowl following chloroquine disphosfate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.S. Saunders" 1 => "T.B. Fitzpatrick" 2 => "M. Seiji" 3 => "P. Brunet" 4 => "E.E. Rosenbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "1965" "volumen" => "33" "paginaInicial" => "87" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14441964" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sequential concentration of choroquine in human hair correlates with ingested doses and duration of therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "U. Runne" 1 => "F.R. Ochsendorf" 2 => "K. Schmidt" 3 => "H.W. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 8 | 20 |
| 2024 Octubre | 95 | 71 | 166 |
| 2024 Septiembre | 121 | 64 | 185 |
| 2024 Agosto | 150 | 102 | 252 |
| 2024 Julio | 128 | 56 | 184 |
| 2024 Junio | 116 | 53 | 169 |
| 2024 Mayo | 115 | 36 | 151 |
| 2024 Abril | 89 | 39 | 128 |
| 2024 Marzo | 93 | 36 | 129 |
| 2024 Febrero | 99 | 38 | 137 |
| 2024 Enero | 85 | 40 | 125 |
| 2023 Diciembre | 86 | 23 | 109 |
| 2023 Noviembre | 97 | 33 | 130 |
| 2023 Octubre | 81 | 49 | 130 |
| 2023 Septiembre | 91 | 53 | 144 |
| 2023 Agosto | 71 | 22 | 93 |
| 2023 Julio | 103 | 42 | 145 |
| 2023 Junio | 78 | 25 | 103 |
| 2023 Mayo | 116 | 27 | 143 |
| 2023 Abril | 91 | 28 | 119 |
| 2023 Marzo | 80 | 42 | 122 |
| 2023 Febrero | 82 | 21 | 103 |
| 2023 Enero | 60 | 47 | 107 |
| 2022 Diciembre | 65 | 42 | 107 |
| 2022 Noviembre | 43 | 26 | 69 |
| 2022 Octubre | 44 | 26 | 70 |
| 2022 Septiembre | 53 | 45 | 98 |
| 2022 Agosto | 58 | 31 | 89 |
| 2022 Julio | 34 | 53 | 87 |
| 2022 Junio | 31 | 31 | 62 |
| 2022 Mayo | 49 | 35 | 84 |
| 2022 Abril | 73 | 35 | 108 |
| 2022 Marzo | 70 | 49 | 119 |
| 2022 Febrero | 60 | 23 | 83 |
| 2022 Enero | 73 | 37 | 110 |
| 2021 Diciembre | 57 | 47 | 104 |
| 2021 Noviembre | 51 | 42 | 93 |
| 2021 Octubre | 66 | 46 | 112 |
| 2021 Septiembre | 44 | 34 | 78 |
| 2021 Agosto | 68 | 27 | 95 |
| 2021 Julio | 57 | 23 | 80 |
| 2021 Junio | 56 | 29 | 85 |
| 2021 Mayo | 56 | 41 | 97 |
| 2021 Abril | 112 | 59 | 171 |
| 2021 Marzo | 105 | 23 | 128 |
| 2021 Febrero | 110 | 23 | 133 |
| 2021 Enero | 52 | 18 | 70 |
| 2020 Diciembre | 44 | 25 | 69 |
| 2020 Noviembre | 44 | 14 | 58 |
| 2020 Octubre | 52 | 13 | 65 |
| 2020 Septiembre | 54 | 13 | 67 |
| 2020 Agosto | 37 | 17 | 54 |
| 2020 Julio | 27 | 14 | 41 |
| 2020 Junio | 37 | 31 | 68 |
| 2020 Mayo | 35 | 17 | 52 |
| 2020 Abril | 37 | 18 | 55 |
| 2020 Marzo | 32 | 33 | 65 |
| 2020 Febrero | 5 | 2 | 7 |
| 2020 Enero | 3 | 5 | 8 |
| 2019 Diciembre | 8 | 8 | 16 |
| 2019 Noviembre | 4 | 4 | 8 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 5 | 9 |
| 2019 Agosto | 3 | 1 | 4 |
| 2019 Julio | 4 | 1 | 5 |
| 2019 Junio | 6 | 34 | 40 |
| 2019 Mayo | 7 | 27 | 34 |
| 2019 Abril | 3 | 2 | 5 |
| 2019 Marzo | 6 | 12 | 18 |
| 2019 Febrero | 0 | 1 | 1 |
| 2019 Enero | 7 | 0 | 7 |
| 2018 Diciembre | 1 | 2 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 3 | 6 |
| 2018 Septiembre | 5 | 6 | 11 |
| 2018 Agosto | 0 | 18 | 18 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 15 | 15 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 3 | 16 | 19 |
| 2018 Febrero | 34 | 6 | 40 |
| 2018 Enero | 62 | 7 | 69 |
| 2017 Diciembre | 66 | 17 | 83 |
| 2017 Noviembre | 55 | 11 | 66 |
| 2017 Octubre | 42 | 8 | 50 |
| 2017 Septiembre | 66 | 16 | 82 |
| 2017 Agosto | 80 | 15 | 95 |
| 2017 Julio | 50 | 9 | 59 |
| 2017 Junio | 49 | 21 | 70 |
| 2017 Mayo | 43 | 22 | 65 |
| 2017 Abril | 41 | 17 | 58 |
| 2017 Marzo | 41 | 22 | 63 |
| 2017 Febrero | 28 | 12 | 40 |
| 2017 Enero | 34 | 23 | 57 |
| 2016 Diciembre | 43 | 17 | 60 |
| 2016 Noviembre | 59 | 16 | 75 |
| 2016 Octubre | 78 | 21 | 99 |
| 2016 Septiembre | 71 | 12 | 83 |
| 2016 Agosto | 71 | 12 | 83 |
| 2016 Julio | 38 | 3 | 41 |
| 2016 Junio | 9 | 10 | 19 |
| 2016 Mayo | 8 | 36 | 44 |
| 2016 Abril | 6 | 14 | 20 |
| 2016 Marzo | 7 | 19 | 26 |
| 2016 Febrero | 5 | 19 | 24 |
| 2016 Enero | 6 | 19 | 25 |
| 2015 Diciembre | 10 | 16 | 26 |
| 2015 Noviembre | 6 | 10 | 16 |
| 2015 Octubre | 12 | 6 | 18 |
| 2015 Septiembre | 8 | 5 | 13 |
| 2015 Agosto | 14 | 7 | 21 |
| 2015 Julio | 50 | 11 | 61 |
| 2015 Junio | 45 | 28 | 73 |
| 2015 Mayo | 73 | 15 | 88 |
| 2015 Abril | 61 | 10 | 71 |
| 2015 Marzo | 37 | 13 | 50 |
| 2015 Febrero | 39 | 9 | 48 |
| 2015 Enero | 42 | 17 | 59 |
| 2014 Diciembre | 50 | 10 | 60 |
| 2014 Noviembre | 32 | 17 | 49 |
| 2014 Octubre | 57 | 14 | 71 |
| 2014 Septiembre | 38 | 13 | 51 |
| 2014 Agosto | 54 | 11 | 65 |
| 2014 Julio | 65 | 18 | 83 |
| 2014 Junio | 79 | 13 | 92 |
| 2014 Mayo | 95 | 16 | 111 |
| 2014 Abril | 71 | 14 | 85 |
| 2014 Marzo | 76 | 21 | 97 |
| 2014 Febrero | 59 | 21 | 80 |
| 2014 Enero | 65 | 21 | 86 |
| 2013 Diciembre | 57 | 15 | 72 |
| 2013 Noviembre | 49 | 20 | 69 |
| 2013 Octubre | 47 | 14 | 61 |
| 2013 Septiembre | 46 | 14 | 60 |
| 2013 Agosto | 42 | 12 | 54 |
| 2013 Julio | 58 | 29 | 87 |
| 2013 Junio | 13 | 8 | 21 |
| 2013 Mayo | 14 | 3 | 17 |
| 2013 Abril | 11 | 14 | 25 |
| 2013 Marzo | 18 | 8 | 26 |
| 2013 Febrero | 34 | 14 | 48 |
| 2013 Enero | 21 | 2 | 23 |
| 2012 Diciembre | 11 | 4 | 15 |
| 2012 Noviembre | 0 | 1 | 1 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Agosto | 0 | 1 | 1 |
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