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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hydroxychloroquine induced melanosis&#46; Hydroxychloroquine induced melanosis of the nails of the hands &#40;Panel A&#41;&#44; the scapha and triangular fossa of the ears &#40;Panel B&#41; and the tongue &#40;Panel C&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 29-year-old Brazilian woman with a previous diagnosis of Systemic Lupus Erythematosus with articular&#44; cutaneous&#44; serous and hematological involvement who immigrated to Portugal 7 months prior presented to our rheumatology department for continuation of care&#46; She was chronically medicated with hydroxychloroquine 400<span class="elsevierStyleHsp" style=""></span>mg for the past 10 years as well as prednisolone 10<span class="elsevierStyleHsp" style=""></span>mg and levothyroxine 88<span class="elsevierStyleHsp" style=""></span>mcg&#46; The objective examination showed hyperpigmentation of the nails of the hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> &#8211; Panel A&#41;&#44; the scapha and triangular fossa of the ears &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> &#8211; Panel B&#41; and the tongue &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> &#8211; Panel C&#41; that was suggestive of hydroxychloroquine induced hyperpigmentation&#46; Other causes of pigmentary changes such as endocrine or metabolic disorders as well as other drug-induced pigmentation were excluded&#46; An ophthalmologic evaluation with OCT was performed and retinopathy was excluded&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Hydroxychloroquine induced hyperpigmentation is an underreported adverse event that may appear in about 10&#8211;25&#37; of the patients after long-term use&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a> It appears mainly on the anterior side of the legs but can also affect other less reported areas such as the nail bed&#44; head&#44; and mucosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> The pathogenesis of this adverse event is poorly understood&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> It is important to consider that hydroxychloroquine induced hyperpigmentation may mimic other pigmented conditions&#44; namely melasma&#44; Addison&#39;s disease&#44; hemochromatosis&#44; Wilson&#39;s disease and vitamins deficiencies&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> It usually improves after drug discontinuation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0015" class="elsevierStylePara elsevierViewall">Informed consent has been obtained from the patient&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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