REVIEW - Plaquenil-induced retinopathy: a dermatologic perspective

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Am J Clin Dermatol. 2006;7(3):171-5.

Hydroxychloroquine-induced retinopathy: a dermatologic perspective.

Tripp JM, Maibach HI.

Department of Dermatology and Skin Sciences, University of British Columbia,

Vancouver, Canada.

Dermatologists use antimalarials to treat conditions such as cutaneous lupus

erythematosus. One potentially serious adverse effect of these agents is

irreversible maculopathy. Although there is some evidence that

hydroxychloroquine and chloroquine have similarly narrow therapeutic indices

with regard to retinal toxicity, the former is thought to be less damaging

to the retina and is thus more widely employed by dermatologists. The

current recommended maximal dose for hydroxychloroquine is 6.5 mg/kg/day,

with the weight in kilograms used for this calculation being the ideal

bodyweight rather than actual bodyweight. Ophthalmologic follow-up is an

important component of monitoring patients taking antimalarials.

Recommendations for follow-up frequency have varied, and we present the

recent guidelines from the American Academy of Ophthalmology. Despite dose

limitations and ophthalmologic monitoring, irreversible retinal damage can

occur. Among the reported cases, there does not seem to be any obvious

predictor of the development of maculopathy. The idiosyncratic nature of

this adverse effect may be related to interindividual differences in drug

metabolism. To understand why only some patients develop retinopathy, better

pharmacokinetic models need to be developed, and further elucidation of the

precise mechanism of retinal damage is required.

PMID: 16734504

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16734504

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