204 Adverse events associated with hydroxychloroquine use in cicatricial alopecia patients

Abstract

The anti-malarial hydroxychloroquine (HCQ) is a common treatment for cicatricial alopecias (CA). Serious adverse events include prolonged QT interval, ventricular arrythmias and irreversible retinopathy. There is limited literature on the incidence of adverse events in CA patients taking HCQ. A retrospective analysis was performed of 60 CA patients, mean age 60 years, prescribed HCQ. Alopecia diagnoses included lichen planopilaris, frontal fibrosing alopecia, discoid lupus, central centrifugal cicatricial alopecia and folliculitis decalvans. Average length of HCQ treatment was 2.98 years. Dosing ranged from 100 to 400 mg daily. 83.3% of patients did not experience an adverse event. Adverse events that occurred include GI distress (n=5), tinnitus or other hearing-related changes (n=2), and allergic skin rash (n=1). One patient developed non-sustained ventricular tachycardia (NSVT) 17 months after starting HCQ 400 mg daily. During her hospitalization, no structural cardiac abnormalities were revealed, and the cause of the NSVT was not determined. She was prescribed daily estradiol-norethindrone hormone replacement therapy (HRT) for several years prior to the NSVT. Her medical history was significant for congestive heart failure and remote history of pulmonary hypertension and left ventricular hypertrophy. The patient permanently discontinued both medications. She has not developed another NSVT episode and remains healthy. Within our cohort, there were no other cardiac related events despite some patients taking concomitant medications known to increase risk of QT prolongation. These patients were monitored with regular electrocardiograms. The risk of HCQ-associated retinopathy increases with > 5 years of cumulative use. No patients included in our analysis developed retinopathy, including the 6.67% taking HCQ for > 5 years. We demonstrate that while adverse events may occur during treatment, HCQ is generally well tolerated by CA patients. We hope this will help support treatment discussions with CA patients.