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Review
. 2025 Mar;26(2):251-264.
doi: 10.1007/s40257-025-00919-x. Epub 2025 Feb 3.

Safety of Hydroxychloroquine: What a Dermatologist Should Know

Luca Rapparini #  1   2 , Stephano Cedirian #  3   4 , Michelangelo La Placa  1   2 , Bianca Maria Piraccini  1   2 , Emanuel Raschi #  5 , Michela Starace #  1   2
Affiliations
Review

Safety of Hydroxychloroquine: What a Dermatologist Should Know

Luca Rapparini et al. Am J Clin Dermatol. 2025 Mar.

Abstract

The unique immunomodulatory properties of hydroxychloroquine (HCQ) have attracted considerable interest beyond its use for malaria and rheumatological diseases, including a variety of dermatological conditions. Over recent years, especially after the coronavirus disease 2019 (COVID-19) pandemic, the prescription of HCQ has also significantly expanded, sometimes inappropriately, thus posing additional challenges on its optimal use, due to emerging safety issues. In this review, we provide dermatologists with the latest advancements on selected clinically relevant toxicities, namely retinopathy, pro-arrhythmia, cutaneous reactions, and neuropsychiatric effects. It is hoped this update can assist dermatologists to identify high-risk patients for tailored monitoring, screening, and risk minimization strategies, thus supporting safer HCQ prescribing.

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Conflict of interest statement

Declarations. Funding: Open access funding provided by Alma Mater Studiorum - Università di Bologna within the CRUI-CARE Agreement. Authors' Contributions: All authors participated equally in the drafting of the manuscript. All authors read and approved the final paper. Conflict of Interest: All authors have no relevant financial or non-financial interests to disclose. Ethics Approval; Patient Consent: Not applicable. Code Availability: Not applicable. Data availability: Not applicable.

Figures

Fig. 1
Fig. 1
The concept of reduced repolarization reserve caused by a synergy among clinical risk factors, and leading to TdP. COVID-19 coronavirus disease 2019, CYP cytochrome P450, ECG electrocardiography, hERG human ether-a-go-go–related gene channel, LQTS long QT syndrome, P-gp P-glycoprotein, TdP torsade de pointes
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