• Pedro Urquiza Jayme Silva, Millena Barroso Oliveira, Walbert Vieira, Sérgio Vitorino Cardoso, Cauane Blumenberg, Ademir Franco, Walter Luiz Siqueira, and Luiz Renato Paranhos.
• Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlandia, Uberlândia, Minas Gerais, Brazil,Department of Restorative Dentistry, Endodontics Division, School of Dentistry of Piracicaba, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil,Division of Pathology, School of Dentistry, Federal University of Uberlandia, Uberlândia, Minas Gerais, Brazil,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil,Department of Dentistry, Faculdade São Leopoldo Mandic, Centro de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil,University of Saskatchewan, College of Dentistry, Saskatoon, SK, Canada,Division of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlandia, Uberlândia, Minas Gerais, Brazil.
• Medicine (Baltimore). 2022 Mar 18; 101 (11).

BackgroundChloroquine and hydroxychloroquine are 2 medications used to treat some systemic diseases.ObjectiveThe aim of this scoping review was to assess the occurrence of oral pigmentation induced by chloroquine or hydroxychloroquine and to understand the pathogenic mechanism behind this phenomenon.MethodsThe review was performed according to the list of PRISMA SrC recommendations and the JBI Manual for Evidence Synthesis for Scoping Reviews. MEDLINE (PubMed), Scopus, EMBASE, SciELO, Web of Science, Lilacs, and LIVIVO were primary sources, and "gray literature" was searched in OpenThesis and Open Access Thesis and Dissertations (OATD). Studies that screened the occurrence of oral pigmentation associated to the use of chloroquine or hydroxychloroquine were considered eligible. No restrictions of year and language of publication were applied. Study selection and data extraction were performed by 2 independent reviewers. The risk of bias was assessed through the JBI tool, depending on the design of the selected studies.ResultsThe initial search resulted in 2238 studies, of which 19 were eligible. Sixteen studies were case reports, 2 had case-control design and 1 was cross-sectional. Throughout the studies, 44 cases of oral pigmentation were reported. The hard palate was the anatomic region most affected with pigmentation (66%). According to the case reports, most of the lesions (44%) were bluish-gray. The minimum time from the beginning of treatment (chloroquine or hydroxychloroquine) to the occurrence of pigmentation was 6 months. The mean treatment time with the medications was 4.9 years, and the mean drug dosage was 244 mg. Most of the studies (63.1%) had low risk of bias (high methodological quality).ConclusionsThe outcomes of this study suggest that hyperpigmentation depend on drug dosage and treatment length. Hyperpigmentation was detected after a long period of treatment with chloroquine or hydroxychloroquine.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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