Eye

Quinacrine has no retinal toxicity. Skin

The skin may acquire a yellow stain from deposition of the drug in at least a third of the patients; according to others, it constantly discolors the skin (Leigh et al. 1979). The conjunctiva is also affected and resembles jaundice. However, plasma levels of bilirubin are normal. Also, hyperpigmentation and blue or black pigmentation the skin ("black and blue marks") and of the nails may occur. These marks consist of membrane-bound intracellular granules of quinacrine that contain large amounts of iron and some sulphur (Leigh et al. 1979). Discoloration was estimated to occur in about every second patient (Wallace 1989). The pigment may reduce its intensity or even disappear after a decrease in the daily dose of more than 50 mg. It resolves with drug withdrawal.

Rashes were reported in 1.6% of persons treated for malaria prophylaxis. Eighty percent were eczematous and 20% were lichenoid or exfoliative (Bauer 1981). The dermatitis resolved after discontinuation of the drug. In SLE, ca. 5% of patients developed a mild, reversible dermatitis with 25 to 100mg/day of quinacrine. The incidence of lichenoid dermatitis was 1:2,000 with 100mg/day and 1:500 with 200 mg/day.This dermatitis was followed by anhydrosis, cutaneous atrophy, alopecia, nail changes, altered pigmentation, and keratoderma (Bauer 1981).Even years later, lichenoid nodules, scaly red plaques, atrophic lesions on the soles, erosions, and leukoplakia of the tongue and fungating warty growths appeared. Progression to squamous cell carcinoma, especially on the palm, had occurred in several cases (Callaway 1979). Urticaria and exfoliative dermatitis, especially in patients with psoriasis, were reported in single cases.

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