key: cord-0980971-fdd95wnk authors: Kutlu, Omer; Özdemir Çetinkaya, Pınar; Aktaş, Habibullah; Metin, Ahmet title: Generalized exanthema due to hydroxychloroquine as a popular drug during COVID‐19 prophylaxis date: 2020-10-28 journal: Int J Clin Pract DOI: 10.1111/ijcp.13793 sha: 4f72d040009d90ee0e1c0110ac4d02d7dbc6f8d5 doc_id: 980971 cord_uid: fdd95wnk Hydroxychloroquine (HCQ) is a drug that is used for both chemoprophylaxis and treatment of COVID‐19. At the moment, HCQ maintain its popularity and tens of thousands of people across the world are still receiving the current drug.(1)After the COVID‐19 pandemic, several cutaneous side effects of HCQ are reported.(2‐7) Herein, we reported generalized exanthema after a single dose of using HCQ. A 58‐year‐old male patient presented with resistant rashes on his upper extremities and neck region. Rashes appeared all over the body along with severe pruritus just a day after receiving a single 200 mg dose of oral hydroxychloroquine for COVID‐19 prophylaxis. prophylaxis Hydroxychloroquine (HCQ) is a drug that is used for both chemoprophylaxis and treatment of COVID-19. At the moment, HCQ maintain its popularity and tens of thousands of people across the world are still receiving the current drug. 1 After the COVID-19 pandemic, several cutaneous side effects of HCQ are reported. [2] [3] [4] [5] [6] [7] Herein, we reported generalized exanthema after a single dose of using HCQ. A 58-year-old male patient presented with resistant rashes on his upper extremities and neck region. Rashes appeared all over the body along with severe pruritus just a day after receiving a single 200 mg dose of oral hydroxychloroquine for COVID-19 prophylaxis. The patient had started hydroxychloroquine without any recommendation. He was also receiving pramipexole for restless legs syndrome for 3 years. He presented to our dermatology outpatient clinic 10 days after the beginning of the rashes. When he presented to our clinic, the rashes have begun to disappear except on the neck and arms. Also, there was still mild pruritus in his body. There was no other new drug, over-the-counter drug, nutrient, food supplement, past or active infection history to explain the rash. With these clinical findings, diagnosis of hydroxychloroquine associated generalized exanthema was made. Due to its characteristic features, we did not perform This article is protected by copyright. All rights reserved a histopathologic examination. We searched published articles in PubMed about cutaneous side effects of HCQ during the COVID-19 pandemic between January 1, and July 1, 2020. These side effects can be listed as acute generalized exanthematous pustulosis, urticaria, palmoplantar itching, erythema multiforme, drug reaction with eosinophilia and systemic symptoms, and exacerbation of psoriasis (Table 1) . [2] [3] [4] [5] [6] [7] As we know there is a dilemma for cutaneous reactions in patients with COVID-19. It is difficult to differentiate whether they appear due to the infection itself or due to the drugs used in the treatment. In this regard we divided articles which were mentioned above into three categories according to the indications in order to analyse HCQ reactions in COVID-19 pandemic as follows: "HCQ use for COVID-19 infection", "HCQ use for COVID-19 prophylaxis", and "HCQ use for diseases unrelated to the COVID-19". The duration of treatment and doses of HCQ is different according to the indications. These differences may give some clues for dilemmas of cutaneous reactions although onset of cutaneous manifestations of COVID-19 are not known exactly. In this context, acute generalized exanthematous pustulosis as in cases 7 and 9 approximately appeared at the same time which may suggest that case 9 was more compatible with a drug reaction rather than a manifestation of COVID-19 (Table 1) . 5, 7 The group of "HCQ use for diseases unrelated to the COVID-19" may show that cutaneous reactions such as AGEP, DRESS, and erythema multiforme may appear with long term HCQ use. On the other hand, "HCQ use for COVID-19 prophylaxis" group shows that even low and single doses of HCQ may lead to cutaneous side effects such as urticaria and pruritus. In this report, we firstly describe a generalized exanthema after using a single low-dose of HCQ during the COVID-19 pandemic. Although the patient had no risk factors for COVID-19, he started 200 mg HCQ per week for 3 weeks on his own. This situation shows the possible effects of unnecessary drug use during the COVID-19 pandemic. Given the anticipated widespread use of HCQ we believe that reviewing cutaneous side effects of the HCQ during the COVID-19 pandemic is important especially for consultations of COVID-19 patients. The authors declare that there are no conflicts of interest regarding the publication of this paper. The data that support the findings of this study are available on re-  able due to privacy or ethical restrictions. The data that support the findings of this study are available on re-  able due to privacy or ethical restrictions. The data of this case are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. This article is protected by copyright. All rights reserved A case of exacerbation of psoriasis after oseltamivir and hydroxychloroquine in a patient with COVID-19: Will cases of psoriasis increase after COVID-19 pandemic? Dermatol Ther Cutaneous side effects of hydroxychloroquine in health care workers in a COVID referral hospital-implications for clinical practice Drug reaction with eosinophilia and systemic symptoms syndrome to hydroxychloroquine, an old drug in the spotlight in the COVID-19 era Ixekizumab for treatment of refractory acute generalized exanthematous pustulosis caused by hydroxychloroquine Hydroxychloroquine-induced erythema multiforme Acute generalized exanthematous pustulosis after COVID-19 treatment with hydroxychloroquine This article is protected by copyright. All rights reserved