Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 3 2020 11 24 89 91 Mona Talaschian Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Anahita Sadeghi Digestive Diseases Research Institute, Shariati Hospital ,Tehran University of Medical Sciences, Tehran, Iran. Sara Pakzad Department of Medical-Surgical Nursing, School Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran. 2020 02 17 2020 04 02 Antimalarial agents, including chloroquine and hydroxychloroquine, have been used for the treatment of various rheumatoid diseases and skin diseases because of their anti-inflammatory and immune-modulating properties. Cutaneous adverse effects such as exacerbation of psoriasis, pruritus, and hyperpigmentation have been reported as side-effects of antimalarial drugs. In this case, we report a middle-aged man with a history of rheumatoid arthritis who was treated with non-steroidal anti-inflammatory drugs and hydroxychloroquine. He complained of hyperpigmentation of the face after one year of initiating the hydroxychloroquine. It was discontinued and methotrexate was started. Skin biopsy was confirmed drug reaction. After more than 10 years of follow up, his skin discoloration had not been improved. https://crcp.tums.ac.ir/index.php/crcp/article/view/342 https://crcp.tums.ac.ir/index.php/crcp/article/download/342/363