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Hydroxychloroquine Toxicity — SCE Dermatology MCQ

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HardDermatopharmacologyHydroxychloroquine ToxicitySCE Dermatology

A 44-year-old woman on long-term Hydroxychloroquine for cutaneous lupus develops bilateral visual field constriction. OCT shows parafoveal thinning of the outer reticular layer with disruption of the ellipsoid zone (bull's eye maculopathy). What is the maximum recommended daily dose of Hydroxychloroquine to minimise retinal toxicity?

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Correct answer: C — 5.0 mg/kg actual body weight per day

The Royal College of Ophthalmologists 2020 updated guidelines recommend a maximum daily dose of Hydroxychloroquine not exceeding 5.0 mg/kg of ACTUAL body weight (changed from the previous 6.5 mg/kg ideal body weight). This change reflects emerging evidence that retinal toxicity risk is dose-dependent and more closely related to actual body weight. Annual retinal screening with OCT and visual field testing is recommended from 5 years of use (or from initiation if additional risk factors exist). Bull's eye maculopathy is often irreversible once established.

Reference: RCOph 2020 HCQ Retinopathy Screening; BAD 2016 Lupus Guidelines