Scleroderma is an autoimmune disease affecting the connective tissue in multiple organs, including the skin, heart, kidneys, and gastrointestinal tract, due to excessive production of collagen, a connective tissue protein. Collagen, a key component important of scar tissue, can in excess lead to hardened and thickened tissue in organs and joints.
There is no cure for scleroderma, but available treatments can help to manage its symptoms and reduce its severity. For some scleroderma patients, medications used to treat malaria may be prescribed. These have been helpful in managing the symptoms of both systemic and localized scleroderma.
How anti-malarial medications work
The exact mechanism of action of anti-malarial medications is not fully understood, but it is known that they directly bind to a cell’s DNA. When cells duplicate, they make a complete copy their entire genome, before dividing into two new cells. Fast-growing cells – like immune cells – must copy their genome quickly and correctly. Anti-malarial medications are thought to interfere with this copying process, slowing cell division.
Types of anti-malarial treatments
There are several anti-malarial medications used to treat scleroderma. All are structurally similar to the first anti-malarial treatment, quinine (brand name Qualaquine), which is isolated from the bark of the cinchona tree. They include:
Hydroxychloroquine (Plaquenil) is the most common anti-malarial treatment for scleroderma. It is occasionally used in combination with quinacrine, when ineffective on its own. However, quinacrine (Atabrine) is not available in the U.S. or Canada.
Chloroquine (Aralen) is used less frequently, as it is more toxic to the eyes than hydroxychloroquine. However, for short periods of time, it is used to treat cases that do not respond to other anti-malarial medications.
Quinine is still sometimes used to treat chloroquine-resistant scleroderma.
Like other immunosuppressant medications, anti-malarial medications can make patients more susceptible to infections.
Side effects of anti-malarial medications can include headaches, dizziness, nausea, vomiting, stomach pain, weight loss, mood changes, skin rashes or itching, and temporary hair loss.
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