Hydroxychloroquine have been used commonly for the treatment of many skin diseases due to its anti-inflammation and immune-modulation. Hyperpigmentation may affect 10%-25% of patients taking antimalarials, and have yellow-brown to slate-gray maculopatches. We report a case of hydroxychloroquine- induced hyperpigmentation presenting in a 28-year-old woman. She was treated with hydroxychloroquine for systemic lupus erythematosus for 2 years. She presented with a mottled mild bluish-gray macular pigmentation involving the upper back and upper extremities. To our knowledge, this is a rare case of hydroxychloroquine-induced hyperpigmentation.