Oral mucosal hyperpigmentation

Lee, Karen; Lian, Christine G.; Vaidya, Anand; Tsibris, Hillary C.

doi:10.1016/j.jdcr.2020.08.013

Cited by 3 publications

(11 citation statements)

References 4 publications

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“…Biopsy of pigmented lesions in AD shows not only melanocytic infiltration of the basal epidermal layer and melanophages in the superficial dermis, but also acanthosis, perivascular lymphocytic infiltrate, and hyperkeratosis [ 25 ]. While the buccal area is the most affected by oral mucosal lesions, the pigmentation may also be located on the palatine arches, lips, gums, and tongue [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Methodsmentioning

confidence: 99%

“…Pigmented oral lesions vary from a patchy lesion (for instance, macular-like or nodular-like) to a diffuse colored area, underlying various histological types [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Different colors are described; the most frequent is dark brown or black [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The dark-blue tendency might be misinterpreted as cyanosis [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

“…The dark-blue tendency might be misinterpreted as cyanosis [ 34 ]. Many cases of oral hyperpigmentation are asymptomatic, but some are accompanied by local pain, itchiness, and burn-like lesions [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The combination of color, localization, and surface arrangement represents a useful index of suspicion for AD, especially in previously unrecognized AD cases [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Methodsmentioning

confidence: 99%

“…Many cases of oral hyperpigmentation are asymptomatic, but some are accompanied by local pain, itchiness, and burn-like lesions [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The combination of color, localization, and surface arrangement represents a useful index of suspicion for AD, especially in previously unrecognized AD cases [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. It is essential to adequately investigate oral lesions since they are frequently registered before extraoral manifestations of AD, as opposed to skin hyperpigmentation which accompanies general signs and symptoms such as hypotension, nausea, vomiting, anorexia, and weight loss [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Methodsmentioning

confidence: 99%

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New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

et al. 2022

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This review highlights oral anomalies with major clinical impact in Addison disease (AD), including dental health and dermatologic features, through a dual perspective: pigmentation issues and AD comorbidities with oral manifestations. Affecting 92% of AD patients, cutaneomucosal hyperpigmentation is synchronous with or precedes general manifestations by up to a decade, underlying melanocytic infiltration of the basal epidermal layer; melanophages in the superficial dermis; and, rarely, acanthosis, perivascular lymphocytic infiltrate, and hyperkeratosis. Intraoral pigmentation might be the only sign of AD; thus, early recognition is mandatory, and biopsy is helpful in selected cases. The buccal area is the most affected location; other sites are palatine arches, lips, gums, and tongue. Pigmented oral lesions are patchy or diffuse; mostly asymptomatic; and occasionally accompanied by pain, itchiness, and burn-like lesions. Pigmented lingual patches are isolated or multiple, located on dorsal and lateral areas; fungiform pigmented papillae are also reported in AD individuals. Dermoscopy examination is particularly indicated for fungal etiology; yet, it is not routinely performed. AD’s comorbidity burden includes the cluster of autoimmune polyglandular syndrome (APS) type 1 underlying AIRE gene malfunction. Chronic cutaneomucosal candidiasis (CMC), including oral CMC, represents the first sign of APS1 in 70–80% of cases, displaying autoantibodies against interleukin (IL)-17A, IL-17F ± IL-22, and probably a high mucosal concentration of interferon (IFN)-γ. CMC is prone to systemic candidiasis, representing a procarcinogenic status due to Th17 cell anomalies. In APS1, the first cause of mortality is infections (24%), followed by oral and esophageal cancers (15%). Autoimmune hypoparathyroidism (HyP) is the earliest endocrine element in APS1; a combination of CMC by the age of 5 years and dental enamel hypoplasia (the most frequent dental complication of pediatric HyP) by the age of 15 is an indication for HyP assessment. Children with HyP might experience short dental roots, enamel opacities, hypodontia, and eruption dysfunctions. Copresence of APS-related type 1 diabetes mellitus (DM) enhances the risk of CMC, as well as periodontal disease (PD). Anemia-related mucosal pallor is related to DM, hypothyroidism, hypogonadism, corresponding gastroenterological diseases (Crohn’s disease also presents oral ulceration (OU), mucogingivitis, and a 2-3 times higher risk of PD; Biermer anemia might cause hyperpigmentation by itself), and rheumatologic diseases (lupus induces OU, honeycomb plaques, keratotic plaques, angular cheilitis, buccal petechial lesions, and PD). In more than half of the patients, associated vitiligo involves depigmentation of oral mucosa at different levels (palatal, gingival, alveolar, buccal mucosa, and lips). Celiac disease may manifest xerostomia, dry lips, OU, sialadenitis, recurrent aphthous stomatitis and dental enamel defects in children, a higher prevalence of caries and dentin sensitivity, and gingival bleeding. Oral pigmented lesions might provide a useful index of suspicion for AD in apparently healthy individuals, and thus an adrenocorticotropic hormone (ACTH) stimulation is useful. The spectrum of autoimmune AD comorbidities massively complicates the overall picture of oral manifestations.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

et al. 2022

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“…Hypercorticoadrenalism (primary or Addison’s disease and secondary) is caused by progressive destruction of the adrenal cortex with consequent insufficient secretion of adrenal androgens, mineralocorticoids and glucocorticoids. Along to the systemic signs and symptoms variably related to the reduced secretion functions (weakness, fatigue, loss of appetite and weight) pigmentation of the skin (also of the head and neck) and of the oral mucosa are common findings [ 148 ]. The latter, as easily detectable, frequently arise the suspicion of disease in still undiagnosed patients.…”

Section: Endocrine Diseases (Miscellanea)mentioning

confidence: 99%

Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview

2021

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Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease.

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Hyperpigmented Papules on the Tongue of a Child

Drolshagen¹

2023

Cutis

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A 9-year-old Black boy presented to the dermatology clinic for evaluation of dark spots on the tongue. The family first noted these spots 5 months prior and reported that they remained stable during that time. The patient's medical history was notable for autism spectrum disorder and multiple food allergies. His family history was negative for similar oral pigmentation or other pigmentary anomalies. A review of systems was positive only for selective eating and rare nosebleeds. Physical examination revealed numerous dark brown, pinpoint papules across the dorsal aspect of the tongue. No hyperpigmentation of the buccal mucosae, lips, palms, or soles was identified. Several light brown streaks were present on the fingernails and toenails, consistent with longitudinal melanonychia. A prior complete blood cell count was within reference range. WHAT'S YOUR DIAGNOSIS?a. Addison disease b. black hairy tongue (or lingua villosa nigra) c. hereditary hemorrhagic telangiectasia d. Peutz-Jeghers syndrome e. pigmented fungiform papillae of the tongue Eligible for 1 MOC SA Credit From the ABD This Photo Challenge in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title "Cutis Photo Challenge." You may report the credit after each activity is completed or after accumulating multiple credits.

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Oral mucosal hyperpigmentation

Cited by 3 publications

References 4 publications

New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden

Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview

Hyperpigmented Papules on the Tongue of a Child

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