Pigmented Lesions

Ko, Eugene; Panchal, Neeraj

doi:10.1016/j.det.2020.05.009

Cited by 8 publications

(8 citation statements)

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“…Clinically, physiological GHP exhibits asymptomatic, multiple or single, well-defined, light-to-dark brown macules of variable sizes that may affect any part of the oral mucosa, particularly gingiva [ 5 ]. Pathological oral hyperpigmentation is caused by excessive melanin pigmentation associated with systemic diseases, such as Addison disease, neurofibromatosis, or Peutz-Jeghers syndrome [ 7 ]. Heavy smoking has a high tendency towards pigmentation (smoker's melanosis).…”

Section: Introductionmentioning

confidence: 99%

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Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

Harb¹,

El‐Sayed

Alkhabuli

2021

International Journal of Dentistry

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Aim of the Study. This study aimed to compare the effectiveness of diode laser (980 nm) and erbium-YAG laser (2940 nm) for gum depigmentation. Background. Gingival hyperpigmentation, “black gum,” refers to black discrete single or multiple pigments on the gingiva. Several factors may play a role in gingival hyperpigmentation ranging from physiologic pigmentation to manifestations of systemic diseases. Several techniques have been used for gingival depigmentation to lighten its color. Methods. Fifteen patients exhibiting nonsmoking melanin hyperpigmentation, with the mean age of 28.6 ± 7.8 years, were recruited. The facial gingiva of the anterior teeth and premolars of each jaw was divided into two halves. The right or left side of each jaw quadrant randomly received either diode laser operating at 980 nm wavelength or erbium-YAG laser at 2940 nm. Parameters such as degree of gingival depigmentation, bleeding, pain, patient satisfaction, and wound healing were assessed and compared between the two techniques. The subjects were followed up to six months for melanin pigmentation recurrence. Results. Both techniques were efficient for gingival depigmentation. Nevertheless, bleeding during surgery was statistically higher for Er:YAG laser technique as compared to diode laser. Wound healing showed statistically nonsignificant differences between the two lasers, although Er:YAG seems to give better outcomes than the diode. The patients were satisfied with both laser techniques during and after gingival depigmentation. However, the pain score was higher for Er:YAG laser than for diode laser. Conclusion. This study demonstrated that both lasers’ techniques are efficient for gingival depigmentation. However, diode laser seems to show less painful experience and relatively better bleeding control.

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Section: Introductionmentioning

confidence: 99%

“…Heavy smoking has a high tendency towards pigmentation (smoker's melanosis). Furthermore, drugs, such as antimalarials, tetracyclines, ketoconazole, and zidovudine also are linked with melanin pigmentation [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

Harb¹,

El‐Sayed

Alkhabuli

2021

International Journal of Dentistry

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“…The pigmented lingual patches may be single or multiple; they are situated at the level of dorsal and lateral areas, either isolated or synchronous with similar lesions at other anatomical parts such as lips and palatine arches [ 45 , 46 , 47 , 48 ]. In addition to hormonal imbalance-related pigmentation, fungiform pigmented papillae are reported in AD individuals [ 49 , 50 , 51 ]. The dermoscopy examination is particularly useful for fungal etiology; yet, it does not represent a popular method of investigation in dental and oral daily practice [ 50 ].…”

Section: Methodsmentioning

confidence: 99%

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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“…Generally, the first diagnosis is made in young adults; however, it can also be diagnosed in childhood. An early clinical presentation is perioral and acral macular pigmentation, and intraoral pigmentation is uncommon (Ko & Panchal, 2020).…”

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confidence: 99%

“…Melanoma is a malignant tumor of melanocytes and primary melanoma in the oral cavity occurs in <1% (Ko & Panchal, 2020).…”

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confidence: 99%

Brown lesion on the tongue of a child

Ohta,

Yoshimura

2023

Oral Diseases

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A healthy 4-year-old Japanese boy was referred for a blown lesion on the tongue present since birth and increased in size with his body growth.He was born at term and developing normally. His parents had no family history of melanoma, mucosal pigmentation, and polyposis. His skin phototype was estimated to be III. Intraoral examination showed a wellcircumscribed, flat, soft, smooth, 8 × 6 mm brown macule on the dorsal tongue (Figure 1). The lesion could not be scraped by gauze. Extraoral examination demonstrated no cervical lymphadenopathy. | WHAT IS YOUR D IAG NOS IS?Based on the patient's history, physical examination, and laboratory findings, which one of the following is the most suspicious diagnosis? 1. Addison disease (Primary adrenal insufficiency) 2. Black hairy tongue 3. Congenital lesion 4. Melanoma 5. Peutz-Jeghers syndrome This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Pigmented Lesions

Cited by 8 publications

References 57 publications

Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

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

Brown lesion on the tongue of a child

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