Multiple Chronic/generalized Pigmentation

Question 1

Multiple Chronic

Answer 1

Erosive Lichen Planus
Lichenoid Mucositis (Drug Reaction)
Benign Mucous Membrane Pemphigoid
Lupus Erythematosus
Pemphigus Vulgaris
Chronic Graft vs. Host Disease

Question 2

Acanthosis Nigricans

Answer 2

Commonly seen on neck and folds of skin
◦ Velvety brown to black papules and plaques found on neck,
axilla and flexural areas of skin
Especially seen with obese patients
◦ Clinical marker for diabetes
◦ Ensure patient is being followed by pediatrician and/or
endocrinology
Lips, tongue and palate may be involved
Nonpigmented hypertrophy of papillae on dorsal surface
and lateral edge of tongue
Buccal mucosa may have velvety white plaques in an
uneven appearance
Interdental gingiva may become hyperplastic and overgrow
onto occulsal surface of teeth

Question 3

Addison’s Disease

Answer 3

Primary adrenal insufficiency
◦ Adrenal cortex destruction (Due to autoimmune, metastasis,
infection or hemorrhage)
Patient weakness, nausea, vomiting, lower blood pressure
Diffuse or patchy pigmentation of the skin and/or mucous
membranes
◦ Due to increased ACTH-cross reacts with melanin receptors
◦ Buccal mucosa, palate, lip and gingiva are common locations
Diagnosis via ACTH test
TX: None for oral lesions, but systemically will need steroid
replacement therapy

Question 4

McCune-Albright Syndrome

Answer 4

Large café-au-lait macules
Endocrine disease
◦ Precocious puberty (Increased estrogen)
◦ Cystic changes in bone
◦ Café-au lait patches on skin
Polyostotic fibrous dysplasia

Question 5

Peutz-Jeghers Syndrome

Answer 5

Pigmented macules on lips, oral mucosa and perioral
areas
◦ Lip lesions may fade, buccal mucosa lesions will not fade
typically
Autosomal dominant
◦ Gene STK11
Gastrointestinal polyps (Hamartomatous and
adenomatous), especially in jejunum
◦ Increased lifetime risk of cancer (Many varieties and
locations)
◦ 37-93% lifetime risk of cancer

Question 6

Heavy Metal Toxicity

Answer 6

Bismuth
◦ Gingivostomatitis that resembles NUG (necrotizing ulcerative gingivitis)
◦ Blue to black pigment of interdental papillae
◦ Bismuth Line – Burning sensation and metallic taste

Lead
◦ Salivary gland swelling and dysphagia
◦ Grey pigmentation of marginal gingiva
◦ Burton’s Line

Mercury
◦ Ropy, viscous saliva
◦ Faint grey alveolar gingival pigmentation
◦ Gingivostomatitis that resembles NUG (necrotizing ulcerative gingivitis)

Question 7

Lead Toxicity

Answer 7

Atyipcal gingivitis

Chronic Manifestations
◦ Nervous System Dysfunction
◦ Renal Disease
◦ Musculoskeletal pain
◦ Headache
◦ Bone and Joint Disorders
◦ Bone Marrow Failure

Question 8

Heavy Metal Toxicity

Answer 8

Silver (Argyria)
◦ Skin appears to be slate gray in color
◦ Diffuse pigmentation

Copper
◦ Blue-green gingiva and teeth
◦ Just think of corrosion on a cooper pipe -> It is blue-green in color

Zinc
◦ Blue-gray line on gingiva
◦ Periodontal involvement

Question 9

Hemochromatosis

Answer 9

Iron storage disease
Bronzing of the skin
Gray pigmentation of the palate / gingiva