Mucosal Hyperpigmentation Research Articles

Hydroxychloroquine-Induced Oral Mucosal Hyperpigmentation.

From the *Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA †College of Health Solutions, Arizona State University, Tempe, AZ. The authors declare no conflict of interest. Correspondence: Eaman Alhassan, MD, Division of Rheumatology, Department of Medicine, 2020 Zonal Ave, IRD 4th Floor, Room 423, Los Angeles, CA 90033. E-mail: [email protected].

Capecitabine-induced oral mucosal hyperpigmentation associated with hand-foot syndrome – A literature review

BackgroundCapecitabine (Xeloda®) is a cytotoxic, antimetabolite chemotherapeutic agent. Its most common adverse events are diarrhea, hand-foot syndrome (HFS), hyperbilirubinemia, hyperpigmentation, fatigue, abdominal pain, and other gastrointestinal effects. HFS or palmar-plantar erythrodysesthesia (PPE) is an adverse reaction resulting from therapy with chemotherapeutic agents, classified into three degrees. Hyperpigmentation, as an adverse effect of capecitabine, can occur in different locations and with different patterns. The skin, nails and oral mucosal membrane can be affected. ObjectiveThe objective of this study was to report and discuss oral hyperpigmentation associated with HFS caused by the use of capecitabine, which is still poorly described in the literature. MethodologyA literature review was carried out using the online databases PubMed, Scielo, BVS, Lilacs, Medline, BBO and Google Scholar, associating the descriptors “Capecitabine”, “Pigmentation Disorders”, “Oral mucosa”, “Cancer” and “Hand-Foot Syndrome”, which were related and used to exemplify, discuss and report the exposed clinical case. ResultsThis case report corroborates the literature regarding the incidence in females and black skin persons like this patient who was affected by HFS when undergoing antineoplastic therapy with capecitabine and presented hyperpigmentation of the hands, feet and oral mucosa. On the oral mucosa, the hyperpigmented spots were diffuse, showing a blackish color and irregular edges. Their pathophysiology remains unknown. Study limitationsFew articles citing capecitabine-associated pigmentation. ConclusionsIt is hoped that this study may contribute to the identification and correct diagnosis of hyperpigmentation in the oral cavity, as well as call attention to the adverse effects related to capecitabine.

Physiologic hyperpigmentation on darker skin

Many, even common, normal variations and nuances of skin of color are less frequently described or often misinterpreted as pathological. Recognizing these physiologic changes is gaining relevance in our increasingly diverse patient population and enables the physician to encourage the acceptance by the patients as well as to manage our resources wisely. Therefore, we explain common hyperpigmentation on dark skin such as demarcation lines, mucosal hyperpigmentation, melanonychia striata, and circumscribed dermal melanocytosis. The aim of this article is to facilitate the classification of these phenomena in clinical practice.

Dermatological adverse drug reactions with particular reference to Steven-Johnson syndrome and toxic epidermal necrolysis

Background: Drug therapy is an inevitable cause of cutaneous adverse reactions. Aims and Objectives: The primary aim was to identify the incidence and magnitude of various dermatological adverse reactions including Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Moreover, secondary aim was to quantify the risks associated with the use of specific medications. Materials and Methods: A prospective and hospital-based study was conducted in the department of dermatology SMHS hospital on hospitalized cases of cutaneous adverse drug reactions (CADRs). Informed consent was sought and reactions were reported on validated questionnaire based on adverse drug reaction (ADR) monitoring form provided by Central Drug Standard Control organization Ministry of Health and Family Welfare, Government of India. These dermatological reactions were assessed for the clinical pattern, causative agents, and prognosis. The WHO-Uppsala Monitoring centre system for standardized case was used for causality assessment of all cases identified. Results: A total of 101 hospitalized patients with varied dermatological ADRs were reported during the study period. Cases were found more in females (n=75, 74.25%) than in males (n=26, 25.75%). CADRs that were reported in our study were exanthematous rash, fixed drug eruptions, urticarial rashes, SJS, TEN, urticarial vasculitis, anticonvulsant hypersensitivity syndrome, erythema multiforme, contact dermatitis, exfoliative dermatitis, mucosal hyperpigmentation, and nail pigmentation, respectively. After a meticulous drug history, the drugs implicated in causing the cutaneous reactions were anticonvalscents such as phenytoin, carbamazepine, lamotrigine, and phenobarbitone. Other drugs identified were non-steroidal anti-inflammatory drugs such as oxicam, antibiotics such as sulfasalazine, cefixime, cefpodoxime, amoxicillin, fluoroquinolones such as levofloxacin and ciprofloxacin, chemotherapeutic agents such as cyclophosphamide, 5FU, and hydroxurea. Conclusion: The present study concluded that skin is most common target for ADRs. Drug-induced cutaneous reactions can be as simple as a mild rash to rare life-threatening SJS and TEN. Moreover, certain group of patients is at increased risk for developing CADR’s as women are more susceptible than men.

Minocycline-induced Conjunctival Hyperpigmentation.

A 73-year-old woman presented with a 1-year history of pigmented conjunctival lesions in both eyes. She had been taking minocycline for decades for recurrent facial cysts. On examination, she had a larger pigmented cystic lesion of her right inferior fornix conjunctiva, and several smaller hyperpigmented lesions in her right inferior, left superior, and left inferior palpebral conjunctivae (Panel A; external photograph). She underwent an excisional biopsy of the large cyst. Pathology showed exogenous brownish-gray pigment granules (circle) deposited in macrophages surrounding vessels in the substantia propia (Panel B; hematoxylin & eosin-stained image at 40× magnification). The pigment granules were stained black (arrow) with Fontana-Masson stain (Panel C; image at 40×). There was no evidence of an atypical melanocytic proliferation. A diagnosis of minocycline-induced hyperpigmentation was made. Minocycline, a tetracycline antibiotic, can be used to treat dermatologic conditions. Extended use can lead to hyperpigmentation of the skin, nails, teeth, oral mucosa, sclera, and conjunctiva. There is a wide range of reported doses and duration of therapy associated with mucosal or cutaneous hyperpigmentation varying by type and site, occurring as early as days to weeks, with a median onset of 1–2 years. Cosmetic concerns should prompt discontinuation, although hyperpigmentation is likely permanent. These lesions were not visually significant nor bothersome, and therefore no additional treatment was recommended.

Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis.

Antiretroviral therapy (ART) increases the survival of HIV-infected children, but might also bring in oral health-related side effects and increase their risks of oral diseases. The review compared the oral health status of children living with HIV (CLWH) undergoing ART with healthy controls. Dual independent screening and study selection from four electronic databases and manual searches, data extraction, risk of bias assessment, and quality-of-evidence evaluation with Grading of Recommendations Assessment Development and Evaluation were performed. Twelve studies were included in qualitative and quantitative analysis. CLWH taking ART had a significantly higher prevalence of periodontal diseases (OR = 3.11, 95% CI 1.62–5.97), mucosal hyperpigmentation (OR = 20.35, 95% CI 3.86–107.39), and orofacial-related opportunistic infections than healthy controls. No significant differences regarding caries prevalence and tooth development were identified. Those with CD4+ T-cell counts below 250 cells/mm3 were more likely to manifest opportunistic infections, while medication duration had minimal influence on the prevalence of orofacial opportunistic infections. The current findings did not identify HIV and antiretroviral status as predisposing factors to dental caries, but affirmed the associated increased risk of periodontal diseases, mucosal hyperpigmentation and candidiasis.

P297 Disseminated histoplasmosis from skin to adrenals a cosmetic catastrophe—a rare case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM BackgroundThe varying presentations of histoplasmosis is always a diagnostic dilemma for clinicians. Cases of disseminated histoplasmosis can present in multiple specialties like dermatology, medicine, endocrinology, with skin, and mucosal hyperpigmentation as the only major symptom.Case ReportHere we present a case of a 54-year-old male with hyperpigmentation all over the body with multiple specialty consultations done in the past 2 years. There was a significant history of loss of weight over a period of 2 years. His cortisol levels were low which explained the focus in the adrenals, with bilateral adrenomegaly found in imaging studies. His diagnostic work-up for TB and possible malignancy was ruled out. The provisional diagnosis of histoplasmosis was made and confirmed with biopsy and culture. Definitive treatment with antifungals was initiated, which showed improvement on follow-up.ConclusionHistoplasmosis is always underreported, because of a lack of information regarding the various clinical presentations. Early diagnosis and prompt treatment may save the patient from catastrophic adrenal insufficiency. The diagnosis of adrenal histoplasmosis should be considered in patients presenting with constitutional symptoms and adrenal masses with or without adrenal insufficiency. Adrenal histoplasmosis can be the only possible presentation in disseminated histoplasmosis.

Oral Findings in Patients with COVID-19 Infection: Report of Two Cases and Review of Literature

Few reports have been published highlighting oral findings in COVID-19 patients. Since the outbreak of the recent pandemic caused by SARS-CoV-2, it is important to illustrate in the very near future how recurrent these oral findings are in the symptomatic COVID-19 patients in contrast to those asymptomatic ones, as there are multiple findings reported. This case study reports a new combination of oral findings in two COVID-19 patients from India, one symptomatic, and other asymptomatic. Cases presenting oral findings in asymptomatic COVID-19 patients are the rarest. Moreover, till now, petechial or purpuric lesions, solely as theoral findings without any associated skin lesions and oral mucosal hyperpigmentation of our patients are the rare oral findings to be reported in COVID-19 patients. These cases provide evidence for a deeper understanding of the oral alterations seen in COVID-19 patients that need to be addressed at present.

Biotin Supplementation Creates the Misleading Diagnosis of Secondary Adrenal Insufficiency

Introduction: Biotin (vitamin B7) is a water-soluble vitamin and an essential cofactor for the metabolism of fatty acids, glucose, and amino acids. Cases of biotin interference with laboratory testing have been described, most of which involve interference with thyroid function tests. Interference with gonadal steroids, adrenal, and pituitary hormones are rare. We report a case of T3 thyrotoxicosis in which biotin supplementation created the appearance of secondary adrenal insufficiency (AI).Case: A 66-year-old woman was referred for the evaluation of low TSH. She had chronic fatigue, low libido, and dizziness on standing. Vitals were stable with BP 135/64 mmHg and BMI 23.5. No evidence of mucosal or cutaneous hyperpigmentation. Laboratory evaluation revealed low ACTH <5 (7.2–63.3 pg/mL), low morning cortisol 3.8 and high DHEA-S 174 (13–130 ug/dL). TSH was low at 0.32 (0.32–5.60 uIU/mL) with normal prolactin and appropriately elevated FSH and LH. The labs raised concern for secondary AI. Cosyntropin stimulation test (CST) was done with a peak cortisol of 17.4 ug/dL. In the setting of suppressed ACTH and failed CST, she was started on Hydrocortisone therapy. Subsequently, CT of abdomen was obtained due to high DHEA-S which showed normal appearance of both adrenals. Pituitary MRI was normal. A detailed review of the medication list revealed that the patient was taking a Biotin containing multivitamin. Repeat labs 1 week after stopping biotin showed normalization of ACTH 13.8 (7.2–63.3). Repeat CST showed a peak cortisol response of 24 ug/dL. Hydrocortisone was discontinued and the patient remained stable on subsequent follow-ups, without the need for further glucocorticoid replacement therapy. Thyroid lab abnormalities persisted after biotin cessation which led to the diagnosis of T3 thyrotoxicosis, the treatment of which caused resolution of the patient’s symptoms.Discussion: The recommended daily intake of biotin for adults is 30 µg/d. Many over-the-counter products, specifically those marketed for hair, skin, and nail growth, contain biotin 100-fold higher than the recommended intake. Biotin interference with competitive immunoassays can cause falsely elevated hormone levels, whereas biotin interference with immunometric “sandwich” assays falsely lowers hormone levels. In our case, low ACTH was clinically misleading, prompting numerous unnecessary radiographic and laboratory testing and treatment with hydrocortisone. The US Food and Drug Administration issued a safety communication regarding biotin interference with laboratory tests. Education and communication between laboratorians, providers, and patients play an important role in investigating potential lab interference and the need for alternative lab assays for an accurate diagnosis. Patients should be asked to stop taking biotin supplements for at least 48 hours prior to specimen collection if possible.

Nail changes associated with pigmentary disorders

Salient nail unit changes serve as pointers toward systemic disease. On similar lines, salient nail changes are associated with pigmentary disorders, and can help toward diagnosis. Nail changes form a part of various physiologic pigmentary changes including racial pigmentation, pregnancy, or neonatal period. At the same time, a number of nail changes can be valuable clues toward disorders of pigmentation associated with genetic syndromes (Laugier–Hunziker syndrome, incontinentia pigmenti, and tuberous sclerosis), endocrine disorders, disorders of metabolism (alkaptonuria), infections (HIV-AIDS), internal malignancies, etc. Nail changes are especially useful if cutaneous pigmentary changes are suspected to be drug-induced based or associated mucosal and/or cutaneous hyperpigmentation. Various drugs that can cause cutaneous pigmentary alterations along with nail changes include cyclophosphamide, adriamycin, vincristine, docetaxel, paclitaxel, carboplatin, psoralens, hydroxyurea, bleomycin, etc. Nail changes are also associated with disorders of hypomelanosis, for example, vitiligo. Pigmentary changes due to endogenous and exogenous pigments are again diagnosable based on the nail changes they induce. This narrative review highlights the importance of nail changes in suspecting and diagnosing various disorders of pigmentation. It also points toward areas which need future research.

Medication-Induced Oral Hyperpigmentation: A Systematic Review.

BackgroundMedication-induced oral hyperpigmentation is an oral condition that impacts patients’ quality of life and has been linked to many systemic therapeutic agents. The exact pathogenesis of tissue pigmentation varies greatly and is not completely known. This systematic review aimed to present data on the causal association between medications and the development of oral/mucosal pigmentation as an adverse drug reaction.MethodsA systematic review and analysis of literature were conducted using the following databases: PubMed, Science Direct, ProQuest, Web of Science, and Scopus. The systematic review included original articles written in English and published between January 1982 and June 2020. Following the PRISMA statement, eligible articles were systematically reviewed, and data were extracted from eligible studies and analyzed.ResultsA total of 235 articles were identified, of which 57 met the inclusion criteria and were included in this review. The mean age of included patients was 46.2±16.38 years (range: 10–90 years) with a male to female ratio of 1:1.45. Oral mucosal hyperpigmentation was reported following the use of several classes of medications such as antiviral (eg, zidovudine), antibiotic (eg, minocycline), antimalarial (eg, chloroquine), anti-fungal (eg, ketoconazole), antileprotic (eg, clofazimine), antihypertensive (eg, amlodipine), chemotherapeutic, and antineoplastic drugs. The risk of developing oral pigmentation was significantly higher with antimalarial medications, antibiotics, antineoplastic and chemotherapeutic agents. Medication-induced oral hyperpigmentation was most frequent among women and in the hard palate.ConclusionFuture research is warranted to better understand the pathogenesis and risk factors for medication-induced oral hyperpigmentation in order to reassure patients during prescription and management.

HIV-ASSOCIATED ORAL MUCOSAL MELANIN HYPERPIGMENTATION: A CASE REPORT

Postinflammatory hyperpigmentation is a reactive hypermelanosis that develops following cutaneous inflammation. Common causes of this condition include intrinsic skin conditions as well as external insults to the skin, including infections. Human immunodeficiency virus (HIV)-associated oral melanotic hyperpigmentation is categorized under "lesions less commonly associated with HIV infection." The aim of this study is to report a case of an HIV-associated oral mucosal melanin hyperpigmentation. A 55-year-old man attended the referral service in oral diagnosis, presenting a blackened spot, showing smooth surface and irregular borders in the region of the right jugal mucosa, measuring about 2 cm in diameter. The patient had previous diagnosis of HIV and did not show pigmentation in other regions of the body. An incisional biopsy was performed. The histopathological examination showed pigmentary incontinence of melanophages in the subepithelial region. The patient is under medical supervision and using antiretrovirals. In addition, he will be observed to follow the evolution of oral condition. Postinflammatory hyperpigmentation is a reactive hypermelanosis that develops following cutaneous inflammation. Common causes of this condition include intrinsic skin conditions as well as external insults to the skin, including infections. Human immunodeficiency virus (HIV)-associated oral melanotic hyperpigmentation is categorized under "lesions less commonly associated with HIV infection." The aim of this study is to report a case of an HIV-associated oral mucosal melanin hyperpigmentation. A 55-year-old man attended the referral service in oral diagnosis, presenting a blackened spot, showing smooth surface and irregular borders in the region of the right jugal mucosa, measuring about 2 cm in diameter. The patient had previous diagnosis of HIV and did not show pigmentation in other regions of the body. An incisional biopsy was performed. The histopathological examination showed pigmentary incontinence of melanophages in the subepithelial region. The patient is under medical supervision and using antiretrovirals. In addition, he will be observed to follow the evolution of oral condition.

Oral mucosal hyperpigmentation

Oral mucosal hyperpigmentation

Prevalence of oromucosal lesions in HIV positive patients receiving haart-A prospective clinical study.

Aim:To determine the preponderance of oral mucosal lesions and conditions in patients receiving highly active antiretroviral therapy (HAART) for Human Immunodeficiency virus (HIV).Material and Methods:Patient tested Seropositive for HIV and on HAART therapy were clinically examined to evaluate prevalence of oral lesions.Results:In the pool of 152 HIV positive patients in the study, age ranged from 7 to 71 years, 67 were males and 85 females. The duration of the HAART medication was 43 months. Oral lesion was present in 51.32% of patients related to infection. Oral lesions seen in descending order of frequency were periodontitis, mucosal hyperpigmentation, acute gingivitis, oral candidiasis, linear gingival erythema, stomatitis, and nonspecific ulcers. Totally, 48.68% of patients had no oral lesions.Conclusion:Majority of the HIV patients on HAART exhibited periodontitis (30.77%), mucosal hyperpigmentation (17.44%), gingivitis (10.77%), anemic stomatitis (11.28%), and other oral lesions accounted to 29.74% which may be attributed to Anti Retro Viral Therapy.

3215 Duodenal Blackout: A Rare, Benign Endoscopic Finding

INTRODUCTION: First described in 1976, psuedomelanosis is a rare, benign, incidental endoscopic finding most commonly seen in the duodenum. PD has been associated with chronic renal disease and the ingestion of various medications including hydralazine and iron supplements. Here we describe a classic presentation of an uncommon endoscopic abnormality. CASE DESCRIPTION/METHODS: A 66-year-old woman with decompensated cirrhosis, end stage renal disease, and hypertension presented to the hospital with hepatic encephalopathy and failure to thrive. Her medications included hydralazine and a history of iron supplementation. An esophagogastroduodenoscopy (EGD) performed for early satiety, weight loss and to initiate a liver transplant evaluation demonstrated diffuse mucosal hyperpigmentation in a striped pattern, predominantly in the second portion of the duodenum (Figure 1). Mucosal biopsy revealed an abundance of brown pigment deposition in the lamina propria (Figure 2) which was negative on Prussian blue stain and immunohistochemistry—consistent with a diagnosis of pseudomelanosis duodeni (PD). DISCUSSION: Despite its striking endoscopic appearance, there is no evidence that pseudomelanosis duodeni is associated with any progressive pathology. Though PD has been described anecdotally in case report and case series, little is known about the pathophysiology. Some have posited PD is related to iron or lipofuscin deposition in the lamina propria. PD has been associated with end-stage renal disease, hydralazine, thiazide diuretics, and iron supplementation. This case describes a classic presentation of PD with the archetypal imaging and histopathology to support the diagnosis of this uncommon condition.

Buccal Mucosa Hyperpigmentation as a Differential Diagnosis in a Patient With Undifferentiated Shock

Buccal Mucosa Hyperpigmentation as a Differential Diagnosis in a Patient With Undifferentiated Shock

MON-368 Familial Glucocorticoid Deficiency Type I with New MC2R Mutation: Presentation of a Pediatric Patient with Oral Mucosal Hyperpigmentation

Familial Glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder in which the adrenal cortex fails to produce glucocorticoids in response to ACTH, but with preservation of mineralocorticoid activity. It is caused by mutations in the melanocortin 2 receptor (MC2R), and thus far over 40 mutations reported. Here we report a new homozygous missense mutation in the MC2R gene [c.536C>T, p.(Thr179Met)] in a young female who presented with mucosal hyperpigmentation.

MON-405 Cushing's Disease: An Oligosymptomatic Patient with ACTH-Secreting Pituitary Macroadenoma

BACKGROUND Cushing's disease (CD) is mainly due to pituitary microadenomas producing ACTH. Only 10% of CD presents with macroadenomas. CD is suspected by the presence of classic signs and symptoms and is often associated with metabolic diseases. We present a case of non-classical presentation of CD due to a pituitary macroadenoma CLINICAL CASE 73-years woman with hypertension, diabetes and dyslipidemia in treatment with metformin 850mg bid, insulin NPH 50U/d, Enalapril 10mg bid and Atorvastatin 20mg was referred to endocrinology clinic for noticed in the last year cervical tumor that increases in volume. She noticed occasional headache and decreased visual acuity, denied difficulty in breastfeeding, menopause at 45 years old. Physical evaluation reveals TA 110/60 Weight 82 Kg BMI 39 Central obesity. Thin skin. Abdomen white and thin striae. Nodule in left thyroid lobe 2cm. Muscular atrophy in lower limbs. Absence of reddish striae, hump, skin or mucosa hyperpigmentation, hirsutism and facial plethora. Campimetry by confrontation: bitemporal heteronymous hemianopsia. Blood analysis: Glucose 103mg/dL HbA1C 11.3% Creatinine 1.25mg/dL Total cholesterol 94mg/dl LDLc 40mg/dl Triglyceride 112mg/dl ALT 18 AST 23 TSH 1.83uU/ml (0.27-4.2) Free T4 0.86ng/ml (0.93-1.7). Thyroid US: left nodule 26x20mm with macrocalcifications, irregular edges and central vascularization. FNA Bethesda III. To rule out secondary hypothyroidism, was requested TSH 2.77 Free T4 0.72 FSH 35.6 (48.6-143) LH 14.35 (13-45) Prolactin 9.98 (18-24) Cortisol AM 10.5 (3.7-19.4). A 75ug qd levothyroxine was started 3 months later, she reported headache more frequently, asthenia and difficulty climbing stairs, lower limbs paresthesias, higher dose of insulin was needed (NPH 58U, insulin Lispro 5U before lunch) Glucose 225 HbA1C 14.9% Triglycerides 300 Cortisol AM 9.3ug/dl Cortisol PM 9.7 ACTH1 118.1pg/ml (5-63) ACTH2 135.8. Free urinary cortisol 76.4ug/24h. Dexamethasone suppression test 2mg/6h by 48h: Cortisol before test was 11ug/dL and after 1.4 Pituitary MRI described a macroadenoma involving the left cavernous sinus and the left carotid artery. After Transsphenoidal surgery, pathology was informed as Pituitary Adenoma, Positive immunohistochemistry ACTH, proliferation index Ki67 1% 1-year post surgery, she had stopped insulin and enalapril. Her only medication is levothyroxine 100ug. Her last blood analysis: Glucose 92 HbA1C 7.2% Creatinine 1.48 Free T4 1.3 FSH 30 LH 16 Prolactin 10.4 Cortisol AM 9.2. CONCLUSION Sometimes, CD can be oligosymptomatic despite being a pituitary macroadenoma, so it can be considered a differential diagnosis in patients with metabolic syndrome REFERENCES Buliman A, et al. Cushing´s disease: a multidisciplinary overview of the clinical features, diagnosis and treatment. J Med Life 2016

Association of oral mucosa hyperpigmentation with imatinib mesylate use: a cross-sectional study and a systematic literature review.

To assess the association between oral mucosa hyperpigmentation in patients with leukemia and imatinib mesylate use. Additionally, we compared our data to those obtained from a systematic review. A cross-sectional study was conducted with 74 patients undergoing treatment with imatinib mesylate. Sociodemographic characteristics, oral mucosa alterations, and medical history were evaluated. Oral hyperpigmentation was scored. The use of imatinib mesylate and hydroxyurea was evaluated. Association between oral hyperpigmentation and imatinib mesylate was assessed. A systematic review was also conducted to retrieve case reports or case series of patients with oral hyperpigmentation associated with imatinib mesylate. Among the 74 participants, 41 were male (55.4%) and 33 were female (44.6%). Participants' mean age was 49.3years. Sixty-six (89.2%) patients developed hyperpigmented lesions in the hard palate mucosa. In multivariate analysis, patients who had used imatinib mesylate for > 72months had a hyperpigmentation score 1.62 times higher than those who had used this medication during a shorter period. Patients who had used hydroxyurea for > 30days had a hyperpigmentation score 1.43 times higher than those who had used this medication during a shorter period. The systematic review retrieved 20 clinical cases of patients undergoing imatinib mesylate treatment and exhibiting oral hyperpigmentation. The development of oral hyperpigmentation is associated with imatinib mesylate use. Hydroxyurea seems to increment such an association. To assist providers in the differential diagnosis of hyperpigmented lesions associated with imatinib mesylate, as well as in the clinical management of such lesions.

Extensive amalgam tattoo (amalgam pigmentation) on the palatal mucosa: a short case report

Introduction: An amalgam tattoo is the most common form of exogenous oral pigmentation caused by the diffusion of dental amalgam into the soft tissue. Observation: Here we describe a case of diffuse pigmentation of amalgam on the hard palate. Discussion: Mucosal hyperpigmentation can occasionally be confused with melanotic lesions, thereby requiring a biopsy for differential diagnosis. Once the diagnosis of an amalgam tattoo has been established, the removal of the lesion is not necessary, except for aesthetic reasons.