Presentation
Longitudinal melanonychia is present in the majority of cases. We present a 45-year-old woman with adult-onset hyperpigmented macules of the oral cavity as well as linear melanonychia that involved multiple fingernails. [escholarship.org]
The longitudinal, pigmented band was present on her fingernails and toenails (Figure 2). Potassium hydroxide examination and fungus culture were negative. [ncbi.nlm.nih.gov]
Addison’s disease, McCune–Albright syndrome) that present with, inter alia, mucocutaneous hyperpigmentation. [edm.bioscientifica.com]
No family history of any mucocutaneous disorder was present. There was no history of any trauma prior to the pigmentation. General physical and systemic examination was normal. [journals.lww.com]
Gastrointestinal
- Vomiting
She had normal built and no history suggestive of intestinal involvement (like recurrent abdominal pain, vomiting, gastrointestinal bleed, malena), palpitation or weakness. There was no history of any drug intake or excessive sun exposure. [ijdvl.com]
She was otherwise healthy with no complaints of any abdominal pain, diarrhoea, vomiting, fatigue, and weight loss; she was not receiving any medication (including antimalarials or minocycline). [journals.lww.com]
He denied any associated discomfort, and results of a review of systems were negative for fatigue, weight loss, weakness, abdominal pain, vomiting, rectal bleeding, anemia, drug exposure, bone pain, or precocious puberty. [consultant360.com]
There was no history of abdominal pain, diarrhea, vomiting, rectal bleeding, hematemesis, fatigue, hypotension or weight loss associated with the onset of pigmentation. There was no family history of similar skin disease. [jcasonline.com]
- Nausea
Cutaneous lesions seem to precede systemic features of fatigue, lethargy, myalgia, nausea, personality changes, and hypotension. [statpearls.com]
Jaw & Teeth
- Oral Pigmentation
Most text books on oral pathology and oral medicine do not include LHS as a cause of oral pigmentation probably because of its benign nature and innocuous course. [jomfp.in]
Keywords: Differential diagnosis, Laugier–Hunziker syndrome, mucocutaneous pigmentation, oral pigments INTRODUCTION Oral mucosal pigmentation may be physiologic or a sign of localized or systemic pathologic condition. [ncbi.nlm.nih.gov]
We also review the potential causes of oral pigmentation. 1. Introduction Pigmentation is frequently encountered in the oral mucosa. [hindawi.com]
Oral pigmentation: a review. J Pharm Bioallied Sci. 2015;7(suppl 2):S403‐S408. doi:10.4103/0975-7406.163471 [consultant360.com]
Other conditions causing diffuse or multifocal pigmented oral lesions are discussed. To read this article in full you will need to make a payment References Eisen D. Disorders of pigmentation in the oral cavity. [oooojournal.net]
Cardiovascular
- Heart Disease
Apart from a noninsulin-dependent diabetes mellitus and coronary heart disease, which had been treated with glibenclamid and sotalol since 1981, his personal history was unremarkable. There was [jamanetwork.com]
Skin
- Hyperpigmentation
We present the case of a 63-year-old female with progressive, asymptomatic hyperpigmentation of buccal mucosa and a 7-year history of hyperpigmentation in several fingernails. [scielo.br]
Bilateral hyperpigmentation of the patient’s tongue. Figure 4. Mandibular gingival hyperpigmentation. Figure 5. Maxillary and mandibular gingival hyperpigmentation. Figure 6. Longitudinal melanonychia on the patient’s left second toe. [consultant360.com]
(B) Longitudinal hyperpigmentation on the anterior gingiva of the lower jaw. [edm.bioscientifica.com]
Hyperpigmentation of basal keratinocytes and melanophage population in the papillary dermis. A, Hematoxylin-eosin, original magnification ×100; B, highlighted hyperpigmentation with Masson-Fontana stain, original magnification ×100. [jamanetwork.com]
Workup
Despite the low prevalence of the LHS, the prompt clinical recognition avoids the need for excessive and invasive procedures and workup. [dpcj.org]
Colonoscopy
- Polyps
There was no family history of intestinal polyps or gastrointestinal (GI) tract malignancy. He denied taking any long-term medications. [consultant360.com]
It is important to distinguish it from Peutz-Jeghers syndrome, which has similar cutaneous features but also has associated gastrointestinal polyps. Peutz-Jegher syndrome is due to mutation of the SKT11 gene. [dermnetnz.org]
[…] characterized by discrete and confluent, slate to brown-black macules on skin and mucosae. [1],[2] It is a rare disorder which represents an important clinical differential to Peutz-Jeghers syndrome (PJS), which is associated with gastrointestinal hamartomatous polyps [ijdvl.com]
Peutz–Jeghers syndrome and Gardner's syndrome are autosomal dominant conditions associated with abdominal pain and intestinal polyps; malignant predisposition may also be present. [journals.lww.com]
Lastly, PJS is associated with hamartomatous polyps of the gastrointestinal tract, whereas LHS is not [3]. [dpcj.org]
Treatment
Patient was offered Q-switched Nd-Yag laser treatment for pigmentation, but she had no cosmetic concerns and denied treatment. Patient was reassured of the benign nature of the disease. [jcasonline.com]
Hence, treatment for LHS is not indicated, except for esthetic and/or psychological reasons. [scielo.br]
The relationships with these conditions have not been well established.[5] TREATMENT No treatment is required for this condition since it is not associated with systemic diseases or complications. [ncbi.nlm.nih.gov]
In this case, target diagnostic evaluation notably reduced the need for additional expensive and invasive procedures and treatments. [edm.bioscientifica.com]
Prognosis
The prognosis of the disease is good as there is no systemic illness or malignancy associated with LHS. [jcasonline.com]
Prognosis The pigmentary lesions of Laugier-Hunziker syndrome usually respond poorly to therapy, and it displays high recurrence. [statpearls.com]
Prognosis Laugier-Hunziker syndrome has a benign course. One report has described spontaneous remission. [9] Systemic illness and malignancy are not features of Laugier-Hunziker syndrome. [emedicine.medscape.com]
Etiology
Hence, this condition represents a rare, acquired mucocutaneous pigmentary disorder of unknown etiology. [icliniq.com]
Click here to view LHS, whose etiology is not fully elucidated, is more common in white people and the average age of onset is 52 years.[2],[3] It has been shown that pigmentation in LHS is most often seen on the lower lip and the buccal mucosa. [dermsinica.org]
The exact etiology and pathogenesis involved in LHS remain still uncertain. It involves the lips, oral mucosa, acral surfaces, nails and perineum. [henrypublishinggroups.com]
Etiology The etiology of melanosis in Laugier-Hunziker syndrome is unknown. Epidemiology Frequency United States The incidence is rare, but it is likely underreported. [emedicine.medscape.com]
Nevertheless, medication-induced melanonychia or ethnic-type melanonychia may have similar dermoscopic patterns. 7 Various differential diagnoses considered for LHS can be ruled out by the appearance and etiology of hyperpigmentation. [ncbi.nlm.nih.gov]
Epidemiology
[…] of Oral and Nail Pigmentation Khouna A1, Daflaoui H1, Bouabdella S1, Dikhaye S1,2 and Zizi N1,2 1Department of Dermatology, Mohammed VI University Hospital of Oujda, Medical School of Oujda, Mohammed First University of Oujda, Morocco. 2Department of Epidemiology [henrypublishinggroups.com]
Epidemiology, diagnosis and treatment. Am J Clin Dermatol. 2001; 2: 253-262 Mirbod S.M. Ahing S.I. Tobacco-associated lesions of the oral cavity. J Can Dent Assoc. 2000; 66: 252-256 Fry L. Almeyda J.R. [oooojournal.net]
Epidemiology Laugier-Hunziker syndrome has more frequently been reported in the Asian population and displays a higher incidence in the Chinese population.[5][6] Cases have also been reported in European regions such as France and Italy. [statpearls.com]
Epidemiology Frequency United States The incidence is rare, but it is likely underreported. White patients and those of Latino descent have been described in the United States. [emedicine.medscape.com]
Dereure, “Drug-induced skin pigmentation epidemiology, diagnosis and treatment,” American Journal of Clinical Dermatology, vol. 2, no. 4, pp. 253–262, 2001. View at: Google Scholar S. M. Mirbod and S. I. [hindawi.com]
Pathophysiology
Pathophysiology of this syndrome is still unknown. It is considered benign with no systemic manifestation or malignant potential. [edm.bioscientifica.com]
[…] abnormalities has moved some authorities to propose a name change to Laugier and Hunziker pigmentation. [1] When associated with nonclassic body locations or atypical features, the name idiopathic lenticular mucocutaneous hyperpigmentation has been used. [2] Pathophysiology [emedicine.medscape.com]
Calderipe, Julianne Bartz Maass, Vinicius Coelho Carrard, Manoela Domingues Martins, Lucas Guimarães Abreu, Lauren Frenzel Schuch, Ana Carolina Uchoa Vasconcelos Oral Diseases. 2021; [Pubmed] | [DOI] 5 Peutz–Jeghers Syndrome and the Role of Imaging: Pathophysiology [jomfp.in]
Prevention
Differentiating LHS from Peutz-Jeghers syndrome can prevent unnecessary aggressive cancer screening protocols. The average age of onset of LHS is 52 years and typically occurs in white adults. [mdedge.com]
Treatment is sought mainly for cosmetic reasons and include Q-switched Nd: YAG or Q-switched alexandrite laser therapy for bothersome melanosis on the skin. [9] Sun protection is important to prevent reoccurrence. [jcasonline.com]
Sun protection is important to prevent reoccurrence.3 LHS is probably more common than is generally recognized.2 We should be more familiar with the disorder. References Laugier P, Hunziker N. [nature.com]