History
• Onset
• Drug history
• Lesions elsewhere in body eg skin
• Onset
• Drug history
• Lesions elsewhere in body eg skin
Examination
• Diffuse or localised
• Peri oral pigmentation
• Associated amalgam restoration (including previous extraction or crown)
• Diffuse or localised
• Peri oral pigmentation
• Associated amalgam restoration (including previous extraction or crown)
Causes
• Racial
• Idiopathic
• Addisons
• Peutz Jeghers (not at increased risk of melanoma)
• Heavy metal poisoning
• Oral melanosis (usually smokers)
• Drug induced (lead, bismuth, Mercury)
• Melanoma (rare <1% oral cavity cancer)
• Kaposi's sarcoma
• Pigmented naevus
• Amalgam tattoo
• Vascular malformations eg haemangioma
• Racial
• Idiopathic
• Addisons
• Peutz Jeghers (not at increased risk of melanoma)
• Heavy metal poisoning
• Oral melanosis (usually smokers)
• Drug induced (lead, bismuth, Mercury)
• Melanoma (rare <1% oral cavity cancer)
• Kaposi's sarcoma
• Pigmented naevus
• Amalgam tattoo
• Vascular malformations eg haemangioma
Investigations
• Blood tests: check U+Es- if sodium normal then highly unlikely to be Addisons. Also for Addisons check serum cortisol and ACTH
• Biopsy- if any concerns of melanoma
• Blood tests: check U+Es- if sodium normal then highly unlikely to be Addisons. Also for Addisons check serum cortisol and ACTH
• Biopsy- if any concerns of melanoma
Drugs associated with oral mucosal pigmentation:
• Antimalarials: quinacrine, chloroquine, hydroxychloroquine
• Quinidine
• Zidovudine (AZT)
• Tetracycline
• Minocycline
• Chlorpromazine
• Oral contraceptives
• Clofazimine
• Ketoconazole
• Amiodarone
• Busulfan
• Doxorubicin
• Bleomycin
• Cyclophosphamide
• 5-Fluorouracil
• Antimalarials: quinacrine, chloroquine, hydroxychloroquine
• Quinidine
• Zidovudine (AZT)
• Tetracycline
• Minocycline
• Chlorpromazine
• Oral contraceptives
• Clofazimine
• Ketoconazole
• Amiodarone
• Busulfan
• Doxorubicin
• Bleomycin
• Cyclophosphamide
• 5-Fluorouracil
Smoker’s Melanosis
• Smoking may cause oral pigmentation in light-skinned individuals and accentuate the pigmentation of dark- skinned patients
• Smoking may cause oral pigmentation in light-skinned individuals and accentuate the pigmentation of dark- skinned patients
Peutz Jeghers
• Pigmented mucocutaneous macules around lips and inside mouth
• Intestinal hamartomatous polyposis
• Increased risk of cancer in many organs
• Pigmented mucocutaneous macules around lips and inside mouth
• Intestinal hamartomatous polyposis
• Increased risk of cancer in many organs
Addison’s Disease
• Hypoadrenalism due to progressive bilateral destruction of the adrenal cortex by autoimmune disease, infection or malignancy
• The lack of adrenocortical hormones in the blood stimulates production of ACTH by the anterior pituitary gland
• ACTH induces melanocyte-stimulating hormone causing diffuse pigmentation of the skin and oral mucosa
• Systemic manifestations including weakness, nausea and vomiting, abdominal pain, constipation or diarrhoea, weight loss and hypotension
• Assess levels of ACTH, plasma cortisol and serum electrolytes
• Addison’s disease can be fatal if left untreated
• Management involves treatment of the underlying cause and corticosteroid replacement therapy
• Hypoadrenalism due to progressive bilateral destruction of the adrenal cortex by autoimmune disease, infection or malignancy
• The lack of adrenocortical hormones in the blood stimulates production of ACTH by the anterior pituitary gland
• ACTH induces melanocyte-stimulating hormone causing diffuse pigmentation of the skin and oral mucosa
• Systemic manifestations including weakness, nausea and vomiting, abdominal pain, constipation or diarrhoea, weight loss and hypotension
• Assess levels of ACTH, plasma cortisol and serum electrolytes
• Addison’s disease can be fatal if left untreated
• Management involves treatment of the underlying cause and corticosteroid replacement therapy
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