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Multi focal/ diuse

pigmentation

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Multifocal / Diuse Pgmentation

Physiologic pigmentationDrug induced melanosis

Smokers melanosis

Post inammatory(Inammatory)Hyperpigmentation

Melasma(chloasma)

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Physiologic pigmentation

Most common multifocal pigmentationften o!ser"ed in childhood and

doesnot de"olop deno"o in the adult#

Mostly restricted to gingi"aHistologically $% increased amount of

melanin pigment &ithin the !asal celllayer

' "arient of normal mucosa

Surgery laser therapy may !e tried!ut eects are temperory

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Drug induced Melanosis

'ntimalarials phenothiaenes oralcontracepti"es cyclophosphamide!usulfan

Diuse yet localied to one mucosalsurface or can !e multifocal andin"ol"e multiple surfaces#

*esions are at and &ith out any

e"idence of nodularity or s&ellingSun e+posure may e+acer!ate

cutaneous drug induced pigmentation

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Microscopicaly$ ,asilar hyperpimentation &ith out

increase I no$ of melanocytes

-oloured drug comple+es may also seen

.hy this Drugs and drug meta!olites stimulates

melanogenesis#

Drugs may physically !ind &ith melaninand cause its retention(chloro0uine)

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Diagnosis$ History of drug intake#

Management $

Discontinue drug 1 discoloration &ill fade&ith in a fe& months

Pigmentation associated &ith hormonetherapy may tend to persists for longer

periods

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Smoker2s Melanosis

Diuse melanosis of anterior facial ma+mand ging ,M *at 3ongue palate and oorof the mouth is occasionally seen#

In certain indi"iduals(dark skinned) melanin

synthesis is stimulated !y to!acco smokeproducts#

Pigmented areas are !ro&n at and irregular

Smokelesss to!acco does not appear to !e

associated &ith oral melanosis#Increases prominantly during 4rst year of

smoking#

5ot a Preneoplastic condition

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'lcohol also associate &ith oralpigmentation

Posterior regions of mouth(soft

palate) are fre0uently in"ol"ed#'ssociated &ith higher risk of cancers

of upper aerodigesti"e tract#

SM6 1 diuse patchy melanotic pigmentation

Preneoplastic condition

Ha!itual che&ing of arecanut

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Post Inamatory(Inamatory)Hyperpigmentation

6ocal/ Diuse pigmentation inareas that &ere su!7ected topre"ious in7ury or inamation

8g$ 'cne face*ichen planus pigmentosus

In patients &ith lichen planus

,asilar hyperpigmentation and melaninincontinence

9pon resolution of lesion pigmentationmay or may not dis appear

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Melasma(-hloasma)

'c0uired symmetric melanosisthat typically de"olops on sun 1e+posed areas of the skin

-ommon sites 1foreheadcheekupperlipschin

6emale predeliction

 3ends to de"olop rapidly o"er aperiod of a fe& &eeks

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 3erm Melasma is most appropriatelyused to descri!e pigmentary changesassociated &ith pregnancy  or

ingestion of contraceptive hormones#-om!ination of estrogen and

progesterone induces pigmentation

Melasma may spontaneously resol"e

after parturition or cessatione+ogenous hormone or regulation ofendogenous se+ hormones#

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 3hank :ou