Drug-associated hyperpigmentation of the oral mucosa: report of 4 cases.

Publication date: Available online 3 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Konstantinos I. Tosios, Eleni-Marina Kalogirou, Alexandra Sklavounou
ObjectiveTo describe four patients with oral mucosa hyperpigmentation associated with four drug classes and review the literature.Study DesignTwo patients under imatinib and hydroxychloroquine treatment exhibited diffuse palatal hyperpigmentation, while two patients medicated with minocycline and golimumab showed multifocal pigmented macules. In all cases biopsies were performed.ResultsMicroscopically, in all cases there was no increase in the number of melanocytes in the epithelium and pigment granules were present in the lamina propria. The pigment granules in minocycline- and golimumab-associated hyperpigmentation were seen in the superficial lamina propria and reacted for silver but not iron, while in imatinib- and hydroxychloroquine-associated hyperpigmentation were found in the reticular lamina propria and reacted both for silver and iron. A review of the literature found 38 cases of oral mucosa hyperpigmentation attributed to minocycline, 23 to imatinib, one to hydroxychloroquine without microscopic documentation, and none to golimumab.ConclusionThe temporal relationship between pigmentation and drug onset, resolution following drug withdrawal and exclusion of other causes support the diagnosis of drug-induced hyperpigmentation. Microscopic examination may be contributory to diagnosis, as there are differences among drugs in the distribution of pigment granules and their histochemical reactions.



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