Approaches to the evaluation of lip hyperpigmentation

Abstract

Hyperpigmentation of the lips is a common condition. It is associated with a wide variety of conditions that include physiologic changes, genodermatoses, inflammatory diseases, endocrinologic disorders, drugs and chemicals, benign and malignant neoplasm, and other non‐melanotic conditions. The aim of this article is to provide a clinical approach to hyperpigmented lesions on the lips based on the extent of lesions, the age of onset, and associated systemic involvements. In this review, we present an algorithm to guide the diagnosis of and plan for therapeutic intervention for pigmented lesions of the lips. The algorithm is based on the typical clinical presentation of each entity and should not be taken as an absolute indicator of diagnosis. Although the differences in color can help to differentiate among pigmented lesions, the interpretation of color can be subjective and is influenced by the amount and location of the pigment within the mucosa. The limitations of this review are that some data are based on case reports and small case series that may not reflect true association.

Q‐switched double‐frequency Nd:YAG (532 nm) laser is an effective treatment for racial lip pigmentation

“…Following this, the lesion must be stratified into either focal or nonfocal extent. For focal lesions, the morphological characteristics are the most vital to assess (to rule out neoplastic lesions), while age‐of‐onset and evaluation for systemic involvement is of greatest importance in establishing a diagnosis for multiple or diffuse lesions . Entities that commonly result in multiple hyperpigmented lesions of the lip include Peutz‐Jeghers syndrome, Addison's disease, Albright's syndrome, lentigo simplex, solar lentigos, and functional melanocytic nevi.…”

“…Entities that commonly result in multiple hyperpigmented lesions of the lip include Peutz‐Jeghers syndrome, Addison's disease, Albright's syndrome, lentigo simplex, solar lentigos, and functional melanocytic nevi. Diffuse involvement without systemic systems, as in the case of the patient above, is common in smokers, but can also be seen with certain drugs, drug eruptions, Laugier‐Hunziker syndrome, and as a normal racial variant . In the case of the patient above, lip hyperpigmentation was most likely the latter, as work‐up revealed no systemic symptoms and she was not a smoker.…”

“…For focal lesions, the morphological characteristics are the most vital to assess (to rule out neoplastic lesions), while age-of-onset and evaluation for systemic involvement is of greatest importance in establishing a diagnosis for multiple or diffuse lesions. 5 Entities that commonly result in multiple hyperpigmented lesions of the lip include Peutz-Jeghers syndrome, Addison's disease, Albright's syndrome, lentigo simplex, solar lentigos, and functional melanocytic nevi. Diffuse involvement without systemic systems, as in the case of the patient above, is common in smokers, but can also be seen with certain drugs, drug eruptions, Laugier-Hunziker syndrome, and as a normal racial variant.…”

Laugier-Hunziker syndrome: a case of asymptomatic mucosal and acral hyperpigmentation

“…Due to the benign nature of the disease, it is critical to differentiate this disorder from conditions with similar mucocutaneous pigmentary changes with somatic abnormalities that require medical attention [12]. The differential diagnosis considered for this adult patient with hyperpigmentation of fingers and lips included medication-induced, exposures to heavy metals, Addison’s disease, and rare genetic syndromes such as Peutz-Jeghers syndrome (PJS).…”

Valproic Acid-Induced Hyperpigmentation

“…Drugs may cause a post inflammatory hyperpigmentation that is a typical non-specific reaction of fixed drug reactions. Hyperpigmentation of the lips is a common presentation in clinical practice that require a systematic approach for the diagnostic that includes a complete medical history, family history, history of cosmetic and medication use, and evaluation of systemic symptoms (30). The list of medications that can cause lip or oral hyperpigmentation include sulphonamides, nonsteroidal anti-inflammatory drugs, carbamacepine, phenothiazines, minocycline, zidovudine, cyclophosphamide, doxorubicin, escitalopram, levodopa, nicotine, tacrolimus, cotrimazole, colchicines, ketoconazole, pyrimethamine and barbiturates (30,31).…”