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Pigmentation on the oral mucosa, hands, and feet

  • Author Footnotes
    1 The authors contributed equally to the work.
    Ziwei Wang
    Footnotes
    1 The authors contributed equally to the work.
    Affiliations
    Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
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  • Author Footnotes
    1 The authors contributed equally to the work.
    Jin Li
    Footnotes
    1 The authors contributed equally to the work.
    Affiliations
    Department of Dermatology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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  • Hong Fang
    Correspondence
    Corresponding authors at: Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University. No. 79, Qingchun Road, Hangzhou 310003, China.
    Affiliations
    Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
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  • Jianjun Qiao
    Correspondence
    Corresponding authors at: Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University. No. 79, Qingchun Road, Hangzhou 310003, China.
    Affiliations
    Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
    Search for articles by this author
  • Author Footnotes
    1 The authors contributed equally to the work.

      1. Case description

      1.1 Pigmentation on the oral mucosa, hands, and feet

      1.1.1 Indication

      A 56-year-old female presented to the dermatology clinic with pigmentation on the lips, gums and tongue for 5 years. The amout and range of lesions gradually increased. The patient denied having digestive tract symptoms. The family history was unremarkable.
      Physical examination showed brown to black spotted patches on the lips, gums and buccal mucosa (Fig. A, B). Light brown stripes appear on multiple nails (Fig. C). Except for the mucocutaneous lesions, no other significant signs were found.
      No abnormality was detected in gastrointestinal endoscopy. The feces examination did not find red blood cells. No endocrine abnormal was found.
      Dermoscopy demonstrated brownish uniform pigmentation on the pale red background of the lips. Brown longitudinal stripes with uniform color were visible on the nails. Histopathology of a biopsy taken from the lip showed hyperpigmentation in the basal layer of the epidermis (Fig. 1).
      Fig 1
      Fig. 1A, B: Brown to black spotted patches on the lips, gums and buccal mucosa. C: Light brown stripes on the nails.

      2. What is the diagnosis?

      2.1 Diagnosis

      A diagnosis of Laugier-Hunziker (LH) syndrome was made. LH syndrome is a rare clinical syndrome, often manifested as pigmentation in the lips and buccal mucosa, hands, feet and nails. The diagnosis of the disease is exclusive. It is necessary to distinguish it from other diseases with mucocutaneous pigmentation, including Peutz- Jeghers syndrome, Addison syndrome, and melanoma. Unlike Peutz- Jeghers syndrome, it often occurs in middle age and has no polyps in the gastrointestinal tract. Peutz- Jeghers syndrome often occurs at childhood and accompanied with multiple polyps in the gastrointestinal tract, although they have similar mucocutaneous appearance. Addison's disease often manifests as diffuse skin and mucous membrane pigmentation, especially in the exposed parts of the face and limbs. Patients with Addison's disease often accompany with hypotension and weight loss [
      • Wang W.M.
      • Wang X.
      • Duan N.
      • Jiang H.L.
      • Huang X.F.
      Laugier-Hunziker syndrome: a report of three cases and literature review.
      ,
      • Duan N.
      • Zhang Y.
      • Wang W.
      • Wang X.
      Mystery behind labial and oral melanotic macules: clinical, dermoscopic and pathological aspects of Laugier-Hunziker syndrome.
      ]. For LH syndrome, the entity is benign and generally there is no tendency to malignant, and it does not need to be treated aggressively. Laser and cryotherapy could be used for patients with cosmetic inquiry [
      • Wei Z.
      • Li G.Y.
      • Ruan H.H.
      • Zhang L.
      • Wang W.M.
      • Wang X.
      Laugier-Hunziker syndrome: A case report.
      ,
      • Paul J.
      • Harvey V.M.
      • Sbicca J.A.
      • O'Neal B.
      Laugier-Hunziker syndrome.
      ].

      Declaration of Competing Interest

      None declared.

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