N° 3 - Salute per tutti

286
M. Kadurina, B. Dimitrov, S. Bojinova, A. Jordanova, I. Litov, V. Kantarjiev, S. Tonev
General examination revealed diffuse melanotic
pigmentation of the buccal mucosae, palate,
gingivae and lower lip (Figures 1, 2, 3).
Longitudinal pigmented streaks were present
on the thumbnails (Figure 4) and on four other
fingers of both hands. Her toenails were unaffected.
Pigmented macules were observed in the
genital region (Figures 5, 6).
Laboratory investigations, including a full
blood count, hematinic levels, serum chemistry,
and inflammatory markers, were all within the
normal range.
The patient underwent an upper gastrointestinal
study, barium enema, and sigmoidoscopic
study, which revealed no evidence of polyps.
To rule out Addison’s disease, the serum cortisol
and adrenocorticotropic hormone (ACTH)
levels were measured, and the values were normal.
Punch biopsy from genital macules revealed
increased melanin pigmentation of basal keratinocytes,
high numbers of melanophages and
areas of melanin incontinence; the appearance
and number of melanocytes present appeared
normal (Figures 7, 8).
D iscussion
The spontaneous occurrence of macular
hyperpigmentation on the lips and oral
mucosa in the absence of associated systemic
lesion was first reported by Laugier and
Hunziker in 1970. 1
In LHS, pigmentary changes usually begin in
the third to fifth decade of life. 2, 3 Women are
affected more frequently than men. The pigmentation
consists of macules, which are usually
round or oval and are occasionally linear and
which may vary in color from brown to slate
gray or black. Classically, the areas affected
include the lips, especially the lower lips, and
oral cavity. 4
The buccal mucosa is commonly aff e c t e d ;
reports also include pigmentation of the hard
and soft palate, gingiva, palatoglossal arch, floor
of the mouth, and tongue. 3, 5
Some cases have been described in which the
neck, thorax, abdomen, fingers, and soles have
been involved. The fingernails are more frequently
involved than the toenails. 3, 5, 6
Our patient was also a woman in whom LHS
developed during middle age. She had pigmentation
of the lower lips, buccal mucosa, and fin-
Journal of Plastic Dermatology 2008; 4, 3
Figure 1
Figure 2
Figure 3
Figure 4