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Dear Colleagues,
I would like to post this case of black tongue and inner lips of this young lady who fixed a metal bridge of silver one month before the appearance of this pigmentation on the inner lips (note the exact match of the bridge and the site of pigment , the presence of pigment on tongue because the patient tongue comes in contact with bridge.
(first three pic are clnical then perl stain, left and below(negatvie) fontana masson middle and below (positive) then H+E right and below)
I performed for her 3 mm punch biopsy and sutures with silk 5/0, the biopsy showed pigment in the dermis with many melanophges, there was no increase pigment in the basal cell layer, so genetic melanosis was ruled out, there was no inflammotory cells so drug eruption and contact and lichen planus were ruled out. Fontana Massson stain was positive though it is not specific for silver because it stains also melanin, but it was positive.
I send this case to agree with my colleague Dermlive that shisha tip if it was made of metal will cause this pigmentation which is practically a form of a tattoo, treatment is difficult and depends on the ability of the melanophages to scavenge abd clean the lamina properia from this silver deposition.
A careful history of contact with metals (bridges, metal tip of sheesha ) should always be asked about in a black tongue and skin biopsy is mandatory in this.
Best Regards
Filed under: tongue | Tagged: Add new tag, tongue
dermlive
dermis111
dr660
skindr
visitor111
epiderma
kamalsaleh
excellent case!
i was thinking racial pigmentation at first, but the temporal relationship with the metal prosthesis seems to be the reason.
then the pigmentation extended on the dorsum to the mliddle of the tongue where there is no direct contact with the metal but she was probably playing with the metal. i would still prescribe antifungal+mouth washes+gentle cleansing
as for the my previous post (black tongue), am having a new differential, i came through a disease called pigmented gungiform papillae where you have prominent erythematous papillae in a hyperpigmented patch along the sides of the tongue, alomost like our patient. its considered a normal variation in 25%of blacks.
and there is this thing called (racial pigmentation in the tongue) but i didnt find a correct discribtion for it in the literature.
we can deal with this lesion as tatoo, so we can treat it by laser therapy for tatoo !, if the patient want to remove this pigmentation from the tongue , any experience in treatment of pigmentation in the mucosa or the tongue by laser before ?