Multi focal/ diffuse

pigmentation

Multifocal / Diffuse Pgmentation

Physiologic

pigmentation
Drug induced melanosis
Smokers melanosis
Post inflammatory(Inflammatory)
Hyperpigmentation
Melasma(chloasma)

Physiologic pigmentation
Most

common multifocal pigmentation

Often observed in childhood and
doesnot devolop denovo in the adult.
Mostly restricted to gingiva
Histologically :- increased amount of
melanin pigment within the basal cell
layer
A varient of normal mucosa
Surgery, laser therapy may be tried
but effects are temperory

Drug induced Melanosis

Antimalarials,

phenothiazenes, oral
contraceptives, cyclophosphamide,
busulfan
Diffuse, yet localized to one mucosal
surface or can be multifocal and
involve multiple surfaces.
Lesions are flat and with out any
evidence of nodularity or swelling
Sun exposure may exacerbate
cutaneous drug induced pigmentation

Microscopicaly:
Basilar hyperpimentation with out
increase I no: of melanocytes
Coloured drug complexes may also seen

Why

this?

Drugs and drug metabolites stimulates

melanogenesis.
Drugs may physically bind with melanin
and cause its retention(chloroquine)

Diagnosis:
History of drug intake.

Management

Discontinue drug discoloration will fade

with in a few months
Pigmentation associated with hormone
therapy may tend to persists for longer
periods

Smokers Melanosis
Diffuse

melanosis of anterior facial max,

mand ging, BM, Lat Tongue, palate and floor
of the mouth is occasionally seen.
In certain individuals(dark skinned) melanin
synthesis is stimulated by tobacco smoke
products.
Pigmented areas are brown , flat and irregular
Smokelesss tobacco does not appear to be
associated with oral melanosis.
Increases prominantly during first year of
smoking.
Not a Preneoplastic condition

Alcohol

also associate with oral

pigmentation
Posterior regions of mouth(soft
palate) are frequently involved.
Associated with higher risk of cancers
of upper aerodigestive tract.
OSMF
diffuse patchy melanotic pigmentation
Preneoplastic condition
Habitual chewing of arecanut

Post Inflamatory(Inflamatory)
Hyperpigmentation
Focal/

Diffuse pigmentation in
areas that were subjected to
previous injury or inflamation
Eg: Acne face

Lichen

planus pigmentosus

In patients with lichen planus

Basilar hyperpigmentation and melanin
incontinence
Upon resolution of lesion , pigmentation
may or may not dis appear

Melasma(Chloasma)
Acquired

symmetric melanosis
that typically devolops on sun
exposed areas of the skin
Common sites
forehead,cheek,upperlips,chin
Female predeliction
Tends to devolop rapidly over a
period of a few weeks

Term

Melasma is most appropriately

used to describe pigmentary changes
associated with pregnancy or
ingestion of contraceptive hormones.
Combination of estrogen and
progesterone induces pigmentation
Melasma may spontaneously resolve
after parturition, or cessation
exogenous hormone, or regulation of
endogenous sex hormones.

Thank You