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Smokers melanosis

Smokers melanosis. Diffuse melanosis of anterior facial maxillary & mandibular gingivae , buccal mucosa , lateral tongue , palate & floor of mouth occasionally seen among cigarette smokers. Pigmented areas are brown , flat & irregular. Melanin synthesis is stimuylated by tobbaco smoke products.

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Smokers melanosis

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  1. Smokers melanosis • Diffuse melanosis of anterior facial maxillary & mandibular gingivae , buccal mucosa , lateral tongue , palate & floor of mouth occasionally seen among cigarette smokers. • Pigmented areas are brown , flat & irregular. • Melanin synthesis is stimuylated by tobbaco smoke products. • Heat of smoke may stimulate pigmentation.

  2. Post inflammatory pigmentation • Focal or diffuse pigmentation in areas that were subjected to previous injury or inflammation. • The mucosa overlying a non melanocytic malignancy may become pigmented.

  3. Melasma / chloasma • Acquired symmetric melanosis that typically develops on sun exposed areas of skin & frequently on face. • Forehead , cheeks , upperlips & chin are most commonly affected areas. • Melasma has been used to describe any form of generalised facial hyperpigmentation including those related to post inflammatory changes & medication use.

  4. Melanosis associated with systemic or genetic disease • Hypoadrenocortism: • As steroid levels decrease , there is a compensatory activity by ACTH secretion , but if persists , the serum levels of alpha melanocyte stimulating hormone also increase. • Mucocutaneous hyperpigmentation • Generalised bronzing of skin &diffuse but patchy melanosis of oral mucosa. • Treatment is exogenous steroid replacement therapy.

  5. Cushings syndrome • Prolonged exposure of endogenous or exogenous corticosteroids. • Due to activating , germline mutations in ACTH receptor. • Weight gain & characterstic “moon facies”. • Diffuse mucocutaneous pigmentation. • Treatment is surgical , radiation or medicinal therapy.

  6. Hyperthyroidism • 40% of black patients with thyrotoxicosis may present mucocutaneous pigmentation. • Pigmentation tends to resolve following treatment of thyroid abnormality.

  7. Primary biliary cirrhosis • Autoimmune • Develops in middle aged women. • Disease results from damage to small intra hepatic bile ducts. • Oral mucosal tissues are not affected

  8. Vitamin B12 deficiency • Generalised burning sensation & erythema & atrophy of the mucosal tissue. • Pigmentation resolves followimg vitamin B12 levels.

  9. Peutz – jeghers syndrome • Autosomal dominant disease associated with mutations in STK11/LKB1 tumor suppresor gene. • Intestinal polyposis , cancer susceptibility & multiple , small , pigmented macules of lip , perioral skin , hand & feet. • Resemble ephelides usually <0.5mm in diameter. • Lesion may develop on anterior tongue , buccal & labial mucosa. • Lip & perioral pigmentation is higly distinctive

  10. Café –au – lait pigmentation • Identified in number of different genetic disorders include • Neurofibromatous type 1 • Mccune – albright syndrome • Noonans syndrome • Present as tan or brown colored , irregularly shaped macules of variable size. • Occur anywhere on skin , oral macular pigmentation have been reported.

  11. HIV / AIDS • Pigmentation may be related to intake of various medications , anti fungal & anti retoviral drugs. • May also occur due to adreno cortical destruction by virulent infectious organisms. • Significant correlation between mucocutaneous pigment & CD4 counts / micro litre lessthan or equal to 200. • Buccal mucosa is most affected site ,gingiva , palate &tongue involved.

  12. Idiopathic pigmentation • Laugier – hunziker pigmentation: • Hyperpigmentation of oral mucosal tissues involve lips & buccal mucosa. • Pigmentation of esophageal , genital & conjunctival mucosae & acral surfaces. • Nail involvement in form of longitudinal melanotic streaks & without evidence of dystrophic change. • Multiple , discrete , irregularly shaped brown oral macules & not more than 5mm in diameter.

  13. Treatment of mucocutaneous melanosis • Laser therapy has proven effective but recurrence occur in 20% of treated patients. • Various types of lasers. • Super pulsed CO2 • Q – switched Nd – YAG • Switched alexandrite lasers • Cryotherapy • Phototherapy include intense pulsed light & fractional photothermolysis.

  14. First- line therapy involves application of tropical medicaments , that is bleaching cream. • Simple agents such as azelaic acid or hydroquinone. • Triple combination therapy • 4% hydroquinone • 0.05% retinoic acid • 0.01% fluocinoloneacetonide has proven effective in 90% of patients.

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