 |
|
Black Taste Buds
James F. Pehoushek, MD;
Scott A. Norton, MD
Arch Fam Med. 2000;9:219-220.
REPORT OF A CASE
A 28-year-old Haitian woman asked for the removal of a small growth on the tip of her tongue. A 3 x 4-mm pale papule on the tip of her tongue was excised with a scissors snip and found to be an oral fibroma. The patient also had groups of dark papillae on the tip and anterolateral aspects of the dorsal surface of the tongue (Figure 1). She reported that the dark spots had been present as long as she could recall. She was otherwise healthy, had never used tobacco, and was taking no medications. A photomicrograph of a hematoxylin-eosin–stained hyperpigmented papilla is shown in Figure 2 (low power, left; high power, right).
What is your diagnosis?
From Raymond W. Bliss Army Health Center, Fort Huachuca, Ariz.
Diagnosis and Discussion: Pigmented Fungiform Papillae of the Tongue
HISTOPATHOLOGIC FINDINGS
The fungiform papilla consisted of a stratified squamous epithelium overlying a loose connective tissue core. Melanocytes and keratinocytes containing brown melanin granules were present along the base of the epithelium. Several melanophages with coarser melanin granules were evident within the connective tissue core or lamina propria.
DISCUSSION
In dark-skinned individuals, pigmented fungiform papillae of the tongue are common, yet they are seldom mentioned in the medical literature. They were first described in 1905 by Leonard1 as a putative adverse effect of human hookworm disease. In 1973, Holzwanger et al2 examined 300 random individuals and noted that among blacks 30% of the men and 25% of the women had some hyperpigmentation of their fungiform papillae. A study in healthy South African blacks found that 33 of 122 had pigmented fungiform papillae.3 The condition is more prevalent in people with dark complexions. In most cases, pigmented lesions are asymmetrical spots or plaques on the dorsal surface and lateral aspects of the tongue.4
The dorsum of the tongue is covered with 3 different types of papillae: filiform, fungiform, and circumvallate. Fungiform papillae predominate along the lateral edges and apex of the tongue but are sparse on most of the dorsal surface of the tongue, where filiform papillae predominate. In pigmented fungiform papillae of the tongue, these papillae become prominently enlarged and hyperpigmented. Histologic examination shows that the pigmentation is due to an accumulation of melanin in macrophages in the papillary dermis.5-6
The main consideration in the differential diagnosis is black hairy tongue. This benign condition has been attributed to the growth of pigment-producing organisms in the oral cavity as well as to exposure of the tongue to oxidizing agents, excessive use of tobacco, antibiotic therapy, exposure to food colorings, vitamin deficiency, gastrointestinal disorders, and poor oral hygiene. In contrast to pigmented fungiform papillae of the tongue, black hairy tongue involves the filiform papillae.7
Lingual hyperpigmentation can be associated with Addison disease, Peutz-Jeghers syndrome, melanoma, amalgam tattoo, toxic reactions to various metals, hemochromatosis, pernicious anemia, scleroderma, Laugier-Hunziker syndrome, and treatment with chemotherapeutic agents and antibiotics, such as minocycline.2, 5, 8-10
AUTHOR INFORMATION
Selected from Arch Dermatol. 1999;135:593. Off-Center Fold.
REFERENCES
|
1. Leonard TMR. Ankylostomiasis or uncinariasis. JAMA. 1905;45:588-594.
2. Holzwanger JM, Rudolph RI, Heaton CL. Pigmented fungiform papillae of the tongue. Arch Dermatol. 1967;95:394-396.
FREE FULL TEXT
3. van Wyk CW. Mouth pigmentation patterns in a group of healthy South African Bantu. S Afr Med J. 1970;44:177-180.
PUBMED
4. Anavi Y, Mintz S. Unusual physiologic melanin pigmentation of the tongue. Pediatr Dermatol. 1992;9:123-125.
PUBMED
5. Ahn SK, Chung J, Lee SH, Lee WS. Prominent pigmented fungiform papillae of the tongue. Cutis. 1996;58:410-412.
PUBMED
6. Isogai Z, Kanzaki T. Pigmented fungiform papillae of the tongue. J Am Acad Dermatol. 1993;29:489-490.
PUBMED
7. Sarti GM, Haddy RI, Schaffer D, Kihm J. Black hairy tongue. Am Fam Physician. 1990;41:1751-1755.
ISI
| PUBMED
8. Veraldi S, Cavicchini S, Benelli C, Gasparini G. Laugier-Hunziker syndrome: a clinical histopathologic, and ultrastructural study of four cases and review of the literature. J Am Acad Dermatol. 1991;25:632-636.
FULL TEXT
|
ISI
| PUBMED
9. Meyerson MA, Cohen PR, Hymes SR. Lingual hyperpigmentation associated with minocycline therapy. Oral Surg Oral Med Oral Pathol. 1995;79:180-184.
10. Dummett CO. Pertinent considerations in oral pigmentations. Br Dent J. 1985;158:9-12.
PUBMED
|
