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Pigmented fungiform papillae of the tongue are a benign condition that is characterized by pigmentation involving the fungiform papillae. Our patient is a 25-year-old female who has an asymptomatic pigmentation over the tongue for 13 years. Examination showed pigmentation confined to the fungiform papillae on the dorsum of the tongue. The diagnosis...
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... Inflammatory conditions such as lichen planus, Peutz-Jeghers disorder, or endocrinological conditions such as Addison's disease, diabetes mellitus, pregnancy, and hyperthyroidism are the examples of endogenous causes. [4,5] Although many patients do not have other complaints, some recorded cases have particular correlations, including linear circumflex ichthyosis, lichen planus, Hori's nevus, melisma, hemochromatosis, scleroderma, pernicious anemia, and iron-deficiency anemia as obtained in our patient. [1,5] There are correlations linking pigmented papillae fungiform to high levels of estrogen as menstrual irregularities and obesity, which is a possible etiology in this case. ...
... [4,5] Although many patients do not have other complaints, some recorded cases have particular correlations, including linear circumflex ichthyosis, lichen planus, Hori's nevus, melisma, hemochromatosis, scleroderma, pernicious anemia, and iron-deficiency anemia as obtained in our patient. [1,5] There are correlations linking pigmented papillae fungiform to high levels of estrogen as menstrual irregularities and obesity, which is a possible etiology in this case. [1,6] PFPs are often described as an oral manifestation of Laugier-Hunziker syndrome, a rare disorder that causes mucocutaneous pigmentations. ...
... [9] There is no reported cure, although one case reported an improvement after the treatment of iron-deficiency anemia. [5] ...
Pigmented fungiform papillae are a rare benign condition. It is commonly considered a diagnosis dilemma as it could be a clinical sign of a serious condition. Our patient was a middle-aged Saudi female presenting with hyperpigmentation along the lateral and anterior aspects of her tongue and was not associated with other cutaneous or mucocutaneous manifestation. Her medical history was significant for iron deficiency anemia, hepatic hemangioma, cervical and lumbar intervertebral disc herniation, and gastroesophageal reflux disease. Upon inspection, she had a longitudinal hyperpigmented tan-brown patch on the lateral aspects of her tongue and pinpoint discoloration evenly distributed on the papillae of the anterior tongue. The examination by mucoscopy revealed a cobblestone appearance along the mentioned distribution. The patient refused to have the biopsy done, but she was reassured about her condition and instructed to visit the clinic if she has any further issues.
... Twenty-six studies reported associated skin and mucosal findings in addition to PFP, such as patch stage mycosis fungoides (1/69) [34], or IA mycosis fungoides (1/69) [35], acanthosis nigricans (1/69) [36], pigmented macules on trunk (1/69) [37] [30], and similar PFP affects also seen in another family member, especially the mother (2/69) [55,56]. A few studies clearly stated that skin, mucosal, or nail pigmentation was not found [31,33,46,49,50,[52][53][54][57][58][59][60] or that parents or family members did not present similar pigmentation of the oral mucosa [38,61,62]. ...
... Only in three studies were some anomalies detected, including low hemoglobin [41], low leucocyte count [41], higher mean corpuscle volume (MCV) [82], and heterozygosity of hemoglobin [36]. The blood glucose [51,69,71,82], vitamin levels [36,49,51,52,69,82], trace element [36,46,47,62,68,82], electrolytes [37,51,69,71,81], and blood chemistry, including ferritin [49,51,52,69] and urea [37,[69][70][71] were reported within normal limits, as well as metabolic panel [46,47,49,62] and some analyses stated as routine laboratory investigations [53,58]. Only one study reported a high level of iron in a Vietnamese male [82]. ...
... Only in three studies were some anomalies detected, including low hemoglobin [41], low leucocyte count [41], higher mean corpuscle volume (MCV) [82], and heterozygosity of hemoglobin [36]. The blood glucose [51,69,71,82], vitamin levels [36,49,51,52,69,82], trace element [36,46,47,62,68,82], electrolytes [37,51,69,71,81], and blood chemistry, including ferritin [49,51,52,69] and urea [37,[69][70][71] were reported within normal limits, as well as metabolic panel [46,47,49,62] and some analyses stated as routine laboratory investigations [53,58]. Only one study reported a high level of iron in a Vietnamese male [82]. ...
The pigmentation of the fungiform papillae of the tongue is a rare idiopathic condition in which only the fungiform papillae appear hyperpigmented. In the absence of any reviews on the subject, we conducted a systematic review of the aetiopathogenesis and pathophysiology of pigmented fungiform papillae (PFP) of the tongue, including its demographic and histopathological features, trying to outline a possible aetiology. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) was performed using PubMed, Scopus, EMBASE databases and manual searches, for publications between January 1974 and July 2022. Inclusion criteria were case reports defining patients’ characteristics, their general medical and dental conditions, histopathological and/or immunohistochemical findings, all with a final definitive diagnosis of PFP. Overall, 51 studies comprising 69 cases of PFP which included histopathological descriptions were reviewed. Prominent features consisted of hyperpigmentation of melanocytes, melanophages, chromatophores, and a lymphocytic infiltrate in the subepidermal area of the fungiform papillae. On special staining, PFP contained melanin, not iron or hemosiderin. On immunohistochemistry, immune-reactive CD3+ T lymphocytes, S-100 and Sox10, but non-immune-reactive melan-A intraepithelial melanocytes were noted in some studies. The presence of hyperpigmented melanocytes and melanophages, with non-immune-reactive melan-A, suggests that PFP are a benign and physiological form of pigmentation. The inflammatory infiltrates described in some papillary lesions could possibly be due to traumatic events during mastication. Nevertheless, the true reasons for the hyperpigmentation of the fungiform papillae are as of yet elusive, and remain to be determined.
... Usually, the number ranges between 3 and 7. Type 3 is characterized by scattered appearance of PPFT on the dorsum surface. 34,35 Visual examination using dermoscopy is helpful in recognizing clinical types and chair side confirmation of PPFT. ...
Introduction
The practice of dermoscopy in dental and oral examination is low due to less popularity and not well established of the diagnostic tool in dental practice. The dermoscopy examination provides a specific dermoscopes details for pigmented papillary fungiform of tongue (PPFT) as cobblestone appearance and rose-petal appearance. With this dermoscopes details serves as a non-invasive diagnostic tool and prevents biopsy procedure.
Objective
We performed a systematic review to evaluate the published papers related to pigmented papillary fungiform on the tongue, aiming to understand the diagnostic role of dermoscopy examination in pigmented papillary fungiform.
Data synthesis
Initial result was 136 studies. Final exclusion of 27 articles was made based on the following factors: reports with no clinical images, studies that did not confirm the diagnosis of PPFT and studies that did not use the dermoscopes details. Finally, seventeen studies with nineteen cases, reported of pigmented papillary fungiform of the tongue. Six studies (consist six cases) reported the dermoscopy and histopathology diagnosis of pigmented papillary fungiform, eleven studies (consist thirteen cases) reported only the dermoscopy. The dermoscopy examination presented cobblestone appearance is 47.37% and rose petal appearance is 52.63%. The comparation study by histopathology diagnosis was done, revealed no specific appearances.
Conclusions
The clinical appearance and dermoscopy is the key for diagnosis of the papillary fungiform on the tongue. Further research is needed for determining the etiology and predisposing factor in papillary fungiform so that the possibility of developing this condition can be predicted and proper treatment could be performed.
... Usually, the number ranges between 3 and 7. Type 3 is characterized by scattered appearance of PPFT on the dorsum surface. 34,35 Visual examination using dermoscopy is helpful in recognizing clinical types and chair side confirmation of PPFT. ...
Importance: The practice of dermoscopy in dental and oral examination is low due to less popularity and not well established of the diagnostic tool in dental practice. The dermoscopy examination provides a specific dermoscopes details for pigmented papillary fungiform of tongue (PFTT) as cobblestone appearance and rose-petal appearance. With this dermoscopes details serves as a non-invasive diagnostic tool and prevents biopsy procedure. Objective: We performed a systematic review to evaluate the published papers related to pigmented papillary fungiform on the tongue, aiming to understand the diagnostic role of dermoscopy examination in pigmented papillary fungiform. Evidence review: A PubMed, Google scholar and Embase databases were searched for the PFTT studies and case reports published during the period 1974-2020. Initial result was 136 studies. Final exclusion of 27 articles was made based on the following factors: reports with no clinical images, studies that did not confirm the diagnosis of PPFT and studies that did not use the dermoscopes details. Finally, seventeen studies with nineteen cases, reported of pigmented papillary fungiform of the tongue. Finding: The diagnosis of tongue papillary fungiform can be determined by dermoscopy examination. Six studies (consist six cases) reported the dermoscopy and histopathology diagnosis of pigmented papillary fungiform, eleven studies (consist thirteen cases) reported only the dermoscopy. The dermoscopy examination presented cobblestone appearance is 47.37% and rose petal appearance is 52.63%. The comparation study by histopathology diagnosis was done, revealed no specific appearances. Conclusions and relevance: The clinical appearance and dermoscopy is the key for diagnosis of the papillary fungiform on the tongue. Further research is needed for determining the etiology and predisposing factor in papillary fungiform so that the possibility of developing this condition can be predicted and proper treatment could be performed.
... Type 3 is hyperpigmentation of all fungiform papillae on the dorsum of the tongue. 11,17 Histological examinations were not performed in our cases because there were no complaints. This condition is 18 and in other cases showed slight lymphocytic infiltrate in the superficial. ...
The normal variant in the oral mucosa is a nonpathological condition. Clinical examination must be carefully performed to avoid misdiagnosis as pathological condition. We reported two rare cases of pigmented fungiform papillae and lingual fimbria. Case 1 presented a 22-year-old Javanese man, with no systemic disease and several dark patches over the tongue for2 years. Case 2 presented a 21-year-old Javanese woman with dark patches over the dorsal and lateral of the tongue which had been known for over 4 to 5 months. Both patients had no systemic issues and there were no complaints about the patches. The dark patches, which appeared in both cases, were found together with linear small bumps on the ventral surface of the tongue and near the lingual frenulum. Further examination and specific treatment were not carried out, in accordance with the condition on the tongue.
