We are grateful for the comments submitted by Dr Urbina and Dr Sudy following the publication of our case and research letter in the November 2011 issue of Actas Dermo-Sifiliográficas.1 Those authors have observed punctate pigmentation of the papillae of the tongue in patients with Laugier-Hunziker syndrome and consider the underlying process to be the same in the cases they have observed and those we describe as pigmentation of the fungiform papillae of the tongue.

Laugier-Hunziker syndrome is a rare condition characterized by pigmented lentiginous lesions that predominantly affect the lips, buccal mucosa, and palate, at times associated with melanonychia.2 The differential diagnosis should be established essentially with Peutz-Jeghers syndrome. Although Laugier-Hunziker syndrome can cause pigmented lesions on the tongue and this pigmentation may be more pronounced in the fungiform papillae, the condition is not related to the pigmented fungiform papillae of the tongue we described. Pigmentation of the fungiform papillae of the tongue is a much more common condition; it has been observed in 30% of black women and 25% of black men3 and can therefore be considered a normal variant of oral pigmentation found in dark-skinned individuals. Pigmentation of the fungiform papillae is not necessarily accompanied by lesions on the lips or at other sites. The fact that some patients with Laugier-Hunziker syndrome may present pigmented macules on the tongue and more marked pigmentation of the fungiform papillae is an interesting observation, but it does not mean that both conditions correspond to the same process.