Case and research letters
Pigmentation of the Fungiform Papillae of the Tongue: A Report of 2 Cases
Pigmentación de las papilas fungiformes linguales. A propósito de dos casos
J. Marcoval
, J. Notario, S. Martín-Sala, I. Figueras
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Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
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A propósito de dos casos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "739" "paginaFinal" => "740" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pigmentation of the Fungiform Papillae of the Tongue: A Report of 2 Cases" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 624 "Ancho" => 950 "Tamanyo" => 118525 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caso 1. 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Marcoval, J. Notario, S. Martín-Sala, I. Figueras" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Marcoval" "email" => array:1 [ 0 => "jmarcoval@bellvitgehospital.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Notario" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Martín-Sala" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Figueras" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pigmentación de las papilas fungiformes linguales. A propósito de dos casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 625 "Ancho" => 952 "Tamanyo" => 95027 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2. Pigmented fungiform papillae of the tongue with a diffuse symmetrical pattern, predominantly affecting the lateral surfaces of the tongue in an indigenous South American woman.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pigmented fungiform papillae of the tongue was first described over a century ago.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although it seems fairly common in black individuals,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> few textbooks of dermatology and oral pathology refer to it.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Some cases have been described in Japanese and Indian populations,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> but it is considered rare in oriental races and very rare in white individuals.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present 2 patients in Spain recently diagnosed with pigmented fungiform papillae of the tongue. The first patient was a 35-year-old black woman. Her medical history included positive human immunodeficiency virus serology detected in 2006 and a cerebral tuberculoma treated with antituberculous drugs in 2007; she is currently on treatment with tenofovir, emtricitabine and nevirapine. The patient attended for pigmentation on the dorsum of the tongue that she had noticed a few months earlier. Examination of the oral mucosa showed that the patient had pigmentation limited to the fungiform papillae on some areas of the dorsum of the tongue. The pigmented papillae were in groups of 15 to 20 papillae, giving the dorsum of the tongue a mottled appearance (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). The second patient was a 43-year-old indigenous South American woman who had undergone cesarean section 22 years earlier. She was not taking any medication on a regular basis. The patient had noticed pigmentation on the dorsum of the tongue a few months earlier. Examination of the oral mucosa showed pigmentation limited to the fungiform papillae of the dorsum of the tongue. The majority of the fungiform papillae were pigmented and were present in a diffuse, symmetrical pattern, predominantly on the tip and lateral aspects of the dorsum of the tongue (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>). The fungiform papillae in the central area were not pigmented. She had no accompanying symptoms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pigmented fungiform papillae of the tongue was described in 1905 and was initially thought to be associated with hookworm infestation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Other authors have reported associations with dermatological disorders such as linear circumflex ichthyosis<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and lichen planus<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>; an association with systemic diseases such as hemochromatosis, scleroderma, pernicious anemia, and iron-deficiency anemia has also been described.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> However, all of these presumed associations were based on individual cases and not on systematic study, and taking into account that a large study conducted in South Africa found pigmented fungiform papillae in 6% of males and 8% of women,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> it is probable that they were merely coincidental. In a more recent study, 30% of black women and 25% of black men had pigmented fungiform papillae.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">From a clinical point of view, pigmented fungiform papillae usually develop in the second or third decade of life,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> though they may begin in childhood. The condition has been observed in black and Japanese individuals,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and in Australian aborigines<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Indians.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Its incidence in those races is unknown but is considered substantially lower than in the black race.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,7,8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The pathogenesis of pigmented fungiform papillae is unknown. Based on the presence of pigmented fungiform papillae in a mother and daughter, Werchniack et al<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> suggested autosomal dominant inheritance; however, this had not been previously described or corroborated in other articles. The reason for the abnormalities being limited to the fungiform papillae also remains unknown. The histological features of pigmented fungiform papillae include numerous melanophages in the lamina propria of the papillae with no inflammatory infiltrate.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,9</span></a> The pigment located within the melanophages stains positive for melanin with Fontana-Masson and negative for iron with Prussian blue.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The acquired nature of the lesions and the presence of melanophages suggests a transient period of inflammation, but the lack of inflammatory infiltrates is a histological marker of the condition.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis should include other causes of pigmentation of the oral mucosa such as hemochromatosis, pernicious anemia, amalgam tattoo, or Addison disease. However, a clear diagnosis can be reached in all those disorders on the basis either of the distribution and clinical characteristics of the pigmentation or the accompanying manifestations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">No effective treatment of pigmented fungiform papillae has been described,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> although in 1 case associated with iron-deficiency anemia a moderate reduction in pigmentation was reported after treatment of the anemia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We describe the first case of pigmented fungiform papillae in an indigenous South American woman and we believe that this condition may be observed in all intensely pigmented races. Given increasing migration into Europe, more cases will be seen; it is important to recognize pigmented fungiform papillae of the tongue to avoid incorrect diagnoses and avoid unnecessary additional tests.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Marcoval J, et al. Pigmentación de las papilas fungiformes linguales. A propósito de dos casos. Actas Dermosifiliogr.2011;102:739-740.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 625 "Ancho" => 952 "Tamanyo" => 103868 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1. Pigmentation limited to the fungiform papillae of the tongue, with irregularly distributed macules on the dorsum and lateral surfaces of the tongue in an indigenous African woman.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 625 "Ancho" => 952 "Tamanyo" => 95027 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2. Pigmented fungiform papillae of the tongue with a diffuse symmetrical pattern, predominantly affecting the lateral surfaces of the tongue in an indigenous South American woman.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ankylostomiasis or uncinariasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.M.R. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 24 | 15 | 39 |
| 2024 Octubre | 249 | 64 | 313 |
| 2024 Septiembre | 239 | 54 | 293 |
| 2024 Agosto | 259 | 93 | 352 |
| 2024 Julio | 265 | 75 | 340 |
| 2024 Junio | 202 | 57 | 259 |
| 2024 Mayo | 204 | 54 | 258 |
| 2024 Abril | 174 | 49 | 223 |
| 2024 Marzo | 240 | 48 | 288 |
| 2024 Febrero | 320 | 49 | 369 |
| 2024 Enero | 457 | 49 | 506 |
| 2023 Diciembre | 376 | 34 | 410 |
| 2023 Noviembre | 464 | 61 | 525 |
| 2023 Octubre | 602 | 50 | 652 |
| 2023 Septiembre | 617 | 39 | 656 |
| 2023 Agosto | 437 | 35 | 472 |
| 2023 Julio | 446 | 53 | 499 |
| 2023 Junio | 470 | 39 | 509 |
| 2023 Mayo | 532 | 59 | 591 |
| 2023 Abril | 449 | 36 | 485 |
| 2023 Marzo | 541 | 35 | 576 |
| 2023 Febrero | 614 | 31 | 645 |
| 2023 Enero | 482 | 44 | 526 |
| 2022 Diciembre | 384 | 48 | 432 |
| 2022 Noviembre | 186 | 40 | 226 |
| 2022 Octubre | 171 | 43 | 214 |
| 2022 Septiembre | 183 | 46 | 229 |
| 2022 Agosto | 191 | 37 | 228 |
| 2022 Julio | 124 | 39 | 163 |
| 2022 Junio | 113 | 45 | 158 |
| 2022 Mayo | 347 | 54 | 401 |
| 2022 Abril | 343 | 63 | 406 |
| 2022 Marzo | 444 | 71 | 515 |
| 2022 Febrero | 409 | 39 | 448 |
| 2022 Enero | 444 | 45 | 489 |
| 2021 Diciembre | 358 | 45 | 403 |
| 2021 Noviembre | 403 | 55 | 458 |
| 2021 Octubre | 524 | 61 | 585 |
| 2021 Septiembre | 383 | 49 | 432 |
| 2021 Agosto | 425 | 59 | 484 |
| 2021 Julio | 397 | 70 | 467 |
| 2021 Junio | 499 | 53 | 552 |
| 2021 Mayo | 439 | 61 | 500 |
| 2021 Abril | 845 | 110 | 955 |
| 2021 Marzo | 402 | 56 | 458 |
| 2021 Febrero | 327 | 69 | 396 |
| 2021 Enero | 269 | 44 | 313 |
| 2020 Diciembre | 239 | 55 | 294 |
| 2020 Noviembre | 199 | 35 | 234 |
| 2020 Octubre | 150 | 55 | 205 |
| 2020 Septiembre | 185 | 30 | 215 |
| 2020 Agosto | 127 | 53 | 180 |
| 2020 Julio | 106 | 38 | 144 |
| 2020 Junio | 118 | 69 | 187 |
| 2020 Mayo | 81 | 64 | 145 |
| 2020 Abril | 64 | 60 | 124 |
| 2020 Marzo | 50 | 71 | 121 |
| 2020 Febrero | 3 | 34 | 37 |
| 2020 Enero | 0 | 39 | 39 |
| 2019 Diciembre | 4 | 38 | 42 |
| 2019 Noviembre | 0 | 16 | 16 |
| 2019 Octubre | 0 | 14 | 14 |
| 2019 Septiembre | 10 | 18 | 28 |
| 2019 Agosto | 0 | 24 | 24 |
| 2019 Julio | 0 | 21 | 21 |
| 2019 Junio | 2 | 32 | 34 |
| 2019 Mayo | 1 | 47 | 48 |
| 2019 Abril | 0 | 65 | 65 |
| 2019 Marzo | 2 | 29 | 31 |
| 2019 Febrero | 0 | 21 | 21 |
| 2019 Enero | 1 | 8 | 9 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 4 | 23 | 27 |
| 2018 Agosto | 0 | 57 | 57 |
| 2018 Julio | 0 | 37 | 37 |
| 2018 Junio | 0 | 36 | 36 |
| 2018 Mayo | 0 | 55 | 55 |
| 2018 Abril | 0 | 51 | 51 |
| 2018 Marzo | 13 | 49 | 62 |
| 2018 Febrero | 398 | 38 | 436 |
| 2018 Enero | 494 | 36 | 530 |
| 2017 Diciembre | 453 | 35 | 488 |
| 2017 Noviembre | 419 | 42 | 461 |
| 2017 Octubre | 392 | 28 | 420 |
| 2017 Septiembre | 283 | 35 | 318 |
| 2017 Agosto | 361 | 39 | 400 |
| 2017 Julio | 333 | 67 | 400 |
| 2017 Junio | 276 | 75 | 351 |
| 2017 Mayo | 294 | 46 | 340 |
| 2017 Abril | 281 | 45 | 326 |
| 2017 Marzo | 279 | 67 | 346 |
| 2017 Febrero | 262 | 55 | 317 |
| 2017 Enero | 228 | 32 | 260 |
| 2016 Diciembre | 368 | 19 | 387 |
| 2016 Noviembre | 432 | 36 | 468 |
| 2016 Octubre | 450 | 42 | 492 |
| 2016 Septiembre | 408 | 33 | 441 |
| 2016 Agosto | 498 | 51 | 549 |
| 2016 Julio | 223 | 22 | 245 |
| 2016 Junio | 13 | 13 | 26 |
| 2016 Mayo | 7 | 29 | 36 |
| 2016 Abril | 5 | 2 | 7 |
| 2016 Marzo | 11 | 31 | 42 |
| 2016 Febrero | 6 | 1 | 7 |
| 2016 Enero | 8 | 31 | 39 |
| 2015 Diciembre | 7 | 31 | 38 |
| 2015 Noviembre | 33 | 23 | 56 |
| 2015 Octubre | 12 | 17 | 29 |
| 2015 Septiembre | 9 | 1 | 10 |
| 2015 Agosto | 13 | 1 | 14 |
| 2015 Julio | 314 | 24 | 338 |
| 2015 Junio | 276 | 15 | 291 |
| 2015 Mayo | 281 | 18 | 299 |
| 2015 Abril | 301 | 15 | 316 |
| 2015 Marzo | 327 | 5 | 332 |
| 2015 Febrero | 293 | 8 | 301 |
| 2015 Enero | 232 | 25 | 257 |
| 2014 Diciembre | 239 | 13 | 252 |
| 2014 Noviembre | 207 | 9 | 216 |
| 2014 Octubre | 237 | 25 | 262 |
| 2014 Septiembre | 218 | 18 | 236 |
| 2014 Agosto | 260 | 16 | 276 |
| 2014 Julio | 250 | 19 | 269 |
| 2014 Junio | 247 | 21 | 268 |
| 2014 Mayo | 243 | 17 | 260 |
| 2014 Abril | 206 | 11 | 217 |
| 2014 Marzo | 259 | 35 | 294 |
| 2014 Febrero | 169 | 35 | 204 |
| 2014 Enero | 165 | 30 | 195 |
| 2013 Diciembre | 147 | 24 | 171 |
| 2013 Noviembre | 101 | 23 | 124 |
| 2013 Octubre | 23 | 30 | 53 |
| 2013 Septiembre | 27 | 32 | 59 |
| 2013 Agosto | 21 | 69 | 90 |
| 2013 Julio | 11 | 51 | 62 |
| 2013 Junio | 10 | 54 | 64 |
| 2013 Mayo | 17 | 73 | 90 |
| 2013 Abril | 30 | 34 | 64 |
| 2013 Marzo | 20 | 22 | 42 |
| 2013 Febrero | 30 | 10 | 40 |
| 2013 Enero | 95 | 12 | 107 |
| 2012 Diciembre | 62 | 4 | 66 |
| 2012 Agosto | 1 | 0 | 1 |
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