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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the case and research letter by Marcoval et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> regarding 2 cases of pigmented fungiform papillae of the tongue&#46; We were surprised that the letter did not mention Laugier disease &#40;or Laugier-Hunziker syndrome&#41;&#44; an entity characterized by essential cutaneous and mucosal pigmentation&#44; originally described on the lips and oral mucosa and&#44; at times&#44; associated with longitudinal melanonychia&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In 1998&#44; we reported 9 cases of Laugier disease&#44; in 1 man and 8 women&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Two of the women presented punctate pigmentation of the tongue identical to the cases reported by Marcoval et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of these patients also had hyperpigmented lesions affecting the oral mucosa&#44; gums&#44; labia menora&#44; and nails&#46; The other presented pigmentation of the lips&#44; gums&#44; oral mucosa&#44; and lateral nail folds on some fingers&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We have found reports of other similar cases described as Laugier-Hunziker syndrome&#59; these patients presented punctate pigmentation of the lingual papillae as described by Marcoval et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in association with pigmentation of the nails&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the lower lip and the toes and fingers&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and in one case the oral mucosa&#44; the lips&#44; and the nails&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> We believe that all of these case reports&#44; including that of Marcoval et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> correspond to the same process&#8212;hyperpigmentation of unknown etiology affecting the lips&#44; oral mucosa&#44; tongue &#40;fungiform papillae&#41;&#44; nails&#44; genitals&#44; and perhaps other areas in a variety of ways&#44; in combination or alone&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">After we reported our series as Laugier disease&#44; we were criticized for omitting Hunziker from the eponymous name&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Our use of the term <span class="elsevierStyleItalic">Laugier disease</span> followed the example of French authors&#44; who preferred this name to that of <span class="elsevierStyleItalic">idiopathic pigmentation of the mucosa</span>&#44; a term that does not include the involvement of the nails&#46; Another reason for our choice was that&#44; in several published reports&#44; the process was considered to be Laugier-Hunziker syndrome only when pigmentation of the oral mucosa was associated with longitudinal melanonychia&#44; a distinction that gave rise to some confusion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In response to the criticism&#44; we put forward our view of what the process should be called when new reports appeared of combined involvement of the oral mucosa and the nails&#44; and in the case of similar lesions affecting the genitals&#44; conjunctiva&#44; larynx&#44; or esophagus as well as other combinations of pigmentation and even isolated lesions affecting only the nails or only a mucosal membrane&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Shortly thereafter&#44; in line with our reasoning concerning variations of the earlier descriptions&#44; a report was published of a case involving the oral mucosa&#44; lip&#44; palate&#44; palm&#44; and esophagus in which the authors referred to the process as Laugier-Hunziker syndrome associated with esophageal melanocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This was the first description of such a combination&#46; Histologic study of biopsy specimens showed acanthosis and basal pigmentation in the esophagus&#44; on the lip and on the palms&#46; Three years earlier&#44; a case had been reported of a patient with pigmented lesions on the lips and oral mucosa associated with pigmentation of several fingers&#44; the eyebrows&#44; and the heels&#46; The title of that article described the case as Laugier-Hunziker syndrome with atypical features and the authors reported that they had considered the possibility of Peutz-Jeghers syndrome&#44; albeit incomplete because of the absence of intestinal polyposis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; several different idiopathic pigmentation disorders of the skin&#44; nails&#44; oral mucosa&#44; and genitals exist&#44; and a variety of names have been used to denominate them&#46; Because of the large number of names used&#44; all probably referring to the same entity&#44; we approve of the proposal by Seoane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> that this condition be called <span class="elsevierStyleItalic">essential mucocutaneous hyperpigmentation&#46;</span> However&#44; as this term encompasses the idea of concurrent involvement of the skin and mucous membranes&#44; which&#8212;as we have shown&#8212;is extremely variable&#44; we consider that the designation should be <span class="elsevierStyleItalic">essential cutaneous and&#47;or mucosal hyperpigmentation</span> or even <span class="elsevierStyleItalic">essential melanin pigmentation of the skin&#44; mucous membranes&#44; or nails</span>&#46; This last designation reflects the melanocytic origin of the condition and the variable involvement in a more detailed and well-defined way&#59; it could also be rendered simply as <span class="elsevierStyleItalic">essential melanin pigmentation</span> &#40;of Laugier-Hunziker if you will&#41;&#44; a name that would do justice to the initial description&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The condition is not as rare as it was thought and we believe that its incidence is influenced by a certain racial predisposition in which some unknown factor triggers the appearance of lesions by way of an increase in the synthesis of melanosomes&#44; with idiosyncratic involvement of a variety of sites which&#44; for unknown reasons&#44; are more susceptible to this condition and vary from case to case&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The principal histologic features are hyperpigmentation of the basal layer without increased melanocytes&#44; associated with acanthosis and the presence of melanophages&#44; and a variable chronic inflammatory infiltrate in the dermis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As this is not a disease or a syndrome&#44; 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Información de la revista
Vol. 104. Núm. 2.
Páginas 173-174 (marzo 2013)
Vol. 104. Núm. 2.
Páginas 173-174 (marzo 2013)
Letter to the Editor
Acceso a texto completo
Pigmented Fungiform Papillae of the Tongue in Laugier Disease (or Laugier-Hunziker Syndrome)
Pigmentación de las papilas fungiformes linguales en la enfermedad de Laugier (o síndrome de Laugier-Hunziker)
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F. Urbina
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fcourbina@hotmail.com

Corresponding author.
, E. Sudy
Dermatologists in private practice, Santiago de Chile, Chile
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To the Editor:

We read with interest the case and research letter by Marcoval et al.1 regarding 2 cases of pigmented fungiform papillae of the tongue. We were surprised that the letter did not mention Laugier disease (or Laugier-Hunziker syndrome), an entity characterized by essential cutaneous and mucosal pigmentation, originally described on the lips and oral mucosa and, at times, associated with longitudinal melanonychia.2

In 1998, we reported 9 cases of Laugier disease, in 1 man and 8 women.3 Two of the women presented punctate pigmentation of the tongue identical to the cases reported by Marcoval et al.1 One of these patients also had hyperpigmented lesions affecting the oral mucosa, gums, labia menora, and nails. The other presented pigmentation of the lips, gums, oral mucosa, and lateral nail folds on some fingers.

We have found reports of other similar cases described as Laugier-Hunziker syndrome; these patients presented punctate pigmentation of the lingual papillae as described by Marcoval et al.1 in association with pigmentation of the nails,4 the lower lip and the toes and fingers,5 and in one case the oral mucosa, the lips, and the nails.6 We believe that all of these case reports, including that of Marcoval et al.,1 correspond to the same process—hyperpigmentation of unknown etiology affecting the lips, oral mucosa, tongue (fungiform papillae), nails, genitals, and perhaps other areas in a variety of ways, in combination or alone.

After we reported our series as Laugier disease, we were criticized for omitting Hunziker from the eponymous name.7 Our use of the term Laugier disease followed the example of French authors, who preferred this name to that of idiopathic pigmentation of the mucosa, a term that does not include the involvement of the nails. Another reason for our choice was that, in several published reports, the process was considered to be Laugier-Hunziker syndrome only when pigmentation of the oral mucosa was associated with longitudinal melanonychia, a distinction that gave rise to some confusion.

In response to the criticism, we put forward our view of what the process should be called when new reports appeared of combined involvement of the oral mucosa and the nails, and in the case of similar lesions affecting the genitals, conjunctiva, larynx, or esophagus as well as other combinations of pigmentation and even isolated lesions affecting only the nails or only a mucosal membrane.8 Shortly thereafter, in line with our reasoning concerning variations of the earlier descriptions, a report was published of a case involving the oral mucosa, lip, palate, palm, and esophagus in which the authors referred to the process as Laugier-Hunziker syndrome associated with esophageal melanocytosis.9 This was the first description of such a combination. Histologic study of biopsy specimens showed acanthosis and basal pigmentation in the esophagus, on the lip and on the palms. Three years earlier, a case had been reported of a patient with pigmented lesions on the lips and oral mucosa associated with pigmentation of several fingers, the eyebrows, and the heels. The title of that article described the case as Laugier-Hunziker syndrome with atypical features and the authors reported that they had considered the possibility of Peutz-Jeghers syndrome, albeit incomplete because of the absence of intestinal polyposis.10

In summary, several different idiopathic pigmentation disorders of the skin, nails, oral mucosa, and genitals exist, and a variety of names have been used to denominate them. Because of the large number of names used, all probably referring to the same entity, we approve of the proposal by Seoane et al.11 that this condition be called essential mucocutaneous hyperpigmentation. However, as this term encompasses the idea of concurrent involvement of the skin and mucous membranes, which—as we have shown—is extremely variable, we consider that the designation should be essential cutaneous and/or mucosal hyperpigmentation or even essential melanin pigmentation of the skin, mucous membranes, or nails. This last designation reflects the melanocytic origin of the condition and the variable involvement in a more detailed and well-defined way; it could also be rendered simply as essential melanin pigmentation (of Laugier-Hunziker if you will), a name that would do justice to the initial description.

The condition is not as rare as it was thought and we believe that its incidence is influenced by a certain racial predisposition in which some unknown factor triggers the appearance of lesions by way of an increase in the synthesis of melanosomes, with idiosyncratic involvement of a variety of sites which, for unknown reasons, are more susceptible to this condition and vary from case to case.

The principal histologic features are hyperpigmentation of the basal layer without increased melanocytes, associated with acanthosis and the presence of melanophages, and a variable chronic inflammatory infiltrate in the dermis.

As this is not a disease or a syndrome, to facilitate naming the entity, some form of eponym will probably come to predominate over the long term.

References
[1]
J. Marcoval, J. Notario, S. Martín-Sala, I. Figueras.
Pigmentación de las papilas fungiformes linguales. A propósito de dos casos.
Actas Dermosifiliogr, 102 (2011), pp. 739-740
[2]
P. Laugier, N. Hunziker.
Pigmentation mélanique lenticulaire essentielle de la muqueuse jugale et des levres.
Arch Belg Dermatol Syph, 26 (1970), pp. 391-399
[3]
F. Urbina, E. Sudy, C. Misad, R. Sandoval.
Enfermedad de Laugier.
Piel, 13 (1998), pp. 333-338
[4]
A. Jabbari, M.E. González, A.G. Franks Jr., M. Sánchez.
Laugier Hunziker syndrome.
Dermatol Online J, 16 (2010), pp. 23
[5]
S. Sachdeva, S. Sachdeva, P. Kapoor.
Laugier-Hunziker syndrome: A rare cause of oral and acral pigmentation.
J Cutan Aesthet Surg, 4 (2011), pp. 58-60
[6]
D.L. Ma, S. Vano-Galván.
Hyperpigmentation in Laugier-Hunziker syndrome.
CMAJ, 183 (2011), pp. 1402
[7]
J. Seoane, J. Vázquez, P.I. Varela.
Pigmentación cutáneomucosa esencial adquirida.
Piel, 14 (1999), pp. 328
[8]
F. Urbina, E. Sudy.
¿Enfermedad de Laugier o Laugier-Hunziker?.
Piel, 14 (1999), pp. 328
[9]
O. Yamamoto, K. Yoshinaga, M. Asahi, I. Murata.
A Laugier-Hunziker syndrome associated with esophageal melanocytosis.
Dermatology, 199 (1999), pp. 162-164
[10]
A.W. Gerbig, T. Hunziker.
Idiopathic lenticular mucocutaneous pigmentation of Laugier-Hunziker with atypical features.
Arch Dermatol, 132 (1996), pp. 844-845
[11]
J. Seoane, J. Vázquez, A.M. Casenave, A. De la Cruz, A. Aguado.
Laugier-Hunziker syndrome. A clinical and anatomopathological study. Presentation of 13 cases.
Rev Stomatol Chir Maxillofac, 99 (1998), pp. 44-48

Please cite this article as: Urbina F, Sudy E. Pigmentación de las papilas fungiformes linguales en la enfermedad de Laugier (o síndrome de Laugier-Hunziker). Actas Dermosifiliogr. 2013;104:173-4.

Copyright © 2012. Elsevier España, S.L. and AEDV
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