Overview
Melanin pigmentation of the oral mucosa refers to abnormal darkening of oral tissues due to increased melanin production, often observed in conditions like Addison's disease, post-inflammatory hyperpigmentation, or certain drug exposures 1.Diagnosis
Clinical examination is primary, noting the distribution and pattern of pigmentation 1.
Biopsy may be considered in atypical presentations to rule out malignancy or other underlying conditions 1.
No specific grading system universally accepted; clinical judgment and correlation with systemic findings are crucial 1.Management
Address underlying causes: discontinue causative drugs if identified (e.g., hormonal contraceptives like ethinylestradiol and norethindrone) 1.
Topical depigmenting agents such as retinoids or corticosteroids may be considered for symptomatic relief 1.
Photoprotection measures recommended to prevent further hyperpigmentation 1.Special Populations
Pregnancy: Limited data; hormonal changes can exacerbate pigmentation; close monitoring and avoidance of unnecessary medications advised 1.
Pediatrics: Rare; typically associated with genetic conditions or post-inflammatory changes; management focuses on underlying causes 1.
Elderly: Increased prevalence of underlying systemic diseases; thorough evaluation for associated conditions essential 1.
Comorbidities: Conditions like Addison's disease require specific endocrine management to address pigmentation 1.Key Recommendations
Identify and discontinue potential drug triggers, particularly hormonal contraceptives, if melasma-like pigmentation is observed (Evidence: Moderate 1).
Implement photoprotection strategies including the use of broad-spectrum sunscreens to prevent exacerbation of pigmentation (Evidence: Expert opinion 1).
Consider biopsy for atypical presentations to exclude other pathologies (Evidence: Moderate 1).References
1 Qu Y, Wang S, Xie H, Meng X, Cui B, Xiao Z. Melasma secondary to drugs: a real-world pharmacovigilance study of the FDA adverse event reporting system (FAERS). BMC pharmacology & toxicology 2025. link