Depigmentation Vitiligo :Relatively common , acquired autoimmune

disease that is associated with hypomelanosis.Focal areas of depigmentationVitiligenous lesion often present as well –

circumscribed , round , oval ,or elongated pale or white colored macules that may coalese into larger areas of diffuse pigmentation.

Arise in any patients undergoing immunotherapy.

Hypomelanosis of inner & outer surfaces of lips & perioral skin may be seen in up to 20% of patients.

Treatment with tropical corticosteroids , systemic photochemical therapies (psoralen & ultraviolet A exposure proven effective.

Medicinal depigmentation that is cutaneoua bleaching to create unified skin color.

Surgical intervention may be only optional (autologus epithelial grafts) used succesfully.

HEMOGLOBIN AND IRON ASSOCIATED PIGMENTATION

Ecchymosis:Traumatic ecchymosis is common on the lips

and face yet is uncommon in oral mucosa except in cases of blunt force trauma and oral intubation.

Immediately following traumatic event erythrocyte extra vasation into the sub mucosa will appear as bright red macule.

The lesion will assume brown coloration within few days, after hemoglobin is degraded to hemosiderin.

PURPURA/PETECHIAE

• Petechiae typically characterised as being pinpoint or slightly larger than pinpoint and purpura as multiple, small 2 to 4 mm collections of extravasated blood.

• Oral purpura may develop as a consequence of trauma or viral or systemic disease, identified in soft palate although any mucosal site may be affected.

HEMOCHROMATOSISChronic, progressive disease that is

characterized by excessive iron deposits (usually in the form of hemosiderin) in the liver and other organs and tissues.

Oral mucosal pigmentation is also well reorganized.

Oral pigmentation is often diffuse and brown to gray in appearance.

Palate and gingiva are most commonly affected.

EXOGENOUS PIGMENTATIONAMALGUM TATTO:

Etiology is deposition of amalgam material into sub mucosal tissue.

Lesions small, asymptomatic, macular and bluish gray or oven black in appearance.

Gingiva, alveolar mucosa, buccal mucosa and floor of mouth are most common sites.

Lesions found in vicinity of teeth with large amalgam restoration or crowned teeth and also in around healed extraction sites.

GRAPHITE TATTOO

Commonly seen on palate and represent traumatic implantation of graphite particles from a pencil

Lesion present similar to amalgam tattoo. So biopsy is often warranted.

ORNAMENTAL TATTOOS

South African female tribal custom includes brushing the teeth and gums with a chewed root of the tree Euclea natalensis with the belief that promotes oral health.

Plant root contain napthoquinones are pigmented and the mouths of root users are typically bright orange.

MEDICINAL METAL INDUCED PIGMENTATIONSilver may cause generalized blue-gray

discoloration (argyria).Gold induced pigment may appear blue-gray

or purple (chrysiasis).Generalized black pigmentation of tongue

due to chewing of bismuth sub salicylate tablets, a commonly used antacid.

HEAVY METAL PIGMENTATIONLead, mercury, bismuth and arsenic have

shown to be deposited in oral tissue if ingested in sufficient quantities over a extended period of time.

Found along the free marginal gingiva, metallic line usually gray-black appearance.

Signs and symptoms of metal poisoning neurologic disorders, intestinal pain and sialorrhea.

HAIRY TONGUEChange in oral flora associated with chromic

antibiotic therapy.Colonization of chromogenic bacteria impart

variety of colors white, green, brown or black.

Various foods, drinks and also smoking of tobacco or crack cocaine has been shown in black hairy tongue.

Treatment is using tongue scrapper and limit ingestion of coloring foods.

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