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| CASE REPORT |
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| Year : 2018 | Volume
: 22
| Issue : 1 | Page : 39-40 |
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Pigmented fungiform papillae of the tongue in a Saudi woman
Nouf Alzahrani1, Ruaa Alharithy2
1 Department of Dermatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
2 Division of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| Date of Web Publication | 31-Jan-2018 |
Correspondence Address:
Ruaa Alharithy
Division of Dermatology, Security Forces Hospital, Riyadh
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | 3 |
DOI: 10.4103/jdds.jdds_9_18
Pigmented fungiform papillae of the tongue are a benign condition that is characterized by pigmentation involving the fungiform papillae. Our patient is a 25-year-old female who has an asymptomatic pigmentation over the tongue for 13 years. Examination showed pigmentation confined to the fungiform papillae on the dorsum of the tongue. The diagnosis of pigmented fungiform papillae of the tongue was made clinically. The patient was reassured and was given a 3-month follow-up. We are reporting this case to increase the awareness of this diagnosis and to avoid unnecessary workup.
Keywords: Oral Pigmentation, pigmented fungiform papillae of the tongue, tongue
How to cite this article:
Alzahrani N, Alharithy R. Pigmented fungiform papillae of the tongue in a Saudi woman. J Dermatol Dermatol Surg 2018;22:39-40 |
| Introduction | |  |
Pigmented fungiform papillae of the tongue are a benign condition that is characterized by pigmentation involving the fungiform papillae. It is more common in dark-skinned individuals, and most reported cases are adults between the second and third decades. However, few cases were reported in children.[1]
We are reporting a patient with this condition. To our knowledge, this is the first reported case from Saudi Arabia.
| Case Report | | |
A 25-year-old Saudi female, with Fitzpatrick skin type IV, not known to have any medical diseases, presented to our outpatient clinic with an asymptomatic hyperpigmentation over the tongue for 13 years. Upon examination, there were diffuse tan, brown, patches over the anterior two-third of the tongue with prominent dark papillae [Figure 1] and [Figure 2]. There was no other mucosal nor skin involvement. The patient had no family history of the same presentation and was never investigated nor treated before. A swab for fungal culture was taken, and it came back negative. With this clinical picture, pigmented fungiform papillae of the tongue were considered. Her Vitamin B12 and ferritin levels were within normal range. The patient was given a 3-month follow-up. | Figure 1: Scattered tan-brown macules confined to fungiform papillae on the anterolateral aspect of the tongue
Click here to view |
| Discussion | | |
The tongue is fully covered by mucosa which has four different types of papillae. Filiform, fungiform, circumvallate, and foliate papillae, each is responsible for recognizing a particular taste. Fungiform papillae are mushroom-shaped papillae that recognize sweet and sour tastes. They are scattered on the tongue, but mostly over the lateral sides of the tongue and apex. Filiform papillae are long and thin and they help to recognize the sour taste. Circumvallate papillae are distributed in a V-shaped form on the posterior part of the tongue. These papillae exist in few numbers around 10–14 in the majority of individuals. Surrounding these papillae are taste buds that recognized the bitter taste. Along sides of the tongue locate the foliate papillae which pick up the salty taste [Figure 3].[2],[3],[4]
Mucosal pigmentation can be classified to either physiological/racial or pathological causes. Pathological causes are further classified into exogenous such as drug induced, smoking or chewed tobacco, and amalgam tattoo. Endogenous causes include inflammatory diseases as Lichen planus, Peutz-Jeghers disorder, or endocrinological disorders as Addison's disease, diabetes Mellitus, pregnancy, and hyperthyroidism.[2],[5],[6]
Pigmented fungiform of the tongue is a relatively common benign condition noticed mainly in darkly pigmented individuals.[7] It is usually manifested during the second or third decade although some cases were reported in children. It presents as asymptomatic well-circumscribed hyperpigmentation confined to the fungiform papillae. There are no alterations in the nail or other cutaneous structures.[8]
PFPT has been classified by Holzwanger et al.[8] into three types. Type 1 is characterized by well-defined hyperpigmented areas involving the fungiform papillae on the anterolateral side and tip of the tongue which is what our patient has. Type 2 has hyperpigmentation involving few fungiform papillae scattered over the dorsal aspect of the tongue. Type 3 is diffuse hyperpigmentation of all fungiform papillae on the dorsum of the tongue.
Although most of the patients are healthy, some reported cases have certain associations such as linear circumflex ichthyosis, lichen planus, Hori's nevus, melisma, hemochromatosis, scleroderma, pernicious anemia, and iron deficiency anemia.[9],[10]
Diagnosis is made clinically and rarely requires histopathological confirmation unless there is a need to exclude other diseases. Up until now, no effective treatment has been used although one reported case has shown improvement after treating iron deficiency anemia.
| Conclusion | | |
Pigmented fungiform papillae are a common racial variant, yet patients do not commonly report it to a dermatologist. We reported this case to increase the awareness of this diagnosis and to avoid unnecessary workup.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Acknowledgment
I would like to thank Dr. Fatimah Alrasheed for taking the photographs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Sharma S, Sharma S. Pigmentation of the fungiform papillae of the tongue in a child secondary to iron deficiency anaemia: An uncommon occurrence and association. Int J Oral Health Dent 2016;2:39-42.  |
| 2. | Kauzman A, Pavone M, Blanas N, Bradley G. Pigmented lesions of the oral cavity: Review, differential diagnosis, and case presentations. J Can Dent Assoc 2004;70:682-3. [ PUBMED] |
| 3. | Meleti M, Vescovi P, Mooi WJ, van der Waal I. Pigmented lesions of the oral mucosa and perioral tissues: A flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:606-16. [ PUBMED] |
| 4. | Patil S, Raj T, Rao RS, Warnakulasuriya S. Pigmentary disorders of oral mucosa. Pigmentary Disorder 2015;2:225. |
| 5. | Greenberg MS, Burket LW, Glick M. Burket's Oral Medicine: Diagnosis and Treatment. Hamilton, Ontario Canada: B.C. Decker; 2003. |
| 6. | Gondak RO, da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral pigmented lesions: Clinicopathologic features and review of the literature. Med Oral Patol Oral Cir Bucal 2012;17:e919-24. [ PUBMED] |
| 7. | Pehoushek JF, Norton SA. Black taste buds. Arch Fam Med 2000;9:219. |
| 8. | Holzwanger JM, Rudolph RI, Heaton CL. Pigmented fungiform papillae of the tongue: A common variant of oral pigmentation. Int J Dermatol 1974;13:403-8. [ PUBMED] |
| 9. | Werchniak AE, Storm CA, Dinulos JG. Hyperpigmented patches on the tongue of a young girl – Quiz case. Arch Dermatol 2004;140:1275-80. |
| 10. | Tan C, Liu Y, Min ZS, Zhu WY. A clinical analysis of 58 Chinese cases of pigmented fungiform papillae of the tongue. J Eur Acad Dermatol Venereol 2014;28:242-5. [ PUBMED] |
[Figure 1], [Figure 2], [Figure 3]
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