Medication related to pigmentation of oral mucosa

Background: The diagnosis of oral melanotic lesions is, more often than not, challenging in the clinical practice due to the fact that there are several reasons which may cause an increase in pigmentation on localized or generalized areas. Among these, medication stands out. Material and Methods: In this work, we have carried out a review in the reference pharma database: Micromedex® followed by a review of the scientific published literature to analyse coincidences and possible discrepancies. Results: Our findings show that there are several prescription drugs that can cause pigmented lesions in the oral mucosa. This must be known by clinicians in order to properly diagnose pigmented lesions. We have identified a set of 21 medicaments which cause these lesions, some of which are used frequently in the clinic, such as Metronidazole, Amitriptyline, conjugated oestrogens and Chlorhexidine gluconate. We also found discrepancies with the data published in specialized literature, some of which wasn’t reflected in the Summary of Product Characteristics. Conclusions: Our work highlights the importance of the proper communication of adverse drug reactions (ADR) by health professionals in order to provide thorough and accurate information and diagnosis.(AU)

Association of TYRP1 with hypoxia and its correlation with patient outcome in uveal melanoma

Purpose Molecular mechanisms of uveal melanoma development in association with high pigmentation are unclear. Tyrosinase Related Protein (TYRP1) is not only one of the important melanogenesis marker that contributes to melanin synthesis, but can also prevents the melanocyte death. The induction of melanogenesis leads to induction of HIF-1α which can affect the behavior of melanoma cells and its surrounding environment. The aim of our study was to determine the expression of TYRP1 and HIF-1α at the protein and RNA level and determine its prognostic significance. Methods In the present study, the expression of TYRP1 and HIF-1α was investigated on 61 formalin-fixed paraffin-embedded choroidal melanoma samples by immunohistochemistry. Fresh 50 samples were validated by real-time PCR. Results were correlated with clinicopathological parameters and Kaplan–Meier was performed to determine the prognostic significance. Results High immunoexpression of TYRP1 and HIF-1α was present in 61 and 54% of patients, respectively. Both TYRP1 and HIF-1α correlated well with high pigmentation and BAP1 (BRCA1 Associated Protein-1) loss (p < 0.05) at IHC level as well as transcriptional level. There was reduced metastatic free survival in patients with necrosis and this was statistically significant (p = 0.010). Conclusion Our findings indicate that TYRP1 can be used as a potential biomarker in the development of targeted therapy in UM. Further studies on melanogenesis markers associated with TYRP1 could provide us a better understanding in this field (AU)

Pigmentación generalizada tras tratamiento a largo plazo con minociclina / Widespread pigmentation following long-term minocycline therapy

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Adenopatías cervicales negras / Black cervical lymphadenopathies

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Enfermedad de Grover en fracaso renal crónico / Grover's disease in chronic kidney failure

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Utilidad de marcadores inmunohistoquímicos para el diagnóstico de lesiones pigmentadas conjuntivales / Immunohistochemical markers in the diagnosis of pigmented conjunctival lesions

Objetivo/Método: Valorar la importancia de los marcadores inmunohistoquímicos para el diagnóstico de certeza de lesiones pigmentadas de la conjuntiva. Debido a la dificultad del diagnóstico clínico exacto, la sospecha de malignidad obliga a realizar una extirpación de la lesión y estudio anatomopatológico en el cual los marcadores inmunohistoquímicos ayudan a determinar la naturaleza de la lesión. Caso clínico/Discusión: Mujer de 25 años que presenta una lesión pigmentada en carúncula de aparición reciente y crecimiento rápido con aumento de la pigmentación. Se sospecha malignidad por lo que se realiza extirpación total de la lesión. El estudio microscópico muestra alteraciones celulares sugerentes de malignidad pero tras realizar marcadores inmunohistoquímicos el diagnóstico es nevus conjuntival compuesto(AU)

Objective/Method: The aim of this study was to assess the importance of immunohistochemical markers in the diagnosis of pigmented conjunctival lesions. Due to the difficulty of making an exact clinical diagnosis, the suspicion of malignancy requires the removal of the lesion and performing a histopathology study in which immunohistochemical markers may help to determine the nature of the lesion. Cases Report/Discussion: A case is presented of a 25 year-old woman with a pigmented lesion in the caruncle. It appeared recently and was growing fast with increasing pigmentation. Due to a suspicion of malignancy, the total lesion was removed. The microscopic study revealed cellular alterations which suggested malignancy. However, after carrying out immunohistochemical markers the diagnosis was conjunctival compound nevus(AU)

Pigmentación lineal hemicorporal en una niña / Unilateral Linear Hyperpigmentation in a Girl

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Talón negro (hematoma subcórneo) / Black heel (subcorneal hematoma)

El talón negro es un proceso relativamente frecuente, caracterizado por la aparición de una lesión negra en la zona de apoyo del talón, que aparece en jóvenes deportistas. Está provocado por pequeños traumatismos que pueden dar lugar a hemorragias superficiales. Su interés patológico radica en la posible confusión con lesiones pigmentarias de estirpe melanocítica, lo que puede originar cierto grado de alarma. El diagnóstico es fácil de realizar y puede llevarse a cabo por el simple raspado de la lesión o mediante el examen con dermatoscopio(AU)

Black heel, or talon noir, is a relatively common condition, especially in young athletes, that is characterized by the development of a black lesion on the part of the heel that is subjected to pressure. It is caused by the rupture of tiny blood vessels and can lead to bruising. It is of interest because of the possible confusion with pigmented melanocytic lesions, a circumstance that can give rise to a certain degree of alarm. The diagnosis is easy to perform and can consist of simple scraping of the lesion or a dermoscopic examination(AU)

Melanoniquia longitudinal en el embarazo / Longitudinal melanonychia in pregnancy

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Clinical efficacy and safety of a depigmented and glutaraldehyde polymerized therapeutic vaccine of Parietaria judaica

Background: The inhalation of Parietaria judaica pollen is a common cause of allergic respiratory diseases in the Mediterranean area. The objective of this study was to investigate the safety and clinical efficacy of a chemically modified (depigmented and glutaraldehyde-polymerized) vaccine of Parietaria judaica. Methods and results: Thirty patients with a well-documented clinical history of seasonal rhinitis and clinical sensitivity to Parietaria judaica pollen were included in a randomized trial during 12 months. The study was conducted following good clinical practices and appropriate consent forms were signed. Patients were divided into 2 groups of 15 individuals; group A received the modified extract and group C did not receive specific immunotherapy. Any adverse event was recorded to assess safety. Symptom scores, symptomatic medication use and the results of specific nasal challenges (before and after 12 months of treatment) were recorded to evaluate clinical efficacy. The treatment schedule consisted of an incremental phase of 5 injections and a maintenance dosage of 0.5 ml per month. Each patient received 14 injections during this period. All the patients completed the trial and no adverse reactions related to immunotherapy were recorded. A significant difference (p < 0.001) in symptom scores and overall use of symptomatic medication was observed between the two groups, being both scores lower in group A. No significant differences in nasal sensitivity existed before treatment among the 2 groups. However, after 12 months, a significant difference (p < 0.05) was observed only in group A patients, who showed a significant improvement in specific nasal challenges. Conclusions: Immunotherapy with depigmented and glutaraldehyde-polymerized extract of Parietaria judaica pollen is safe and effective to treat patients with allergic rhinitis and clinical sensitivity to this pollen (AU)

Antecedentes: La inhalación del polen de Parietaria judaica es una causa frecuente de enfermedades respiratorias alérgicas en la región mediterránea. El objetivo de este estudio era investigar la seguridad y la eficacia clínica de una vacuna químicamente modificada (despigmentada y polimerizada con glutaraldehído) de Parietaria judaica. Métodos y resultados: Se incluyó en un estudio aleatorizado de 12 meses de duración a 30 pacientes con historia clínica bien documentada de rinitis estacional y sensibilidad clínica al polen de Parietaria judaica. El estudio se llevó a cabo conforme a las buenas prácticas clínicas y se firmaron los formularios de consentimiento apropiados. Se distribuyó a los pacientes en dos grupos de 15 sujetos; el grupo A recibió el extracto modificaco y el grupo C no recibió inmunoterapia específica. Para evaluar la inocuidad se registraron las reacciones adversas. Para evaluar la eficacia clínica se registraron las puntuaciones de los síntomas, el uso de medicación sintomática y los resultados de pruebas de provocación nasales específicas (antes y después de 12 meses de tratamiento).El régimen de tratamiento consistió en una fase de incremento de 5 inyecciones y una posología de mantenimiento de 0,5 ml al mes. Cada paciente recibió 14 inyecciones durante ese período. Todos los pacientes se sometieron al ensayo completo y no se registraron reacciones adversas relacionadas con la inmunoterapia. Se observó una diferencia significativa (p < 0,001) en las puntuaciones de los síntomas y el uso global de medicación sintomática entre los dos grupos; ambas puntuaciones fueron menores en el grupo A. Antes del tratamiento no se observaron diferencias significativas en la sensibilidad nasal de los dos grupos. Sin embargo, al cabo de 12 meses, se observó una diferencia considerable (p < 0,05) sólo en los pacientes del grupo A, los cuales experimentaron una mejoría significativa en pruebas de provocación nasales específicas. Conclusiones: La inmunoterapia con extracto despigmentado y polimerizado con glutaral de hído de polen de Parietaria judaica es segura y eficaz para tratar a los pacientes con rinitis alérgica y sensibilidad clínica a este polen (AU)

Pigmentación intra-ampolla tras facoemulsificación / Intra-bleb pigmentation after phacoemulsification

Se describe la aparición de una pigmentación intensa dentro de la ampolla filtrante 24 horas después de la realización de una facoemulsificación en un paciente previamente trabeculectomizado. El grado de pigmentación se redujo progresivamente en revisiones sucesivas, permaneciendo en todo momento la tensión ocular controlada sin tratamiento médico. Discusión: La presencia de pigmento dentro de la ampolla ha sido descrita recientemente por Wanichwecharungruang tras trabeculectomía aislada o cirugía combinada; sin embargo, no ha sido referida tras facoemulsificación aislada. Suele estar relacionada con dispersión intraoperatoria de pigmento. Su visualización se facilita en ampollas de paredes delgadas y puede considerarse un signo indirecto de filtración eficiente (AU)

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Melanoniquia e hiperpigmentaciónmucocutánea debida a la administración dehidroxiurea a una paciente infectada por VIH / Melanonychia and mucocutaneous hyperpigmentation due to hydroxyurea use in an HIV-infected patient

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