Chemotherapy Induced Lingual Hyperpigmentation| Iquebal Hasan

Chemotherapy Induced Lingual Hyperpigmentation|  Iquebal Hasan

Iquebal Hasan| Chemotherapy Induced Lingual Hyperpigmentation


Introduction

Many side effects are associated with chemotherapy treatment. Oral side effects may include mucositis, xerostomia, taste disturbances, candidiasis, and mucosal pigmentation [1] (Figure 1). Oral hyperpigmentation can be difficult to diagnose due to a variety of conditions having similar clinical appearance. It is important to consider the very common diagnosis of racial pigmentation. Pigmentation can be caused by a variety of drugs like, hormones, oral contraceptives, chemotherapeutic agents, anti-anxiety, antimalarial, anti-microbial and anti-fungal agents [2].

irispublishers-openaccess-dentistry-oral-health

Chemotherapy drugs can cause hyperpigmentation, altering the pigmentation of skin, mucous membranes, and nails in generalized or localized areas [3,4]. Palate and gingiva are the most common sites affected. However, it can also be seen on the tongue. Darkened blotches on the tongue may appear as soon as 1or2 chemotherapy doses into treatment. Hyperpigmentation acquired in conjunction with chemotherapy may begin to fade between weeks to months after completion of treatment [4]. However, this can also remain long-term and become a permanent side-effect of chemotherapy.

Iquebal Hasan Articles from Iris Publishers


Case Report

This article presents a 58-year-old African American female experiencing localized gum bleeding during brushing as well as hyperpigmentation on the tongue (Figure 2). Upon presentation, the patient’s current medical status included hypercholesterolemia, diabetes, irritable bowel syndrome, and dissociative identity disorder. Her medication regimen included simvastatin and metformin. Past medical history included breast cancer with surgical history of C-section and modified radical mastectomy. Cyclophosphamide was the chemotherapeutic drug used to treat her breast cancer.

irispublishers-openaccess-dentistry-oral-health

Results

Patient’s lingual hyperpigmentation was previously diagnosed by her former dentist as racial pigmentation. Racial pigmentation of the oral cavity is usually observed in dark-skinned populations. This type of pigmentation ranges in color and location within the oral cavity. Color changes range from light to dark brown and is most commonly located within the gingiva and buccal mucosa. Other reported sites include lips, palate, and tongue [5]. It is crucial to correlate pigmentary changes with time of presentation onset to rule out the possibility of racial pigmentation. Environmental, physiological, and pathological causes should all be considered during development of a differential diagnosis for oral hyperpigmentation. It is important to note the patient’s medical history in conjunction with the symptoms presented to look for a possible correlation. Diagnosis of drug-induced pigmentary changes is this case was based on correlating the onset of presentation with the initiation of chemotherapeutic drug use.

Discussion

There are certain side-effects associated with chemotherapy that effect the oral cavity in a variety of ways. These side effects can be classified into two categories: short term and long term. Fortunately, the majority of the side effects are short term which do not last more than a few weeks after completion of chemotherapy. Hyperpigmentation of the oral mucosa is one of the only long-term or permanent side-effects. Principles, techniques, and management of oral hyperpigmentation is still not fully understood. Currently, based on observations, the only known adverse side-effect of oral hyperpigmentation is poor aesthetics. To remove oral hyperpigmentation established during chemotherapy, patients need to undergo relatively invasive treatments. For example, some of the available surgical depigmentation options include scalpel surgery, abrasion with rotary abrasives, and diode lasers [6]. Adverse side effects other than unfavorable aesthetics and less invasive treatment or preventative options need to be researched and developed.

Some of the chemotherapeutic agents known to cause hyperpigmentation may include cyclophosphamide, busulfan, bleomycin, hydroxyurea, doxorubicin, cisplatin, etoposide and fluorouracil [2,3]. However, there is lack of data and knowledge to declare chemotherapeutic drug classes associated with this side effect. Drug dosages causing oral hyperpigmentation should also be investigated. Moreover, prevalence of oral hyperpigmentation associated with chemotherapy remains unknown.

There are conflicting ideas as to the mechanism driving oral hyperpigmentation with chemotherapy. Proposed mechanisms include accumulation of drug or drug metabolite deposition in oral mucosa, enhanced melanin deposition with or without an increase in melanocytes, or drug-induced post inflammatory changes [2]. Understanding the mechanism tied to this side effect may facilitate better treatment options or preventative mechanisms in the future. We need to develop better strategies to help with diagnosis of oral hyperpigmentation. History or record of pigmentation prior to chemotherapy should be properly investigated. Upon initial presentation, a size measurement and photo of the lesion should be documented. Initial size and appearance information and documentation can be used to monitor the lesion over the course of time. Lesion size or color changes are important to recognize when trying to rule out the possibility of melanoma. Chemotherapy is often the treatment of choice and first line of defense against many types of cancers. With a rise in cancer cases and chemotherapy use, dentists are likely to encounter patients with oral complications as a result of chemotherapy. Although oral hyperpigmentation is not very common, it is one of the complications that dentists may encounter. Based on current knowledge, this is a benign condition that does not significantly impact a patient’s overall health or quality of life. Correct diagnosis will avoid patients concern and unnecessary biopsies. It is imperative that dentists should have the knowledge and expertise to diagnose and monitor chemotherapy-induced oral hyperpigmentation.

Chemotherapy is often the treatment of choice and first line of defense against many types of cancers. With a rise in cancer cases and chemotherapy use, dentists are likely to encounter patients with oral complications as a result of chemotherapy. Although oral hyperpigmentation is not very common, it is one of the complications that dentists may encounter. Based on current knowledge, this is a benign condition that does not significantly impact a patient’s overall health or quality of life. Correct diagnosis will avoid patients concern and unnecessary biopsies. It is imperative that dentists should have the knowledge and expertise to diagnose and monitor chemotherapy-induced oral hyperpigmentation.

 Read More Iris Publishers Online Journal of Dentistry & Oral Health Articles:

Comments

Post a Comment

Popular posts from this blog

Iris Publishers - Online Journal of Dentistry & Oral Health| The Relationship between Rehabilitation of Severe Early Childhood Caries and Well-Being in 5 Years Old Patient, A Case Report

Image
  Authored by  Chaza Kouchaji, Introduction ECC experience is defined as the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child aged 71 months or younger [1]. ECC is the most commonly observed chronic disease in children [2]. ECC continues to be pandemic disease according to World Health Organization. The prevalence generally ranges from 27%-48%, with more than 76% reported from the Middle East [3]. While in Syria the burden of ECC amongst Syrian children aged 3-5 years was dmft value of 4.25 ± 4.2 per child [4]. Main risk factors that contribute to the formation of ECC were microbiological, environmental and dietary factors [5]. The clinical appearance of the teeth in S-ECC in a child 2, 3, or 4 years of age is typical and follows a definite pattern. There is early carious involvement of the maxillary anterior teeth, the maxillary and mandibular first primary molars, and sometim...
Read more

Oral Pyogenic Granuloma: Case Report of an Atypical Presentation

Abstract “Granulomas seem to be a defensive mechanism that triggers the body to “wall off” foreign invaders such as bacteria or fungi to keep them from spreading” [1]. Pyogenic granuloma is a relatively common benign skin growth that consists of vascular nodules of proliferating capillaries [2]. They grow rapidly and often occur following a minor injury or trauma, most likely as a vascular or fibrous response to injury or irritant [2]. Ultimately, the etiology of pyogenic granuloma is still unknown. Oral pyogenic granuloma is most commonly found on the gingiva, followed by the lips, tongue, buccal mucosa, and hard palate [3]. It often presents as a red, smooth, or lobulated exophytic lesion which can be pedunculated or sessile and often bleeds on provocation [4]. A microscopic evaluation of pyogenic granuloma often reveals that the lesion is fully or partially covered by parakeratotic or non-keratinized stratified squamous epithelium. The majority of the lesion is formed by a lobulated...
Read more

Hepatitis B Virus among Dental Clinic Workers and the Risk Factors Contributing for its Infection

Abstract Objectives:  Dental clinic workers (DCWs) in Yemen have an additional risk of getting infected with HBV from their workplace and till now they are not routinely vaccinated against HBV infection. This study aimed to estimate prevalence of hepatitis B virus infection and associated risk factors among DCW in selected dental clinics in Sana’a city. Study design:  Data were acquired from a cross sectional survey conducted among DCWs in 2014 at the Faculty of Dentistry, Sana’a University, in Sana’a city. A proportionate to size random sample was drawn per DCW category. A structured questionnaire was used to collect data about socio-demographic characteristics and risk factors. ELISA was used to test sera for HBV markers. Result:  The study included 246 dentists and 263 dental assistants, the sero-prevalence of current hepatitis B virus infection was 6.1%; while prevalence of life time exposure to hepatitis B virus infection was 18%. Prevalence of needle stick injuries,...
Read more