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Zhao M, Liang G, Wu X, Wang S, Zhang P, Su Y, Yin H, Tan Y, Zhang J, Lu Q (2012) Abnormal epigenetic modifications in peripheral blood mononuclear cells from patients with alopecia areata
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Since ethanol caused a direct, unspecific, damage to the mucosa independent of GSH status (Table 1), the extent of injury in TNBS+ethanol-treated rats due to ethanol was subtracted to evaluate the injury due to the metabolism of TNBS
10% develop oral pigmentation Oral pigmentation like Addisons disease Ectopic ACTH production Rare Excess ACTH production by bronchial adenocarcinoma Oral hypermelanotic pigmentation similar to Addisons disease, but possible additional involvement of the soft palatal mucosa Chloasma Feature of late pregnancy Manifests as melanotic hyperpigmentation of the midface Involvement of the oral mucosa is extremely rare Albrights (McCune-Albright) syndrome Rare Polyostotic fibrous dysplasia, sexual precosity, cutaneous hyperpigmentation, occasional other endocrinopathies Possible melanotic hyperpigmentation of the oral mucosa (in addition to unilateral or bilateral fibrous dysplasia) Haemochromatosis Autosomal recessive Mechanism of iron overload not clear Iron deposition in hepatocytes More commom in males (female menstruation will lessen the iron load) Usually does not present clinically until the 5th decade Haemochromatosis Investigations: Elevated serum iron, reduced TIBC, elevated ferritin Iron in hepatocytes of biopsy Thalassemia Patients may have a dusky-brown complexion - reflects iron accumulation post-transfusion Rarely there may be melanotic pigmentation of the oral mucosa and gingivae Pigmentary incontinence Uncommon Usually arises in late age in association with oral lichen planus Patients are often tobacco smokers Areas of melanotic pigmentation in site of present or past lichen planus Asymptomatic Exclude Addisons disease Drug-induced oral mucosal pigmentation Colours can be blue, brown, black, grey, green Drug-induced oral mucosal pigmentation Blue Amiodarone Antimalarials Bismuth (overdose) Mepacrine Minocycline Quinidine Silver Sulphasalazine Drug-induced oral mucosal pigmentation Brown Betal nut Busulphan Clofazimine Oral contraceptives Cyclophosphamide Doxorubicin Doxycycline Fluorouracil HRT Heroin HRT Ketoconazole Menthol Minocycline Pholphthalein Propanolol Zidovudine Drug-induced oral mucosal pigmentation Black Amiodaquine Betal nut Methyldopa Drug-induced oral mucosal pigmentation Green Copper Grey Amiodiaquine Chloroquine Fluoxetine Hydroxycholoquine Lead Silver Tin/zinc Local causes of oral pigmentation Ecchymoses Ephelis Melanoma and other malignancies Melanoacanthoma Naevus Melanoticmacule Tattoos (amalgam, ink, graphite etc) Local causes of oral pigmentation - melanotic macules Brown or black Usually affect lips or gingivae Arise at any age Not premalignant - tattoos Caused by intentional or accidental implantation of exogenous pigments into the mucosa Amalgam tattoo or focal argyrosis is the most common and appears as blue-black, non-elevated discoloration that is usually irregular in shape and variable in size
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