Hyperpigmented macules of oral mucosa and melanonychia: is i
The following case has been published in the Journal of American Academy of Dermatology.

A 69-year-old woman presented with a 15-year history of asymptomatic, dark spots gradually increasing in number on the lips and oral mucosa. Physical examination found coalescing, hyperpigmented macules on the buccal mucosa, palate, and lower lip mucosa. Longitudinal melanonychia was noted on the right great toe.

A punch biopsy specimen was taken from the buccal cheek. Peutz-Jeghers syndrome was ruled out although it has a similar presentation, the patient lacked a family history of the disease, gastrointestinal polyps, and pigmented macules in infancy or early childhood. Additionally, Peutz-Jeghers syndrome typically spares the tongue, palate, and fingernails.

The patient was finally diagnosed with Laugier-Hunziker syndrome. It is a benign, acquired condition that involves gradual progression of asymptomatic macular hyperpigmentation of the mucocutaneous surfaces and nails.

Major takeaways:-

- The most common extra-oral site of pigmentation in this condition are the nails. Melanonychia has been described in up to 60% of cases of Laugier-Hunziker syndrome. Nail involvement usually presents as single- or double-striped longitudinal lines. Fingernails are more commonly affected than toenails.

- No treatment is necessary other than for cosmetic reasons. Cosmetic treatment modalities that have been successfully used include cryosurgery and ablation with Q-switched alexandrite, neodymium-doped yttrium aluminium garnet (Nd:YAG), and diode lasers.

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