A 28-year-old lady with Fitzpatrick skin type IV presented with an asymptomatic pigmentation over the tongue for the past 6 months. Examination revealed multiple discrete tan-brown pin-head papules on the anterolateral aspect of the dorsum of the tongue, representing the fungiform papillae. [Figure 1] There was no other mucocutaneous and systemic involvement. Routine laboratory investigations were unremarkable. Dermoscopy (DermLite DL4; polarized mode with 10x magnification) revealed ovoid hyperpigmented projections with dichotomized vessels originating at its base, giving the appearance of “rose petals” [Figure 2]. This clinico-dermoscopic finding is a characteristic of pigmented fungiform papillae of the tongue (PFPT).
Figure 1.
Pigmented fungiform papillae of the tongue
Figure 2.
Dermoscopy (DermLite DL4; polarized mode with 10× magnification) showing ovoid hyperpigmented projections with dichotomized vessels originating at its base, giving the appearance of ”rose petals”
Fungiform papillae are discrete projections found on the tongue's dorsal surface involving the tip and anterio-lateral aspect. PFPT is well-circumscribed hyperpigmentation confined to only these papillae.[1] This benign condition is classically noticed in darkly pigmented individuals, manifesting during the second or third decade, although cases involving children have been reported.[2] Although PFPT remains asymptomatic in most patients, associations like linear circumflex ichthyosis, lichen planus, Hori's nevus, melasma, hemochromatosis, scleroderma, pernicious anemia, and iron deficiency anemia have been documented.[3] Dermoscopy typically demonstrates projections with pigmented borders interspersed with dichotomized vessels that originated at their base, giving the aspect a “rose petal” appearance.[4] This correlates with melanophages without any inflammation in the dermis on histopathology; staining positive for melanin with Masson-Fontana but negative for iron with Prussian blue.[5] Such a unique finding will not be visualized in clinical mimickers like oral melanotic macule, melanocytic nevus, Peutz-Jeghers syndrome, Addison disease, and rarely Laughier-Hunziker syndrome.
The characteristic dermoscopic pattern provides an additional clue to help clinicians recognize and differentiate this ethnic, acquired, and benign condition, and avoid unnecessary investigative work-up. To the best of our knowledge, dermoscopic features of PFPT is yet to be described in the Indian population.
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