Etiology • Therapeutic drug-related tissue pigmentation • Many drugs may cause change—see listing below
Clinical Presentation • Macular mucosal discoloration (brown, gray, black) • Palate and gingiva are most common sites affected • In addition to mucosal changes, teeth in adults and children
may be bluish gray owing to minocycline/tetracycline use (see “Tetracycline Staining” on page 138).
Microscopic Findings • Most cases are due to increased melanin production. Some are
related to the deposition of a drug complex or a metabolized drug.
Clinical Presentation • Macular mucosal discoloration (brown, gray, black) • Palate and gingiva are most common sites affected • In addition to mucosal changes, teeth in adults and children
may be bluish gray owing to minocycline/tetracycline use (see “Tetracycline Staining” on page 138).
Microscopic Findings • Most cases are due to increased melanin production. Some are
related to the deposition of a drug complex or a metabolized drug.
Diagnosis • History • Clinical appearance
Differential Diagnosis • Physiologic changes • Smoker’s melanosis • Mucosal melanotic macule
Treatment • Drug withdrawal
Prognosis • Good
Drugs Capable of Producing Tissue Pigmentation • Antimalarials: chloroquine, mepacrine, quinidine, old-time
antimalarials • Antibiotics: tetracycline group, minocycline • Antivirals: azidothymidine • Phenothiazine: chlorpromazine
• Clofazimine • Heavy metals: gold, mercury salts, silver nitrate, bismuth, lead • Hormones: ACTH, oral contraceptives • Cancer/chemotherapy drugs: busulfan, cyclophosphamide,
cis-platinum • Other: methyldopa