Refractory Pigmentation Associated with Laugier-Hunziker Syndrome following Er:YAG Laser Treatment

The present report describes a case of Laugier-Hunziker syndrome (LHS), a rare benign condition. A patient with LHS develops acquired melanotic pigmentation of the lips and buccal mucosa, often with pigmentation of the nails occurring. No systemic symptoms are associated with this syndrome. Normally, no treatment is required for this condition, unless for aesthetic reason, mainly due to pigmentation on the lip mucosa. We present a case of LHS, 37-year-old female, whose pigmentations on her lip and in the oral cavity were treated with an Er:YAG laser. At the postoperative 12th month followup, the lesions recurred. The effects of any surgical attempt to treat pigmentations associated with LHS were discussed. 1. Introduction The Laugier-Hunziker syndrome (LHS) is a rare benign condition, characterized by acquired pigmentation of the nails and melanotic pigmentation of the parts of the oral cavity such as lips, buccal, and palatal mucosa, [1]. Oral pigmentation is either focal or diffuse. Lip lesions and mucosa present as multiple, flat, smooth, discrete or confluent pigmented macules of variable size and color, ranging from grey to brown or blue-black [2]. Focal lesions may be more worrying, and require an examination of a biopsy specimen for an accurate diagnosis and, mainly, for excluding melanoma. Histopathological examination of oral pigmentation associated with LHS is not a diagnosis in itself; it only shows a significant increase in melanin or melanocytes in the basal layer. Diagnosis of LHS should be made on a clinical basis, by excluding other similar disorders such as Peutz-Jeghers syndrome and adrenal insufficiency [3]. It has been reported that very few patients actually receive treatment for LHS because it is a benign condition. We present a case of LHS treated with Er:YAG laser to remove the oral pigmentations which were cleared after four sessions but recurred twelve months later. 2. Case Report A 37-year-old Turkish woman was referred to the department of oral surgery because of pigmented areas in her mouth. She had noticed the pigmented lesions in her oral cavity 3 years ago and till the beginning of the treatment no major change in the oral cavity was observed by the patient. Oral examination revealed multiple, painless brown-black pigmentation, on the buccal mucosa, lower lip and posterior of the palate, bilaterally (Figure 1). No cutaneous or fingernail lesions were observed. She was systemically healthy and was not on any medication. She was neither a smoker nor a habitual drinker of alcohol. There was no family history of abnormal