Approach to tongue hyperpigmentation: connecting the dots with associated conditions in general practice

Kanwal, Fatima; Suleman, Waseem; Butt, Aayesha

doi:10.20396/bjos.v25i00.8675864

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Original Research • Braz J Oral Sci. 25 • 2026 • https://doi.org/10.20396/bjos.v25i00.8675864 linkcopy

Approach to tongue hyperpigmentation: connecting the dots with associated conditions in general practice

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Addressing hyperpigmentation in exposed areas of the body can be challenging in general practice and can raise a variety of questions, from possible serious illnesses to aesthetic concerns. Reviewing the case of a 21- year-old female, this study investigates concurrent benign hyperpigmentation of the tongue and conjunctiva while exploring potential links to iron and vitamin D deficiencies. The diagnostic journey involves a comprehensive evaluation, ruling out extrinsic causes and systemic illnesses for tongue hyperpigmentation, and discusses the approach leading to the diagnosis of Pigmented Fungiform Papillae (PFP) on the tongue and Complexion Associated Melanosis (CAM) in the conjunctiva. The article advocates for a cost-effective, minimally invasive approach in managing such cases in general medical practice.

Anemia, iron-deficiency; Melanosis; Glossitis; Conjunctival diseases; Hyperpigmentation

Investigation	Patient Values	Reference Range
Hb	7 g/dL	12 to 16 g/dL (female)
MCV	50 fL	80–100 fl
WBC	6.5 x 10^3/uL	4.5 to 11.0 x 10^3/uL
Plt	511 x 10^3/uL	150-450 x 10^3/uL
Urea	23.54 mg/dL	5-22 mg/dL
SGPT	40 IU/L	13 - 69 U/L
Cr	0.57 mg/dL	0.7 to 1.3 mg/dL
Vitamin D	13.62 ng/mL	20 to 40 ng/mL
Na	141 mmol/L	136 to 144 mmol/L
K	3.8 mmol/L	3.7 to 5.1 mmol/L
Cl	106 mmol/L	97 to 105 mmol/L
HCO3	23.7 mmol/L	22 to 30 mmol/L
UDR	All parameters within normal limits	-
Serum Iron	9 µg/dL	60 to 170 µg/dL
TIBC	423 µg/dL	240-450 µg/dL
TG	74 mg/dL	<150 mg/dl
Serum Cholesterol	103 mg/dL	<200 mg/dL
HDL	32 mg/dL	>40 mg/dL
LDL	67 mg/dL	<100 mg/dl
VLDL	14.8 mg/dL	2 to 30 mg/dL
TSH	4.250 µIU/mL	0.4 to 4.0 mIU/L
Free T4	1.06 ng/dL	0.8 to 1.8 ng/dL
Serum Cortisol (8am)	20.36 µg/dL	5 to 25 mcg/dL
ACTH	29 pg/m	10 and 60 pg/mL

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[TFN1] TABLE 1: Investigations

[TFN2] Hemoglobin (Hb), Mean Corpuscular Volume (MCV), White Blood Cell count (WBC), Platelet count (Plt), Urea, Serum Glutamate Pyruvate Transaminase (SGPT), Creatinine (Cr), Vitamin D, Sodium (Na), Potassium (K), Chloride (Cl), Bicarbonate (HCO₃), Urine Dipstick Analysis (UDR), Serum Iron, Total Iron-Binding Capacity (TIBC), Triglycerides (TG), Serum Cholesterol, High-Density Lipoprotein (HDL), Low-Density Lipoprotein (LDL), Very Low-Density Lipoprotein (VLDL), Thyroid-Stimulating Hormone (TSH), Free Thyroxine (Free T₄), Serum Cortisol (8 am), and Adrenocorticotropic Hormone (ACTH).