lesi pigmentation

1. ORAL PIGMENTED
LESION
ERIS NURUL RAHMADHINI
160721220004
PPDGS ILMU PENYAKIT MULUT
2022
PEMBIMBING :
DRG. RIANI SETIADHI, SP.PM(K)

2. Daerah / area yang mengalami perubahan
warna pada mukosa mulut :
• Proses fisiologis
• Proses patologis --> Deposisi /
pengendapan, produksi, maupun akumulasi
berbagai zat berpigmen endogen atau
eksogen
• Bahan asing tertanam dalam jaringan.
ORAL PIGMENTED LESION
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• C. Sreeja, K. Ramakrishnan, D. Vijayalakshmi, M. Devi, I. Aesha, and B. Vijayabanu. Oral Pigmentation : a Review. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408. doi: 10.4103/0975-7406.163471

3. Pigmentasi
Patologis
Endogen
Eksogen
Sumber :
melanin,
hemoglobin,
hemosiderin
peristiwa
traumatis atau
iatrogenik yang
mengakibatkan
deposisi bahan
asing langsung
ke jaringan
mukosa.
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• C. Sreeja, K. Ramakrishnan, D. Vijayalakshmi, M. Devi, I. Aesha, and B. Vijayabanu. Oral Pigmentation : a Review. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408. doi: 10.4103/0975-7406.163471

4. PIGMENTASI ENDOGEN
Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology
Burket’s
Oral
Medicine.

5. PIGMENTASI EKSOGEN
Textbook of Oral Medicine, Oral
Diagnosis, and Oral Radiology
Burket’s Oral
Medicine.

6. Pigmented
Lesions of the
Oral Mucosa
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland

7. MELANOTIC
MACULE
Lesi berpigmentasi jinak,yang
dikarakteristikkan dengan
adanya peningkatan pigmen
melanin secara fisiologik di
mukosa rongga mulut.
• Buku PPK Ilmu Penyakit Mulut. 2020
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer

8. EPIDEMIOLOGI
• 3% Populasi
• Perempuan : Laki-Laki = 2 : 1
• 6% pasien dengan infeksi
HIV
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Cawson RA, Odell EW. Oral Pathology and Oral Medicine. 9th Ed. 2017. Elsevier

9. ETIOLOGI
MELANOTIC MACULE
Faktor Resiko :
• Trauma
• Reaksi Fisiologis (pigmentasi ras)
• Gangguan endokrin
• Terapi anti-malaria
• sindrom Peutz-Jeghers
• Belum ditentukan secara definitif
--> Berhubungan dengan peningkatan melanin
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Alawi Faizan. Pigmented Lesions of the Oral Cavity : An Update. Dent Clin North Am. 2013 Oct; 57(4): 699–710. Published online 2013 Aug 15. doi: 10.1016/j.cden.2013.07.006
• Pais S, Hegde SK, Bhat S S. Oral Melanotic Macule - a Case Report. J Indian Soc Pedo Prev Dent June (2004) 22 (2) 73 - 75

10. Gambaran Klinis
• Lesi pigmentasi berwarna hitam
kecoklatan / kebiruan
• Lesi soliter
• Datar (Makula)
• Berbentuk oval / bulat
• Berbatas tegas, irreguler
• Berukuran : Diameter 1-2 mm
• Asimptomatik
• Letak : labial (terutama bibir bawah),
gingiva, mukosa bukal, palatum
• Blanching test (-)
• Tidak membesar / menjadi lebih gelap
• Buku PPK Ilmu Penyakit Mulut. 2020
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Alawi Faizan. Pigmented Lesions of the Oral Cavity : An Update. Dent Clin North Am. 2013 Oct; 57(4): 699–710. Published online 2013 Aug 15. doi: 10.1016/j.cden.2013.07.006

11. Gambaran Histologi
• Peningkatan melanin pada lapisan
basal dan parabasal di stratified
squamous epithelium tanpa
peningkatan jumlah melanosit
• Tidak ada pemanjangan rete ridges
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Alawi Faizan. Pigmented Lesions of the Oral Cavity : An Update. Dent Clin North Am. 2013 Oct; 57(4): 699–710. Published online 2013 Aug 15. doi: 10.1016/j.cden.2013.07.006

12. Diversification
Presentations are tools that
can be used as lectures.
Liquidity
Presentations are tools that
can be used as lectures.
Divisibility
Presentations are tools that
can be used as lectures.
Less Risk
Presentations are tools that
can be used as lectures.
PATOGENESIS

13. Diversification
Presentations are tools that
can be used as lectures.
Liquidity
Presentations are tools that
can be used as lectures.
Divisibility
Presentations are tools that
can be used as lectures.
Less Risk
Presentations are tools that
can be used as lectures.
PATOGENESIS

14. • Anamnesis
• Pemeriksaan Klinis
• Pemeriksaan penunjang (histologi)
--> Optional
PENEGAKAN DIAGNOSIS
• Buku PPK Ilmu Penyakit Mulut. 2020

15. ALGORITMA PENEGAKAN DIAGNOSIS
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.

16. ALGORITMA PENEGAKAN DIAGNOSIS FOCAL PIGMENTED LESION
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13

17. DIAGNOSIS BANDING
• Melanocytic Nevus
• Amalgam Tattoo
• Melanoma Malignant
• Focal Ecchymosis
• Buku PPK Ilmu Penyakit Mulut. 2020
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland

18. ALGORITMA PENEGAKAN DIFFERENSIAL DIAGNOSIS
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.

19. TATA LAKSANA
Observasi setiap 6-12 bulan
Melihat Perubahan :
• Ukuran
• Warna
• Bentuk
Estetika
• Eksisi
• cryosurgery
• Electrocauter
• Ablasi Laser
• Buku PPK Ilmu Penyakit Mulut. 2020
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Pais S, Hegde SK, Bhat S S. Oral Melanotic Macule - a Case Report. J Indian Soc Pedo Prev Dent June (2004) 22 (2) 73 - 75

20. PROGNOSIS DAN
KEBERHASILAN PERAWATAN
• Prognosis : Baik
• keberhasilan perawatan :
⚬ Tidak membesar / berubah warna
⚬ Tidak bergejala
• Buku PPK Ilmu Penyakit Mulut. 2020

21. DAFTAR
PUSTAKA
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology.
2nd Ed. Elsevier.
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine.
Vol 13
• C. Sreeja, K. Ramakrishnan, D. Vijayalakshmi, M. Devi, I. Aesha, and B. Vijayabanu. Oral
Pigmentation : a Review. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408. doi:
10.4103/0975-7406.163471
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer.
Switzerland
• Buku PPK Ilmu Penyakit Mulut. 2020
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Alawi Faizan. Pigmented Lesions of the Oral Cavity : An Update. Dent Clin North Am. 2013
Oct; 57(4): 699–710. Published online 2013 Aug 15. doi: 10.1016/j.cden.2013.07.006
• Pais S, Hegde SK, Bhat S S. Oral Melanotic Macule - a Case Report. J Indian Soc Pedo Prev
Dent June (2004) 22 (2) 73 - 75
• Cawson RA, Odell EW. Oral Pathology and Oral Medicine. 9th Ed. 2017. Elsevier

22. TERIMA KASIH
Eris Nurul Rahmadhini

23. FRECKLE
(EPHELIS)
Makula hiperpigmentasi yang
biasanya terlihat pada kulit
wajah dan perioral
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland

24. EPIDEMIOLOGI
• Anak-anak (usia 2-3 tahun) - remaja -
-> memudar seiring bertambahnya
usia
• Individu berkulit terang >>
• Individu berambut merah dan pirang
>>
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Praetorius C, Strum RA, Steingrimsson E. Sun Induced Freckling : Ephelides and Solar Lentigines. Pigment Cell Melanoma Res 2014 May;27(3):339-50. doi: 10.1111/pcmr.12232.

25. • Polimorfisme Genetik
--> gen melanocortin-1 receptor (MC1R) --> reseptor terletak pada
membran melanosit
ETIOLOGI FRECKLE /
EPHELIS
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Praetorius C, Strum RA, Steingrimsson E. Sun Induced Freckling : Ephelides and Solar Lentigines. Pigment Cell Melanoma Res 2014 May;27(3):339-50. doi: 10.1111/pcmr.12232.
• Faktor Resiko
--> Sun burn

26. Gambaran Klinis
• Lesi pigmentasi berwarna coklat
• Datar (Makula)
• Berbentuk oval / bulat
• Berbatas tegas dan reguler
• Berukuran : Diameter 1-3 mm
• Asimptomatik
• Letak : daerah yang sering terekspose sinar
matahari, pada daerah perioral biasanya
pada vermilion bibir terutama bibir bawah
• berubah menjadi lebih gelap bila terpapar
sinar matahari dalam waktu yang lama
• Jumlah : > 1
• Buku PPK Ilmu Penyakit Mulut. 2020
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Alawi Faizan. Pigmented Lesions of the Oral Cavity : An Update. Dent Clin North Am. 2013 Oct; 57(4): 699–710. Published online 2013 Aug 15. doi: 10.1016/j.cden.2013.07.006

27. Sinar UV
Individu
dengan MC1R
mengaktivasi ligan
a- melanocyte
stimulating
hormone (aMSH)
and the adre-
nocorticotropic
hormone (ACTH)
mengaktivasi
melanosit
PATOGENESIS
Peningkatan
produksi
melanin pada
sel basal

28. TATA LAKSANA
Treatment tidak diindikasikan
untuk anak-anak dan remaja
• pemakaian sunscreen --> mencegah
lesi menjadi lebih gelap dan timbulnya
lesi baru
Estetika
• chemical peeling
• laser therapy
• cryotherapy
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland

29. AMALGAM
TATTOO
Lesi iatrogenik pigmentasi
eksogen akibat masuknya
partikel amalgam ke dalam
mukosa mulut
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• C. Sreeja, K. Ramakrishnan, D. Vijayalakshmi, M. Devi, I. Aesha, and B. Vijayabanu. Oral Pigmentation : a Review. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408. doi: 10.4103/0975-7406.163471
• Galletta V, Dal Vechio AM, et all. Extensive Amalgam Tattoo on the Alveolar-gingival Mucosa : case report. An Bras Dermatol. 2011;86(5):1019-21.

30. EPIDEMIOLOGI
• 1-3% populasi
• Wanita > Pria --> kepatuhan
perawatan gigi
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13

31. ETIOLOGI
• Partikel Amalgam
⚬ Area abrasi mukosa sebelumnya dapat terkontaminasi
oleh debu amalgam di dalam cairan mulut --> transfer
pasif oleh gesekan kronis mukosa terhadap restorasi
amalgam
⚬ Masuknya partikel amalgam ke dalam jaringan saat
prosedur pencabutan
⚬ Benang gigi terkontaminasi partikel amalgam dari
restorasi yang baru dipasang
⚬ Amalgam dari prosedur retrofill endodontik dapat
tertinggal di dalam jaringan lunak di tempat bedah
⚬ Partikel logam halus dapat didorong melalui mukosa
mulut dari tekanan bor turbin udara berkecepatan tinggi.
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• C. Sreeja, K. Ramakrishnan, D. Vijayalakshmi, M. Devi, I. Aesha, and B. Vijayabanu. Oral Pigmentation : a Review. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408. doi: 10.4103/0975-7406.163471
• Galletta V, Dal Vechio AM, et all. Extensive Amalgam Tattoo on the Alveolar-gingival Mucosa : case report. An Bras Dermatol. 2011;86(5):1019-21.

32. Gambaran Klinis
• Lesi pigmentasi berwarna hitam / keabuan
• Datar (Makula)
• Berbatas tegas dan irreguler
• Berukuran kecil (0.1 - 1 cm)
• Asimptomatik
• Letak : daerah yang dekat dengan tambalan
amalgam atau ada riwayat tambalan
amalgam sebelumnya
• Radiografi : adanya partikel amalgam yang
terdeteksi (apabila ukuran memadai)
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• C. Sreeja, K. Ramakrishnan, D. Vijayalakshmi, M. Devi, I. Aesha, and B. Vijayabanu. Oral Pigmentation : a Review. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408. doi: 10.4103/0975-7406.163471
• Galletta V, Dal Vechio AM, et all. Extensive Amalgam Tattoo on the Alveolar-gingival Mucosa : case report. An Bras Dermatol. 2011;86(5):1019-21.

33. Gambaran Histologi
• Terlihat warna coklat keemasan atau
hitam pada kolagen dan serat elastis
• Infiltrasi inflamasi limfositik makrofag
ringan
• Terlihat Multinucleated foreign body
giant cells --> bila partikel amalgam
berukuran besar
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer

34. Partikel
amalgam
masuk ke
dalam jaringan
mengendap
pada lamina
propia
PATOGENESIS
terjadi
pewarnaan
pada serat
kolagen dan
elastis
Terbentuk
makula
inflamasi
ringan
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• C. Sreeja, K. Ramakrishnan, D. Vijayalakshmi, M. Devi, I. Aesha, and B. Vijayabanu. Oral Pigmentation : a Review. J Pharm Bioallied Sci. 2015 Aug; 7(Suppl 2): S403–S408. doi: 10.4103/0975-7406.163471
• Galletta V, Dal Vechio AM, et all. Extensive Amalgam Tattoo on the Alveolar-gingival Mucosa : case report. An Bras Dermatol. 2011;86(5):1019-21.

35. TATA LAKSANA
Treatment tidak diperlukan
Estetika
• laser therapy
• cryotherapy
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Galletta V, Dal Vechio AM, et all. Extensive Amalgam Tattoo on the Alveolar-gingival Mucosa : case report. An Bras Dermatol. 2011;86(5):1019-21.

36. PEUTZ-JEGHERS
SYNDROME
Sindrom poliposis herediter
langka bersifatautosomal
dominan, memiliki karakteristik
utama polip hamartoma,
pigmentasi mukokutaneus, dan
peningkatan kerentanan terhadap
keganasan(malignancy).
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Daniell J, Plazzer JP, Perera A, Macrae F. An exploration of genotype-phenotype link between Peutz-Jegherssyndrome and STK11: A review. Fam Cancer 2018;17(3):421-7.

37. EPIDEMIOLOGI
• Prevalensinya sekitar 1 dari 100.000 orang atau
bahkan
• Insidensi 1 dari 150.000 hingga 200.000 orang.
• Tanpa memandang ras atau jenis kelamin. Rasio PJS
pria-wanita adalah 1: 1
• PJS menghasilkan polip dan pigmentasi mukokutan
yang terbukti sejak masa kanak-kanak atau awal
masa dewasa
• Peutz-Jeghers memiliki peningkatan risiko 15 kali
lipat terkena kanker usus dibandingkan dengan
populasi umum
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Brad W. Neville, Oral andMaxillofacial Pathology, FourthEdition, 2016
• Maharani Laillyza Apriasari, Angular cheilitis and oral pigmentation as early detection of Peutz-Jegherssyndrome, Dental Journal, 2018

38. • Terkait dengan mutasi gen supresor tumor
STK11 / LKB1 (serine/ treonine kinase 11) yang
terletak pada kromosom 19p13.3
--> STK11 merupakan gen supresor tumor (tumor suppresor
gene/TSG) yang berperan dalam induksi growth arrest pada fase
G1 dalam siklus sel.
⚬ Mutasi gen STK11/LKB1 juga memiliki pengaruh
hipoaktivitas jalursupresi tumor (tumor suppresor
pathways) p53.7
ETIOLOGI
• Deepak Sharma, Peutz-jeghers Syndrome: A Case Report, International Journal Of Advances In Medicine,2015
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13

39. Gambaran Klinis
• Pigmentasi mukokutaneus dapat
ditemukan pada 95% kasus PJS dan sangat
sering menjadi penanda utama PJS
• Lesi pigmentasi ini umumnya berwarna
hitam atau kecoklatan
• Bentuk : bulat atau oval
• Batas : irreguler
• berdiameter 1-5 mm,
• mayoritas berlokasi di mukosa bukal dan
bibir
• Lesi juga bisa ditemukan di sekitar dan
dalam mulut, mata, lubang hidung(nostrils),
dan perianal, serta di jari tangan dan kaki
michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
Brad W. Neville, Oral andMaxillofacial Pathology, FourthEdition, 2016
Maharani Laillyza Apriasari, Angular cheilitis and oral pigmentation as early detection of Peutz-Jegherssyndrome, Dental Journal, 2018

40. • Lesi sekunder sering ditemukan pada penderita
PJS
• Anemia laten sering menyebabkan kelainan pada
mukosa mulut, antara lain:
⚬ Glositis,
⚬ Angular cheilitis,
⚬ Stomatitis aphthous rekuren, dan
⚬ Sindrom mulut terbakar.
Lesi
Sekunder
Maharani Laillyza Apriasari, Angular cheilitis and oral pigmentation as early detection of Peutz-Jeghers syndrome, Dental Journal,

41. Gambaran Histologi
• Menunjukkan peningkatan melanin
basilar dengan masuknya melanin ke
dalam submukosa
• tidak disertai peningkatan melanosit
• Brad W. Neville, Oral and Maxillofacial Pathology, FourthEdition, 2016.
• Laillyza MA, Nindia A, Angular cheilitis and oral pigmentation as early detection of Peutz-Jegherssyndrome, Dental Journal, 2018.
• Hamid Reza Mozaffari, case report : Seven-Year Follow-Up of Peutz-Jeghers Syndrome, Hindawi 2016.

42. DRUG INDUCED
PIGMENTATION
• bentuk abnormal pigmentasi pada
kulit dan atau mukosa akibat obat-
obatan melalui beberapa mekanisme
yang berbeda, termasuk melanosis.
• Melanosis --> Suatu lesi pigmentasi
yang dikarakteristikkan dengan
adanya peningkatan pigmen melanin
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Shahzeb Hassan, Xiaolong Zhou. Drug Induced Pigmentation. 2021

43. • Beberapa obat dapat menyebabkan pigmentasi
ETIOLOGI
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland

44. EPIDEMIOLOGI
• 10-20% kasus hiperpigmentasi di dunia dapat
diinduksi oleh obat-obatan
• Tidak ada perbedaan signifikan antara jenis kelamin,
usia, dan kelompok ras tertentu
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Shahzeb Hassan, Xiaolong Zhou. Drug Induced Pigmentation. 2021

45. Drug intake
• Akumul
asi
melani
n
• sintesis
pigmen
khusus
• Deposisi
besi
PATOGENESIS
• Dereure O. Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. Am J Clin Dermatol. Am J Clin Dermatol.
deposit
metabolisme
obat
• pembent
ukan
melanog
enesis

46. Gambaran Klinis
• Perubahan warna secara perlahan dengan
perluasan progresif
• Pola distribusi lebih jelas pada pigmentasi yang
diinduksi obat
• Jenis warna lesi kurang spesifik/bervariasi
• Pigmentasi memudar ketika obat penyebab
dihentikan
Ankita Bohra SB. Drug Induced Oral Mucosal Pigmentation- A Review. J Pigment Disord.

47. Gambaran Klinis Anti Malaria
• Pigmentasi berwarna abu-
abu kebiruan hingga ungu
• Quinacrine (mepacrine)
• Mefloquine
• Chloroquine
• Hydroxychloroquine
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Shahzeb Hassan, Xiaolong Zhou. Drug Induced Pigmentation. 2021

48. Gambaran Klinis Antibiotik
• Clofazimine → reddish-blue
• Dapsone → blueish-gray
• Isoniazid → purplish
• Levofloxacin, Pefloxacin → blueish-gray
• Minocycline → blueish-black / brown-gray
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. E
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Shahzeb Hassan, Xiaolong Zhou. Drug Induced Pigmentation. 2021

49. Gambaran Klinis
• michael glick, martin s Greenber, peter B Lockhart stphen JC. 2021. Burket’s Oral Medicine. Vol 13
• Farah CS, Balasubramaniam R, et all. Contamporary Oral Medicine. 2019. Springer. Switzerland
• Ongole R, BN Praveen. 2013. Textbook of Oral Medicine, Oral Diagnosis, and Oral Radiology. 2nd Ed. Elsevier.
• Bruch JM, Treister NS. Clinical Oral Medicine and Pathology. 2010. Humana Press. Springer
• Shahzeb Hassan, Xiaolong Zhou. Drug Induced Pigmentation. 2021

50. Gambaran Histologi
• Deposisi pigmen kecoklatan pada
lapisan basal epitel region perivascular
(Chloroquine)
• Nahhas AF, Braunberger TL, Hamzavi IH. An Update on Drug-Induced Pigmentation. Am J Clin Dermatol. 2019

51. TATA LAKSANA
• Komunikasikan kondisi yang dialami pasien
• Instruksi menjaga oral hygiene
• Tidak diperlukan intervensi lebih lanjut → perubahan warna sering memudar
beberapa bulan
• setelah obat dihentikan
• Konsultasikan dengan sejawat bidang terkait untuk modifikasi terapi
• Instruksi membatasi paparan sinar matahari langsung → menggunakan alat
dan bahan pelindung
• Nahhas AF, Braunberger TL, Hamzavi IH. An Update on Drug-Induced Pigmentation. Am J Clin Dermatol. 2019
• Shahzeb Hassan, Xiaolong Zhou. Drug Induced Pigmentation. 2021