Pigmented papillae of the tongue (PFPT) is a benign condition characterized by well-circumscribed hyperpigmentation confined solely to fungiform papillae. Lesions are generally asymptomatic.

PFPT is generally considered as a common finding in African American individuals, in Australian aborigines and Indians. It is considered rare in people with light skin.

The pathogenesis and the reason for the abnormalities being limited to the fungiform papillae remains unknown. It could be considered a benign variant of oral hyperpigmentation seen in high phototypes and would denote an active pigmentation system in an area where it is generally inactive.

The histological features of pigmented fungiform papillae include numerous melanophages in the lamina propria of the papillae with lack of inflammatory infiltrates. The pigment located within the melanophages stains positive for melanin with Fontana-Masson and negative for iron with Prussian blue.

Differential diagnosis include other causes of pigmentation of the oral mucosa such as hemochromatosis, pernicious anemia, amalgam tattoo, Peutz-Jeghers syndrome, Addison’s disease, von Recklinghausen syndrome and melanocytic nevus.
However, a clear diagnosis can be reached in all those disorders on the basis either of the distribution and clinical characteristics of the pigmentation or the accompanying manifestations.

No treatment is required as the condition may be considered as normal variant.