Atopic labial pigmentation: a new diagnostic feature in Asian
patients with atopic dermatitis
, Ki-Heon Jeong,
, Mu-Hyoung Lee,
, and Min-Kyung
Department of Dermatology, School of
Medicine, Kyung Hee University, Seoul,
Department of Dermatology
School of Medicine
Kyung Hee University
#23, Kyung Hee Dae-ro, Dongdaemun-gu
Conﬂicts of interest: None.
Background Pigmented lesions on the lips can be caused by physiological or pathological
factors, along with exogenous or endogenous factors. Many patients with atopic dermatitis
(AD) and labial pigmentation are seen in clinical practice. The aim of our study was to
further explore the association of labial pigmentation and AD.
Methods We performed a retrospective chart review of patients who visited the
Department of Dermatology at Kyung Hee Medical Center, Seoul, Korea, from January 1
to December 31, 2016. The study consisted of 178 patients with AD and a control group of
178 age- and sex-matched patients without AD.
Results The patients with AD had both a signiﬁcantly higher prevalence of labial
pigmented lesions and a signiﬁcantly higher number of labial pigmented lesions than was
observed in the control group. Moreover, the pigmented lesions were found mainly in the
middle section of the upper lip and showed multifocal distribution. The patients with AD
and labial pigmentation were signiﬁcantly younger at the onset of AD, showed a greater
association with allergic disorder, and had a higher immunoglobulin E (IgE) level than
patients without labial pigmentation.
Conclusion Our ﬁndings strongly suggest that labial pigmentation occurs in patients with
AD. Although labial pigmentation was not present in all patients with AD, this might be a
particularly helpful diagnostic feature of AD in Asian patients.
Atopic dermatitis (AD) is a chronically relapsing, inﬂammatory
skin disease and is characterized by intense pruritus, dry skin,
and typically distributed eczematous skin lesions. The diagnosis
of AD is based on the presence of various basic and minor fea-
tures established through physical examinations by Haniﬁn and
Recently, the diagnostic signiﬁcance of minor features
has been shown to vary according to race and age, but minor
features and other signs provide important clues for the diagno-
sis of AD.
For example, although not seen in all AD patients,
exfoliative cheilitis and recurrent crackled keratotic digital pulpi-
tis can be important features for diagnosis.
Therefore, it is
important to uncover new minor features or signs that are often
associated with AD.
Pigmented lesions on the lips can be caused by physiological
or pathological factors, along with exogenous or endogenous
factors. To our knowledge, there was only one report on the
association of labial pigmentation and atopic dermatitis,
although many patients with AD and labial pigmented macules
or patches are seen in clinical practice.
There are also only a
few case reports that describe patients with AD who develop
labial melanotic macules after topical application of tacrolimus
Therefore, we investigated the incidence of
labial pigmentation in Asian patients with and without AD. Fur-
thermore, we compared clinical features between AD patients
with labial pigmentation and AD patients without labial
Materials and methods
For patient identiﬁcation, we performed a retrospective chart
review of patients who visited the Department of Dermatology
at Kyung Hee Medical Center (KHMC), Seoul, Korea, from
January 1 to December 31, 2016. The Ethics Committee of
KHMC (institutional review board approval #KHMC IRB 2017-
07-076) approved the study.
The study included 178 patients with AD and a control group of
178 age- and sex-matched patients without AD. All 178 patients
were diagnosed with AD in accordance with the AD diagnostic
criteria established by Haniﬁn and Rajka. We excluded subjects
ª 2018 The International Society of Dermatology International Journal of Dermatology 2018, 57, 817–821