addison's disease 303 



Pigmentation. A peculiar pigmentation of the skin is one 

 of the most striking findings in Addison's disease. Addison 7 

 described the pigmentation as a "dingy or smoky appearance 

 or various tints or shades of deep amber or chestnut brown." 

 With progress of the disease, the skin becomes light brown, 

 bronze, dark brown, and ultimately the dark hue of a negro. 

 Although pigmentation has been considered by some authors 

 as an indispensable symptom in diagnosis, Lewin 392 found pig- 

 mentation in only 72 per cent of his cases. Lewin's estimate 

 is probably too low, but there are a number of recorded 

 cases 119, 54 ° in which the diagnosis has been confirmed by au- 

 topsy and which during life were typical examples of Addison's 

 disease except for the absence of pigmentation. In acute 

 cases, particularly, pigmentation may be absent. In many 

 cases the pigmentation may be the first symptom to attract 

 the attention of the patient's friends. 



The pigmentation is most marked in regions normally pig- 

 mented or exposed to light or pressure. It appears first on 

 the face, neck, backs of the hands, and particularly on the 

 knuckles. The skin of the scalp and areas covered by hair 

 usually escape the pigmentation as do also the nail beds, palms, 

 and soles. 119 



Pigmentation of the mucous membranes of the mouth, con- 

 junctiva, and vagina, and of the serous membranes also com- 

 monly occurs. In the mouth this pigmentation usually is 

 found as small spots and streaks of a bluish black color, on 

 the lips, on the border of the tongue, the buccal mucosa, and 

 gums. 540 



Cases of remission in the pigmentation and even its disap- 

 pearance have been recorded. However, an apparent reduc- 

 tion of the pigmentation is produced by hydration of the skin. 

 This may account for the claimed diminution in pigment ob- 

 served after various forms of treatment. 



Biopsy of the skin in Addison's disease shows the deposition 

 of an abnormal amount of melanin in an epidermis and cutis 



