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©2013 UpToDate ® Print Email Buccal hyperpigmentation due to ACTH excess Lips and gums of a 32-year-old man demonstrating hyperpigmentation of the buccal mucosa along the line of dental occlusion (an area of repeated trauma) and of the gums (in the area of chronic inflammatory periodontal disease). The high plasma ACTH concentrations responsible for the hyperpigmentation were due in this case to primary adrenal insufficiency; similar changes can be seen in patients with ACTH-dependent Cushing's syndrome or Nelson's syndrome. Reprinted with permission from: Williams Textbook of Endocrinology, 8th ed, Foster, DW, Wilson, JD (Eds), WB Saunders, Philadelphia, 1996.