Pigmented Fungiform Papillae in Children: Clinical and Dermoscopic Characteristics with an Illustrative Case

Pigmented fungiform papillae (PFP) is a benign oral pigmentation variant characterized by localized brown-black hyperpigmentation confined to the fungiform papillae, most commonly involving the tip and anterolateral aspects of the tongue. Due to its rarity in childhood and its resemblance to other pigmentary disorders of the oral mucosa, PFP is frequently misdiagnosed. This study aimed to summarize the clinical and dermoscopic characteristics of pigmented fungiform papillae in children based on the available literature and to emphasize the role of dermoscopy in the differential diagnosis, together with an illustrative pediatric case from our clinical practice. A literature search was performed in the PubMed database using the terms “pigmented fungiform papillae,” “pigmented fungiform papillae of the tongue,” “pigmented fungiform lingual papillae,” “tongue pigmentation,” “pediatric,” “child,” and “children,” and publications from database inception to 1 January 2026 were reviewed. Studies reporting clinical and/or dermoscopic findings in patients aged 18 years or younger were included, whereas articles focusing exclusively on adults or lacking pediatric data were excluded. Forty-four pediatric patients with PFP were identified in the literature. Lesions were typically described as multiple, well-demarcated brown macules or papules confined to the fungiform papillae, most frequently involving the anterior or anterolateral tongue. Among cases with available dermoscopic data, dermoscopy most commonly demonstrated the rose-petal pattern, followed by the cobblestone pattern, with both patterns coexisting in a substantial proportion of cases. Pigmented fungiform papillae represents a benign and stable oral pigmentation variant in childhood, and recognition of its characteristic clinical and dermoscopic features may support accurate diagnosis and help avoid unnecessary invasive procedures.