Treating Geographic Tongue
Scarlet, raw, fissured tongue Malar and supraorbital pigmentation Vitamin C Bleeding, spongy gums The mouth and tongue are also areas where typical manifestations of deficiency can be detected. A red tongue is a classic sign of riboflavin deficiency but has also been associated with niacin deficiency the latter may also include fissures. Conversely, a pale tongue may indicate iron deficiency. Glossitis, with or without color changes, has been linked to pyridox-ine deficiency. A similar condition, including pain and intense red color, has been associated with biotin deficiency. Angular stomatitis and ulcerations and other lip lesions are associated with riboflavin or ascorbic acid deficiencies. In the latter, extensive involvement of the gums (swelling and bleeding) is also typical. Atrophy of the papillae occurs in vitamin B12, niacin, and folate deficiencies. Excess vitamin A intake may result in discoloration of the gingival mucosa.
Lichen planus, hyperplastic candidiasis, geographic tongue, and certain genodermatoses. Of note, OHL is not associated with progression to malignancy, despite the well-known oncogenic association of EBV with other malignancies (Burkitt's lymphoma, nasopharyngeal carcinoma, and others).
Melkersson-Rosenthal syndrome is characterized by a triad of recurrent episodes of facial paralysis and facial edema along with a fissured tongue. Other neurologic sequelae have been documented, including headache, trigeminal neuralgia, cranial nerve dysfunction, and autonomic dysfunction. Although the etiology is unknown, recent investigation points toward a granulomatous disease leading to recurrent attacks of edema and inflammation of the face and oral cavity with a predilection for facial nerve involvement. Facial nerve involvement may be unilateral or bilateral, with varying frequencies of attacks and progression. No confirmatory blood test, histopathology, or radiographic evaluation is available, as the diagnosis is entirely clinical.
Apart from the ruddy complexion, specific head and neck manifestations are unusual. Epistaxis in addition to bleeding from other sites may occur in up to 40 of patients. Pyoderma gangrenosum is reported to occur with the MPD. This is a necrotizing skin ulceration that occurs most commonly on the limbs of patients with inflammatory bowel disease. It can also occur on the face. Manifestations of iron deficiency may include glossitis and cheilosis.
NME is the hallmark finding in glucagonoma syndrome. It is characterized by a polymorphous eruption that most commonly presents as scaly, erythematous papules and plaques with superficial erosions. The lesions typically are in a perioral distribution on the face (Fig. 9), but also involve the perineum, lower abdomen, thighs, buttocks, and less commonly the distal extremities. NME has been reported to be the presenting complaint in approximately two-thirds of patients with this tumor, but there are only rare cases of glucagonoma without NME ever occurring. Stomatitis, glossitis, dystrophic nails, and alopecia can also be seen. The eruption is frequently misdiagnosed as seborrheic dermatitis or intertrigo and can also resemble pemphigus foliaceus, acrodermatitis enteropathica, chronic mucocutaneous candidiasis, or psoriasis.
Topically, sage is used as a gargle for laryngitis, pharyngitis, stomatitis, gingivitis, glossitis, minor oral injuries and inflammation of the nasal mucosa (Blumenthal et al 2000). These uses can be based on the pharmacological activity of its chemical components. In an open-label, single-blind, RCT of 420 patients, the non-steroidal anti-inflammatory drug, benzydamine hydrochloride, was found to be more effective than sage in relieving postoperative pain when used as a mouthwash after tonsillectomy in children and adults (Lalicevic & Djordjevic 2004).
Burning mouth is an intraoral chronic pain disorder that is usually without associated mucosal or oral signs. You may feel a burning sensation on your tongue, and stinging and itching in the front and back regions of your tongue. It can be caused by a geographic tongue (inflammation sporadically mapped out on your tongue) or an infection such as candidiasis. Or you may have a contact allergy from wearing dentures. Other causes may be a nervous condition, such as the biting of one's tongue or other tongue habits, or an allergic reaction to medications being taken. A person can have burning of the tongue or surrounding areas if he or she is anemic with this condition there is a reddened area on the tongue called glossitis. This condition is either continuous or intermittent, and typically worsens as the day progresses. It is relieved temporarily by eating and drinking. It is estimated that 8 percent of males and 6 percent of females suffer from this condition.
Following inoculation by the tick, the spirochete spreads locally in the skin in the majority of patients, resulting in erythema migrans. It is at this point that the spirochete may be recovered and cultured from the skin lesion more readily than at any subsequent stage. During the second stage of the illness, the spirochete will spread to the lymph and blood, resulting in widespread systemic dissemination and the subsequent constellation of multiorgan symptoms characterizing the disorder. Clinical Manifestations. Lyme disease occurs in stages, manifesting different clinical signs symptoms at each stage. The typical patient experiencing the untreated course of illness develops erythema migrans (stage I) followed by meningitis or facial palsy (stage II) followed months and perhaps years later by arthritis (stage III) (8). It is now known that specific symptoms do not always occur in a specific stage and that both symptoms and stage of infection may vary significantly from...
Deficiency impairs energy-yielding metabolism and results in a group of symptoms known as ariboflavinosis, including cracking of the skin at the corners of the mouth (angular stomatitis), fissuring of the lips (cheilosis) and tongue changes (glossitis) seborrhoeic accumulations appear around the nose and eyes. Not fatal because there is very efficient recycling of riboflavin in deficiency.
The gumma is a granulomatous lesion that can appear in any organ but typically affects the mucocutaneous surfaces and skeletal system. While considered benign, they can be locally destructive, and symptoms, if any, are related to the organ system involved. They vary in size from microscopic nodules to large masses. They begin as irregularly shaped nodules or plaques with a tendency toward central necrosis and ulceration (Fig. 5). When skin lesions ulcerate, they tend to heal with thin, atrophic scars and leave punched-out lesions. Though gummas can develop anywhere, there is a predilection for the arms, back, and face, and may be triggered by minor trauma. Complications within the head and neck can include palatal perforation, saddle-nose deformity secondary to destruction of nasal cartilage, and glossitis. Gummatous involvement of the larynx can produce hoarseness or late complications of subglottic stenosis, vocal cord adhesions, or arytenoid fixation. Gummas can also be seen in the...
This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source Photo courtesy of Bruce Barker, DDS. FIGURE 45 Atrophic candidiasis. This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source Photo courtesy of Bruce Barker, DDS. FIGURE 46 Central papillary atrophy. Also referred to as median rhomboid glossitis, this was long believed to be a developmental condition. It is now...
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