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TONGUE

Black hairy tongue

A black, velvety, hair-like thickening of the dorsum of the tongue is characteristic of black hairy tongue (Fig.20.27). It may be precipitated by topical or oral antibiotics, poor oral hygiene, smoking, alcohol, or the use of mouthwashes. Any precipitating factors should be eliminated and good oral hygiene maintained. Tretinoin (e.g. gel or lotion twice daily) has been used.

Figure 20.28 (a–c) Geographic tongue. These annular lesions and atrophic areas change on a weekly basis.

Figure 20.29 Median rhomboid glossitis.

Figure 20.30 Pseudomembranous candidiasis.

Figure 20.31 Lichen planus.

Figure 20.32 Iron deficiency.

Figure 20.33 Herpes zoster.

Figure 20.34 Hereditary hemorrhagic telangiectasia.

Figure 20.35 Dental sinus. (a,b) A chronic infection of a tooth can drain to the skin.

Figure 20.36 Radiograph of a periapical abscess. The lucent area at the base of the tooth represents the abscess that is draining to the skin.

Geographic tongue

The eruption termed geographic tongue, also known as benign migratory glossitis or glossitis areata migrans, is a constantly moving, annular eruption that may occur alone or in association with psoriasis (it is four to ve times more prevalent in patients with psoriasis than in the general population). Smooth, atrophic, ‘bald', red patches or annular, serpiginous, white, yellow lines are seen (Fig.20.28). Combinations of the two forms occur, and other parts of the mouth may be affected.

    No treatment is needed (the condition is often asymptomatic); however, topical tretinoin solution or a medium- to high-potency topical steroid may be tried.

Eruptive lingual papillitis

This acute stomatitis of unknown cause typically affects children less than 5 years of age. The classic sign is inflammatory hypertrophy of the fungiform papillae on the tip and dorsolateral part of the tongue. Angular cheilitis may occur as well. Fever, cervical lymphadenopathy, and spread to other family members are common. The condition remits spontaneously in 1–2 weeks.

Candidiasis

Median rhomboid glossitis is a red, eroded, diamond-shaped lesion in the middle of the tongue, due to candidiasis (Fig.20.29; see also Ch.26). More extensive creamy white pseudomembranous candidiasis affects the tongue and palate (Fig.20.30).

Lichen planus

Lichen planus appears as white patches, often annular, on the tongue (Fig. 20.31 and see also Fig.8.22).

Iron deficiency

Chronic iron deficiency causes loss of papillae from the tongue, which appears smooth (Fig.20.32). Generalized pruritus is also a feature of iron deficiency.

Herpes zoster

Herpes zoster may rarely affect the tongue (Fig. 20.33).

Hereditary hemorrhagic telangiectasia

Also known as Osler–Weber–Rendu disease, this syndrome with autosomal dominant inheritance presents initially with epistaxis in childhood. Later, telangiectatic mats develop on the tongue, lips, fingertips, and elsewhere (Fig. 20.34; see Ch.15).

White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.