Treating Geographic Tongue
Median rhomboid glossitis (figure 2-9) appears as a smooth, flat, depressed or elevated nodular area on the dorsum of the tongue just anterior to the circumvallate papillae. It is usually an oval or diamond-shaped area and stands out because the area has no filiform papilla. Median rhomboid glossitis is believed to be caused by a Candida infection, often with secondary hyperplasia. Treatment may include the use of an antifungal drug and surgical removal of the hyperplastic tissue. Figure 2-9. Median rhomboid glossitis. Figure 2-9. Median rhomboid glossitis.
This rare dermatosis occurs most frequently on the genital skin and lower abdomen. The distinctive eruption consists of an erythema with erosions, vesiculation, and bulla formation. The rash extends outward with healing and crusting at the outer edge. Postinflammatory pigmentation is common. There is also an associated weight loss, glossitis, and angular cheilitis. The patient may also have diabetes. Histologi-cally, there is marked epidermal necrolysis and a mild dermal lymphocytic infiltrate. It is nearly always associated with an underlying pancreatic glucagonoma. The dermatosis resolves with treatment of the glucagonoma and correction of nutritional deficiencies secondary to malabsorption (Table 15).
Geographic tongue, or benign migratory glossitis, is characterized by alternating red areas with a yellowish-white border (figures 2-11 and 2-12. This appearance is caused by alternating areas of hypertrophy and atrophy of the filiform papillae. In the areas of atrophy, the fungiform papillae appear as irregular, reddish areas surrounded by horny growth (keratosis). In the areas of hypertrophy, filiform papillae appear as whitish areas. The patterns developed are variable with changes in shape and position from time to time. The cause of this lesion is unknown. Developmental defects may also be present. These defects are responsible for a secondary burning sensation caused by debris collection, Treatment consists of proper cleansing of the tongue. Figure 2-11. Geographic tongue, dorsal view. Figure 2-11. Geographic tongue, dorsal view. Figure 2-12. Geographic tongue, lateral view. Figure 2-12. Geographic tongue, lateral view. d. Fissured Tongue. In fissured (or...
They occur 3-8 times the first year, 53 each month, 33 every 2-4 months and 14 more sporadically. The primary episode is the most serious, with erythema, edema and even necrosis. It lasts about 2-6 weeks, and it is accompanied by local and systemic symptoms like headache, malaise and fever. Labial herpes is generally localized at the margin between the skin and mucosa. It predominates on the lips or close to the mouth, but herpetic gingivostomatitis and geometric herpetic glossitis have been described. Genital herpes affects the glans or vulva (Fig. 53.2). Perianal and rectal herpes is seen in homosexuals. It is accompanied by tenesmus and anal discharge and is rarely complicated by urinary retention. Herpetic whitlow in children affects fingers by autoinoculation, almost always arising from an oral infection. In adults, it may be caused by HSV-2, and it follows digital-genital contact. There may be involvement of any part of the body such as cheeks, thighs, and buttocks. Neonatal...
Clinical features in addition to anaemia include glossitis and neurological disease. The neurological disease is referred to as subacute combined degeneration and comprises peripheral neuropathy as well as spinal cord involvement. It is manifest by paraesthesiae and initially loss of sensations passing through the posterior columns, i.e. loss of vibration sense and proprioception, but the sensations of touch and temperature are preserved until the disease is advanced. There is thus ataxia and spastic weakness. Patients can also suffer from neuropsychiatric impairment, especially memory loss and depression.
Infection in the mouth, thrush, is manifested by redness and whitish mucosal plaques (Fig. 3.1). Lesions can be diffuse or affect a single region like the palate, the buccal mucosa, gums, or tongue (glossitis). Plaques are asymptomatic or accompanied by a burning sensation. The following forms have been described erosive, hyperplastic, pseudomembranous, erythematous (atrophic), acute or chronic, as well as forms with plaques and nodules. Lip involvement is exceptional, but frequently in the corners of the mouth, angular cheilitis, a triangular area of fissures and erythema, is seen. Black-hairy tongue may be due to Candida or Geotrichum strains. Esoph-ageal involvement occurs mainly in patients with AIDS and in leukemic patients. Fig. 3.1. Glossitis due to Candida. Fig. 3.1. Glossitis due to Candida.
The answer is b. (Fitzpatrick, 3 e, pp 671, 678-687, 762-765.) The rash described in the patient is erythema migrans (EM), the early pathog-nomonic eruption of Lyme disease, a spirochetal infection transmitted to humans by the bite of an infected ixodid deer tick. Most cases in the United States involve the northeast or north central areas of the country. The rash typically occurs 1-2 wk after the bite, but less than 20 of patients recall a bite. Rickettsia rickettsii, transmitted by the dog or wood ticks, is the etio-logic agent of Rocky Mountain spotted fever. The characteristic macu-lopapular rash begins peripherally and often involves the palms and soles. Bartonella henselae (formerly Rochalimaea henselae) is the etiologic agent responsible for cat-scratch disease (CSD). Mycobacterium marinum infections follow a traumatic inoculation in aquariums and swimming pools. The bite of the brown recluse spider (Loxosceles) begins as an area of erythema. In some cases, the bite...
Lyme disease is a tick-borne (Ixodes tick) illness caused by the spirochete Borrelia burgdorferi. Tick reservoirs include deer and mice. Lyme disease is divided into early disease (stages 1 and 2) and late disease (stage 3) stage 1 is characterized by the presence of a distinctive skin lesion termed erythema migrans (EM, or erythema chronicum migrans). Stage 2 is a disseminated phase of infection with manifestations in the skin, CNS, musculoskeletal system, and heart. Late disease, or stage 3, reflects persistent infection that is clinically manifest more than one year after the onset of disease. This stage most often involves the skin, joints, and CNS.
Humans are inoculated through the skin giving rise to erythema migrans, in which the organism can be identified in nearly 90 of cases. The organism then disseminates to the joints, heart and CNS. The disease has protean manifestations, and probably many cases are unrecognized. Infection occurring during pregnancy may cause fetal damage or fetal death at any stage.
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