White Tongue as a Manifestation of Diverse Skin Diseases
Asian Journal of Research in Dermatological Science,
Background: The mouth, along with tongue, represent a site for important dermatologic disorders and could be the earliest involved site in many systemic conditions.
Objective: To delineate and evaluate the possible etiologies in patients presenting with white tongue, early or during the course of their predisposed diseases and providing a path for dealing with this condition.
Patients and Methods: In this observational descriptive study that was carried out during the period from 2013 to 2021, twenty three patients with white tongue were included. Full history and clinical, systemic and cutaneous, examination were performed aiming to delineate the specific diagnosis. Additional general investigations and skin biopsy were done when it was needed.
Results: Twenty three patients, 13 (56.5%) males and 10 (43.5%) females, suffering from white tongue were enrolled in the present study. Their age at presentation was ranged from 16-50 years with mean 37.4±9 years. Symptomatic white tongue was the presenting complaint in 19 (82.6%) patients and the symptoms ranged from mild oral discomfort to sever oral burning and soreness that interferes with oral functions. This study highlighted that lichen planus was the major disease predisposed to the white tongue in (56.52%) of patients followed by Behcets disease (13.04%), psoriasis (8.7%), oral candidiasis (8.7%), acrodermatitis enteropathica (8.7%) and pemphigus in (4.34%) cases. Associated cutaneous lesions were found in 78.3% of patients where in many of them, the rash was mild and discovered accidently on routine examination.
Conclusion: White tongue is not uncommon complaint with possible important and serious underlying causes. The current study showed that lichen planus , Behcets disease ,psoriasis, oral candidiasis, acrodermatitis enteropathica and pemphigus can manifested as white tongue either initially and/or during the course of the disease. Hence, dermatologists and oral physicians should be aware for this distinguished clinical observation.
- White tongue
- lichen planus
- Behcets disease
- oral candidiasis
How to Cite
Rogers RS 3rd, Bruce AJ. The tongue in clinical diagnosis. J Eur Acad Dermatol Venereol. 2004;18(3):254-9.
Joseph BK, Savage NW. Tongue pathology. Clin Dermatol. 2000;18(5):613-8.
Vahedi M, Abdolsamadi HR, Mortazavi H, Abdollahzadeh SH. Evaluation of the therapeutic effects of zinc sulfate in patients with geographic tongue. Avicenna J Dent Res. 2009;1(1):11– 4.
Sharma A. Oral candidiasis: An opportunistic infection: A review. Int J Appl Dent Sci. 2019;5(1):23-27.
Sharquie KE, Noaimi AA, Zeena AA. Upsurge of Cases of Lichen Planus in Iraqi Population in Baghdad City with Frequency of Hepatitis Viruses. IOSR J Dent Med Sci. 2015;14(12):78–81.
Edwards PC, Kelsch R. Oral lichen planus: Clinical presentation and management. J Can Dent Assoc. 2002;68(8):494-9.
Eguia A, Villarroel M, Martínez-Conde R, Echebarría MA, Aguirre JM. Adamantiades-Behçet disease: An enigmatic process with oral manifestations. Med Oral Patol Oral Cir Bucal. 2006; 11:E6-11.
Bulur I, Onder M. Behçet disease: New aspects. Clin Dermatol. 2017;35(5):421-434.
Al-Hamamy HR, Al-Turfy IA, Abdul-Reda FS. Infliximab therapy in iraqi patients with moderate to severe psoriasis. Journal of Cosmetics, Dermatological Sciences and Applications. 2015;5:78-85.
Suliman NM, Åstrøm AN, Ali RW, Salman H, Johannessen AC. Oral mucosal lesions in skin diseased patients attending a dermatologic clinic: A cross-sectional study in Sudan. BMC Oral Health. 2011;11:24.
Kumar S, Thakur V, Choudhary R, Vinay K . Acrodermatitis Enteropathica. J Pediatr. 2020;220:258-259.
Dagistan S, Goregen M, Miloglu O, Cakur B. Oral Pemphigus vulgaris: A case report with review of the literature. J Oral Sci. 2008;50(3):359-62.
Mangold AR, Torgerson RR, Rogers RS 3rd. Diseases of the tongue. Clin Dermatol. 2016;34(4):458-69.
Anastasi JK, Chang M, Quinn J, Capili B. Tongue Inspection in TCM: Observations in a Study Sample of Patients Living with HIV. Med Acupunct. 2014;26(1):15-22.
Danser MM, Gómez SM, Van der Weijden GA. Tongue coating and tongue brushing: a literature review. Int J Dent Hyg. 2003; 1(3):151-8.
Mollaoglu N. Oral lichen planus: A review. Br J Oral Maxillofac Surg. 2000;38(4):370-7.
Tak MM, Chalkoo AH. Demographic, Clinical Profile of Oral Lichen Planus and its Possible Correlation with Thyroid Disorders: A Case-Control Study. Int J Sci Stud. 2015;3(8):19-23.
Kaushik D, Gupta B. Demographic and clinical profile of oral lichen planus in patients attending a tertiary care hospital in North East India. IP Indian J Clin Exp Dermatol. 2021;7(1):24-29.
Sharquie KE, Najim RA, Al-Dori WS, Al-Hayani RK. Oral zinc sulfate in the treatment of Behcet's disease: a double blind cross-over study. J Dermatol. 2006 ;33(8):541-6.
Al-Rawi ZS, Sharquie KE, Khalifa SJ, Al-Hadithi FM, Munir JJ. Behçet's disease in Iraqi patients. Ann Rheum Dis. 1986; 45(12):987-90.
Sharquie, K.E., Noaimi, A.A. and Alobaidi, M.H. A New Regimen in the Treatment of Psoriasis Using Oral Methotrexate. Journal of Cosmetics, Dermatological Sciences and Applications. 2019;9:165-176.
Brice DM, Danesh-Meyer MJ. Oral lesions in patients with psoriasis: Clinical presentation and management. J Periodontol. 2000;71(12):1896-903.
Hernández-Pérez F, Jaimes-Aveldañez A, Urquizo-Ruvalcaba Mde L, Díaz-Barcelot M, Irigoyen-Camacho ME, Vega-Memije ME, Mosqueda-Taylor A. Prevalence of oral lesions in patients with psoriasis. Med Oral Patol Oral Cir Bucal. 2008;13(11): E703-8.
Daneshpazhooh M, Moslehi H, Akhyani M, Etesami M. Tongue lesions in psoriasis: A controlled study. BMC Dermatol. 2004; 4(1):16.
Lier GC, Mrowietz U, Wolfart M, Warnke PH, Wiltfang J, Springer IN. Psoriasis of the tongue. J Craniomaxillofac Surg. 2009; 37(1):51-3.
Perafán-Riveros C, França LF, Alves AC, Sanches JA Jr. Acrodermatitis enteropathica: Case report and review of the literature. Pediatr Dermatol. 2002; 19(5):426-31.
Sharquie KE, Al-Jaralla FA. Burn- like dermatoses: A neglected group of skin diseases with a new classification. Am J Derm Vener. 2019;8:88-93.
Uwitonze AM, Ojeh N, Murererehe J, Atfi A, Razzaque MS. Zinc adequacy is essential for the maintenance of optimal oral health. Nutrients. 2020;12(4):949.
Niyaz A, Viswanath BK. Atypical presentation of pemphigus vulgaris - A rare case report. Our Dermatol Online. 2019; 10(1):88-90.
Rimal J, Sumanth KN, Ongole R, George T, Chatterjee S. A rare presentation of oral pemphigus vulgaris as multiple pustules. Kathmandu Univ Med J (KUMJ). 2007; 5(4):541-5.
Yang Y, Lin M, Huang SJ, Min C, Liao WQ. A rare presentation of pemphigus vulgaris as multiple pustules. Indian J Dermatol. 2010;55(3):293-5.
Veraitch O, Ohyama M, Yamagami J, Amagai M. Alopecia as a rare but distinct manifestation of pemphigus vulgaris. J Eur Acad Dermatol Venereol. 2013;27(1):86-91.
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