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I wrote earlier about geographic tongue and lichen planus...
Apr 24, 2000

I sent you a question very recently, but I've learned a few things after doing some further research. I mentioned that I noticed patches in my mouth that appear translucent with a bluish or whitish tint. I think this is probably leukoedema, which is apparently unrelated to what I am observing on my tongue. I now think that the white arcs and circles are probably geographic tongue, but I'm not sure. I'm trying to rule out hairy leukoplakia. These are the symptoms I am observing: white lines, arcs, and circles that usually (but not always) form on the edges of my tongue towards the front appear and expand leaving a reddish area behind. They generally fade within a week as new ones appear at different locations. They expand across both the top and bottom of my tongue. When they are on the bottom, the white outlines are less prominent. They sometimes cause me minor discomfort, especially when they rub against my teeth. I realize these symptoms sound exactly like geographic tongue but I want to make sure, because lately they've left the front edges of my tongue with a slightly lumpy look. I know that such a lumpy appearance is common in hairy leukoplakia. However there is no white coating, and I think the lumpy appearance may be due to small fissures left behind by geographic tongue. I read that small fissures are common along the white lines that appear with geographic tongue. So in your professional opinion, would you rule out hairy leukoplakia given the information I've presented here as well as the fact that my small yet possible chance of HIV infection occurred less than a year ago? Also, is leukoedema HIV-related or related to any of the other symptoms I've listed? And finally, I always read that no treatments are presented for geographic tongue because it is minor and comes and goes. But there must be something that can be done to limit its effects. Anything?

P.S. Thank you for providing this great service to the many people out there who are looking for information and explanations of what they are experiencing.

Response from Dr. Reznik

Oral Hairy Leukoplakia (OHL), the vast majority of the time, appears on the lateral border of the tongue as a white, corrugated, asymptomatic lesion. The manifestation you have described does not sound at all like OHL, but rather very much like geographic tongue. As you are aware, I am unable to give you a definitive diagnosis via this Forum and suggest you visit your dentist the next time you have an outbreak.

Can geographic tongue be treated? Again, you have researched this topic well and are correct in that geographic tongue is usually not treated due to the self limiting nature of this condition. If you have an extreme or painful outbreak, a topical steroid mouth rinse such as Decadron elixir can be prescribed. I honestly cannot remember the last time I prescribed Decadron elixir for geographic tongue.

Leukoedema is not a condition seen in association with HIV infection nor is it pathology, but rather a common condition that is most often seen in people of African decent.

Take care,

DR


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