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Oral Medicine Competency

Oral Medicine Competency. Brett Cotham 11/15/2010. Patient. Unknown patient with two conditions of interest. Lesion 1. Widespread red plaque like lesions on the dorsum and lateral borders of the tongue.

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Oral Medicine Competency

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  1. Oral Medicine Competency Brett Cotham 11/15/2010

  2. Patient • Unknown patient with two conditions of interest.

  3. Lesion 1 • Widespread red plaque like lesions on the dorsum and lateral borders of the tongue. • The lesion has peripheral zone of white to yellow color that appears to involve the epithelium. • Some areas of the lesion appear to have become fused.

  4. Lesion 1

  5. Differential Diagnosis • Geographic tongue • Atrophic Glositis • Median rhomboid glossitis • Reiter’s disease • Traumatic ulceration

  6. Pt Dialogue • Have you noticed the lesion before? If so, does it seem to come and go over time? • Have you been under stress? • Do you have any nutritional deficiencies? • Do you use any steroids? (inhaler, topical) • Do you remember injuring yourself? Burn your tongue? Put anything irritating in your mouth? • Do you have arthritis, uveitis, conjuctivitis, urethritis, or any gastroenteral/ urogenital infection? (Reiter’s disease)

  7. Provisional diagnosis/Treatment • Benign Migratory Glossitis (geographic tongue) • Treatment: Since symptoms are rare pt should just be informed of the benign nature of the lesion. • If the lesions becomes symptomatic/painful then topical anesthetics may be prescribed. Steroids and antihistamines may be rarely used.

  8. Lesion 2 • Lesion presents as widespread areas of sharply demarcated depigmented skin on the hands and fingers. • The lesions are well circumscribed round to oval and pale to white colored maculae that coalesce as you move distally along the digits. The surface epithelium is intact.

  9. Differential Diagnosis • Addison’s disease • Vitiligo • Tineaversicolor • Steroid induced depigmentation • Thermal injury • Chemical injury

  10. Pt. Dialogue • Have you injured your hands recently? Hot liquid etc? • Have you ever had a bad sunburn in the area? • Do you have a history of Addison’s disease? • Have you received any immunotherapy? • Do you have any other autoimmune conditions?

  11. Provisional Diagnosis and treatment • Provisional Diagnosis : Vitiligo • Therapeutic intervention is to stimulate repigmentation. • Topical corticosteroids and topical photocheotherapies can be effective. • Some choose to develop a more unified skin color with skin bleaching. • Some surgical techniques using epithelial grafts have been successful.

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