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Have swollen tongue with fissures and migrating white patches. Not cured by medicines. What am I suffering from?

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Practicing since : 2005
Answered : 1391 Questions
I have had the following symptoms since February of this year: swollen tongue with fissures and migrating white patches. The insides of my cheeks also seem to be swollen. My tongue is sensitive to spicy, salty, and acidic foods and drinks. In that time I have also noticed an occasional blister on the inside of my right cheek (3 times to be exact). I have seen an ENT who first treated me for thrush, however, the medication did not work. After that, he tried prednisone, but the swelling did not subside. I was then given a topical steroid, which did not work. Tried prednisone again, but had no luck. I cut out out anything that caused additional irritation, such as toothpaste with whitening agents, and so far, have not noticed a difference. I was referred to a dermatologist who prescribed a topical ointment, which seemed to help a little with the surface of my tongue, but not the swelling. I had my B-12 levels tested, and they came back normal. We tried one more round of prednisone, but still, no luck. I was finally referred back to the ENT for a biopsy. The pathology report first indicated inflammation. When the final results came in, I was told that it was lichenoid reaction. The dermatologist tried a metal patch test, which came back negative, and referred me to an allergist. The allergist is doing blood work to check for systemic inflammation. All three doctors have told me that this is not contageous. Two so far have told me that it is nothing serious. However, I am still concerned. I have been researching my symtoms, which may not be a good idea. I read that licehnoid reaction can be tied to oral HPV, which I understand can be contageous, and that some can even cause cancer. Looking for professional insight on what this could be, and if oral HPV is likely given my symptoms and biopsy results.
Posted Sun, 25 Nov 2012 in Infections
Answered by Dr. Sudarshan 5 hours later

Thanks for writing in.
I see that you have been visiting a lot of doctors without much relief.

The possibilities in your case can be geographic tongue,oral lichen planus, oral candidiasis etc.

Oral HPV would not present in this way.All the above conditions are not contagious and treatable.

Also I would like to know-
Do you have any history dental treatment /filling done?
Do the patches on tongue remain static or they change position?
Which topical steroid was prescribed how was the response?
Can you upload the photos of the affected area?

Photos can be helpful alot.

Upload the photos and answer the questions and we can continue the discussion here.

Dr sud
MD dermatology.

Above answer was peer-reviewed by
Follow-up: Have swollen tongue with fissures and migrating white patches. Not cured by medicines. What am I suffering from? 4 hours later
Hello Dr. XXXXXXX and thank you for your response. In answer to your questions, I did have fillings done, but I have had them for over 25 years. The patches on my tongue change from day to day. My dermatologist had me apply Trentinoin gel. I have uploaded a photo. Please let me know if the photo is not clear enough. I don't know if I mentioned it, but I was treated for thrush, but it was ruled out as I did not respond to the anti-fungal that was prescribed by the ENT.
Answered by Dr. Sudarshan 4 hours later
Hi Again,

Thanks for the details and images.

Images however are not clear and therefore not much helpful.

Your description suits diagnosis of geographic tongue.

Treatment of candidiasis would be to have FLUCONAZOLE tablet orally and apply clotrimazole mouth paint applied thrice daily.Have you received this treatment ?
if not then you should repeat it for atleast 10 days.

As you have taken prednisone previously without relief then it rules out lichen planus as the cause.Oral lichen planus is responsive to oral and topical steroids.

Now my suggestion for you would be-
- apply Triamcinolone Acetonide Dental Paste USP,0.1% to affected area at bedtime.It has good response in both geographic tongue and lichen planus.

-Along with these things you should take ZINC supplements orally twice a day.Zinc lozenges are also available and helpful.

-You should avoid smoking/tobacco, Hot, spicy, or acidic foods or dried, salty nuts
Toothpaste with additives, whitening agents, or heavy flavoring (toothpaste for sensitive teeth is a better choice).

-Mouth washes containing clorhexidine can also be helpful.

Hope this helps.

I would be available for follow up.

Above answer was peer-reviewed by
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