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How is median rhomboid glossitis treated ?

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General Surgeon
Practicing since : 1980
Answered : 2130 Questions
I have what has been labeled Median rhomboid glossitis x one year. Very painful to eat. Started when I had a broken tooth now fixed. Bleeds in am. Atrophic fissure running down centre of tongue. Neg biopsies. No response to fluconazole or daktarin oral gel. Non smoker 69 year old male. Practising doctor. Non HIV ( I think)
Posted Sun, 15 Apr 2012 in General Health
Answered by Dr. Rajinder Bajoria 1 hour later
Thanks for your query.     

Median rhomboid glossitis is seen in middle of the tongue's top surface, and as it is XXXXXXX shaped so the word "rhomboid" and "glossitis" indicate there is an inflammatory condition of the tongue.

Median rhomboid glossitis, usually causes no other symptoms.

As this disease / condition responds to anti-fungal medications,so the candida is considered to be its cause .

As biopsy is negative and you have taken full course of fluconazole or daktarin gel without any response .

But bleeding is not so common in median rhomboid glossitis .
As doctors are exposed to plenty/variety of patients ,so there is no harm in getting tested for HIV .
Some other possibility should be kept in mind

Erythema migrans a benign migratory glossitis , is a fairly common condition in which irregularly shaped smooth patches are found on the top surface of the tongue. This is often asymptomatic.

So more detailed investigation may through more light on it .

If possible please send the photo of your young.

So some other possibility be considered.

Hope I have answered your query, I will be available to answer your follow up queries, Wish you Good Health and trouble free speedy recovery.
Above answer was peer-reviewed by
Follow-up: How is median rhomboid glossitis treated ? 4 hours later
Hi Dr Bajoria. Thank you. I would send photograph of my tongue but can't see how to send attachments here. I feel perfectly healthy in every respect so do not believe that I could have AIDS.

The surface of this lesion is atrophic, the usual epithelium is stripped away. It is mid-line and about 2.5 cms long. In the mornings this is coated my a very thin layer of clotted blood which after a bit of vigorous mouth rinsing breaks away and that's what I mean by "bleeding", during the day the lesion has a thin layer of exudate or slough.

I have a bit of lip and buccal mucosa involvement as well -- "kissing" lesions. Thanks for your patients and endeavour. I am not expecting miracles!
Answered by Dr. Rajinder Bajoria 8 hours later
Nice to see you again

     I don`t think at all you have AIDS , that was in reference to as medical professionals are exposed to variety of patients.

2.5 cm atrophic lesion in the centre of tongue with clotted blood in the morning & thin layer exudate in the day is not so quite common in candiasis or fungal infection.

As you have developed kissing lesions also in the lip and buccal mucosa .

But biopsy is negative .

In my opinion of good ENT surgeon and further investigation may be more beneficial.

You can send photo to WWW.WWWW.WW to Sub; ATTN Dr Rajinder Bajoria .

‘Hope I have answered your query, “Wish you Good Health and trouble free speedy recovery”

Above answer was peer-reviewed by
Follow-up: How is median rhomboid glossitis treated ? 10 hours later
Hi Dr Bajoria. Thank you for your help. Attaching photo as suggested. I agree with your observation that this lesion is unlikely to be associated with candidacies. It is just sooo frustrating not to be able to come up with a diagnosis or any kind of useful treatment. It does not even respond to oral steroids! I’m not sure if even a good ENT surgeon would help.

Many thanks indeed,

Andrew Rynne MD
Answered by Dr. Rajinder Bajoria 2 hours later
Nice to see you again

      Thank you very much for attaching the photograph

I have seen the photo very carefully after enlarging it.

It is in the middle of anterior half of tongue with exudative crust on it .

Please send the exudative crust after scraping for culture sensitivity of bacteria ,virus and fungus if feasible . It may be due to some slow growing chronic localized infection.

In my opinion steroid has no role ,so i don`t recommend its use .

Candidiasis or fungal infection is out of question

If still no final diagnosis and no relief with in another few months ,repeat biopsy may help

‘Hope I have answered your query, Wish you Good Health and trouble free speedy recovery.

Above answer was peer-reviewed by
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