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2o year old man with pigmented spots over his tongue for 6 months. He smokes sheesha occasionally. He denies any bad smell.
On examination he has multiple pigmented patched over the sides of his toungue. other parts of his oral mocosa are intact. No ulcers
Could this be a hairy tongue?
But the dorsum of the tongue is not involved and only subtle hypertropthy of the filiform paillae.
Other DDX
Oral Candidiasis
Venous lake? (looks bluesih)
Any thoughts appreciated
Filed under: tongue | Tagged: dermatology, tongue
dermlive
dermis111
dr660
skindr
visitor111
epiderma
kamalsaleh
This case is familiar to me, I may post another one soon, this patient most likely underwent fixation in his teeth or bridging and this is amalgam tatoo (silver tatoo), skin biopsy will confirm the diagnosis .
Other differential diagnosis include: allergic contact dermatitis with post inflammatory hyperpigmentation,
fixed drug eruption and lichen planus.
propably the contact of the metal tip of the sheesha has caused a tatoo or contact dermatitis or even frictional melanosis( there are melanocytes in the mucous membranes and the patient looks type V.skin biopsy is mandatory in this patient to reach proper diagnosis and PAS could be done to rule out candidiasis (though I dont think this is the diagnosis)
I think incisional biopsy is indicated in this case,to get proper dignosis for lesion before any treatment, and follow up the patients more frequently, and look for cervical lymph nods,and advice the patient to stop using of shesha from now.
I still think that biopsy is diagnostic and this is not a malignancy, skin biopsy nowadays is performed to confirm many inflammatory skin diseases.Again we want further history if this patient has a teeth bridge or if the sheesha tip is metal?
he came back to me today…he used a bridge in the past (a year ago) but what i think has caused it is the shesha tip. the lesions are bilateral and symmetrical which speaks for an extrinsic influences.
i gave him nystatin, advised him to brush and rinse with mouth washes.
if he doesnt improve i will consider biopsy. but i dont think we dealing with a malignancy which usually present in the oral mucosa as persistant ulcers (single lesions) or indurated eroded raised papules or nodules
from now on i will be posting new cases on saturdays, and whenever there is a biopsy i will try to present it too..
thanks guys for ur efforsts
( :
this case is normal,it is common on negro and black people (genatic)
Hi,
I think that this this patient has 2 pathology:
1) he has hairy tongue on the dorsal aspect of the tongue (yellowish colour) and in this case smoking may be the cause
2) the hyperpigmented macule look like RACIAL PIGMENTATION that is common and normal in blacks.
venous lake usually present as bluish vascular papule and commonly involve the lip
waiting for the biopsy result
reply -1, possibly, though filiform papillae appear consistent with the norm, patient may simply be presenting with yellowed dorsal plaque deposit with smoke, tanin other staining
2 – an additional differential could include Kaposi’s Sarcoma
Hello,
It could be related to smoking, or could be racial , also lichen planus.
is there any history of drug intake? it could simply be pigmentary incontinence.
Dr. Sarah Al-Breiki
showed it to fellow dr in oral surgery
he thinks its either racial or sth called pigmented fungiform papillae wher u have prominent papillae plus pigmentation.
the two conditions overlap.
am still clinging to the sheesha being the cause of it !
at least it will make him quit
( :
THis IS most probably racial ,please ask about family history . we are seeing many with this presentation and we advice for follow up 3-6 month for any changes.
Thanks