Ask a Doctor and Get an Answer to Your Medical Question ASAP
Hi Carrie. Do you have any redness, sores or whitish film on your tongue?
The list of possible causes of glossitis is long. It sounds like your doctors have ruled out at least several of them. One commonly overlooked cause is lichen planus. This is an immunologic condition that affects skin or mucosal surfaces, such as the mouth and tongue. Two manifestations of lichen planus include a white, lacy pattern that affects the mucosa of the tongue and an erosive form that appears as shallow ulcerations. Candida can coexist with lichen planus and requires treatment with an antifungal agent. Reticular lichen planus does not require treatment. Ulcerative lichen planus can be treated with topical steroids, such as fluocinonide dental paste or clobetasol gel (Temovate) applied twice per day for two to three weeks. Biopsy is indicated if the diagnosis is unclear.
Another fairly common diagnosis that is often made late is burning tongue syndrome. A burning sensation of the tongue can represent a primary syndrome, or it can be secondary to a condition that leads to the denudation of the normal tongue surface. Burning tongue has an unknown etiology and seems to affect women seven times more often than men. It is often marked by a fairly sudden onset of a sensation similar to that of a scalded tongue that becomes more frequent over the course of the day. The tongue often appears normal. It is benign and typically resolves spontaneously after a few years. Only alpha-lipoic acid, clonazepam (Klonopin), and cognitive behavior therapy have been shown to reduce symptoms in controlled trials. In very difficult cases, an approach similar to that for any chronic neuralgic pain can be helpful, and there may be a role for nerve stabilizing medications such as gabapentin or pregabalin.