A 50 year old pt complains of burning sensation and irritation in her jaws. No history of any habits. No systemic problems. No medications she is taking I had prescribed her turbocort for the lesion along with chlorhexidiene mouthwash 0.12% . But still the lesion exists. What is the differential diagnosis?? is a swab needed in this case? what medication is needed

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One of the typical clinical signs associated with Oral Lichen Planus is hyperpigmentation. It's post inflammatory hyperpigmentation but not the Steroid. The Hyperpigmented patches represent healed OLP, which disappears within a year or two. Many a times active OLP is evident over hyperpigmented macule. So no worry. Continue the Corticosteroid with tapering dosage. Chlorhexidine better be avoided. Add Candid mouth paint to avoid superadded fungal infection. Keep Tacrolimus (TACROZ Forte twice daily) in reserve for latter use, if this case does not respond to Triamcinolone. Post inflammatory hyperpigmentation is also observed in other oral lichenoid lesions, pemphigus, pemphigoid, periodontal disease, Steven-Johnson syndrome and graft versus host disease. Regards.

Will definitely follow accordingly. Thanks for the in depth explanation
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Hyperpigmentation macule Angular cheilitis Erythroplakia Oral lichen planus Mouthwash Gum paint Multivitamins Maintain oral hygiene

I think it is case of burning mouth syndrome treat with amitryptlene and lipoic acid with multivitamins.... She will in stress condition also due family or may be due to any other region..

As far as I conc. Seem to be a erosive olp..sir did u notice that very pigmentations increased after application of corticosteroid ?.......if so I would suggest you to prescribe tacrolimus oral base ointment... With good source of antioxidant like lycopene , green tea extract, oral alovera gel..

Yes doc..the pigmentation did increase after corticosteroid application but the pain had subsided. Can u please suggest a brand name for tacrolimus ointment and antioxidants
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Thank you every one for the advice. I have just uploaded the fotos of patients blood report. As it was suspected patient is anemic and has vitamin D deficiency. Have started the streatment according. In 5 days itself patient is responding really well to the treatment.

Great work
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It's Anaemia, Angular chelitis. For lichen planus check properly and take the history that lesion waxes and wanes. Medications: 1) Anaesthetic mouth wash (cool ora mouth wash) 2) Oldid mouth paint 3) Immunoceforte 1tab OD 4) Kenacort 3times tropical application Later oral corticosteroids

Glossitis due to ane mia...hematologist con adviced

Yes doc. I have refered her to a haematologist, improve her diet by eating fruits and veggies. Also she has very lil exposure to sunlight so told to improve that
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Could be an anemic condition, go for complete blood picture along with multivitamin tab

Surely..will do that
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Angular cheilits.. with erythroplakia.. Of buccal mucosa.. Suggestive of multivitamin deficinecy.. There might be a habit of spicy food intake also..

Hb 6.3 .microcytic hypochromic ane mia.. rule out systemic causes

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