patient about 78 yrs female complain of burning sensation from one month I prescribed candid mouth paint itraconazole orally antioxidant no abnormality in medical history after 2 week patient not get satisfactory result suggest me further treatment planning@@Dr. Chandrasekhar Lakkoju @Dr. Siddhartha Chakraborty @Dr. Narayana S

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@Dr. Prasanth S Sir, probably you are thinking in the right direction & I share your views. Here I would request our beloved & most respected @Dr. Asv Prasad Sir to guide us.

Thank you for tagging, Dr ParthaSarathy sarma sir. U have diagnosed it rt sir- it is median rhomboid glossitis.- red, bald -due to denuded lingual papillae infront of circumvallate paillae on the dorsum of the tonge , romboidal in shape with atrophic mucosa. Treatment is also as suggested by u. But the problem here is non response after 2 weeks of anyifungal treatment. So we have to look beyond the lesion. One is steroid spray she might be using for copd/ asthma.. secondly smooking and ghutka.use Thirdly debilitating disesas like malignancy elsewhere ourthly immunosupression due to HIV ETC. Look for kissing lesions on the palat which indicates immunosupression. 5thly it may need some more time. Give it. Infact the denuded surface on tongue should result in mucosal regeneration untill the raw area and burning sensation may continue. Lastly look out for drug resistance. Ucan subject tongue scrapings for PCR and pyroseauensing to identify any point mutation or susceptibilty to itra. Excude other things and give sometime b 4 resorting to molecular testing. Boost resistance and give vit c tab for what it is worth (or worthless) !
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Median rhomboid glossitis. Treatment for candidiasis

Oral thrush The following medical treatments may be used for oral thrush. Fluconazole (Diflucan). Fluconazole is an oral antifungal medication. Clotrimazole (Mycelex Troche). Nystatin (Nystop, Nyata). Itraconazole (Sporanox). Amphotericin B (AmBisome, Fungizone).

Also care of dentures if she wears one.....

Check..cbc.Hb..hiv..vdrl.. Dd.median rhoboid glossitis..luetic glossitis..tuberculos ulcer...

Oral trush

Agree with Dr.Asv Prasad sir

Oral thrush ! Poor oral hygiene, nutritional deficiencies..

Check if the patient is using that medication....?? sometimes the reflexes and memory becomes weak.....

Median rhomboid glossitis

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