Burning Tongue and Lips

Abstract

A 64-year-old woman visited one of us (M.T.B.) in the Oral Medicine Practice, Carolinas Medical Center, Charlotte, N.C., with a chief complaint of burning tongue and lips. She reported that she began to experience the sensation of a burning and coated tongue in June 2007. The burning sensation soon included her lips, and her tongue felt like sandpaper. The patient also reported having an abnormal taste but not a decreased taste sensation. Four weeks before she developed the burning sensation, the patient was treated with cephalexin and minocycline for a toe infection and staphylococcal blepharitis. In October 2007, she was treated with clindamycin for a recurrent staphylococcal blepharitis infection. The patient’s physician had treated her for an intraoral fungal infection with clotrimazole troches, fluconazole tablets and itraconazole tablets. She reported that her best response to treatment resulted from using clotrimazole troches, but that a coated tongue always returned when she discontinued use of her medications. She also reported having been treated with dexamethasone elixir, which worsened her condition. The patient’s medical history was significant for anxiety, osteoarthritis and peripheral neuropathy. She was being treated with several medications, including testosterone, progesterone, gabapentin, diclofenac sodium, nortriptyline, alprazolam, glucosamine and chondroitin. She had no known allergies, denied using tobacco or illicit drugs and drank wine occasionally in a social setting. A comprehensive review of systems revealed a woman who was moderately distressed as a result of her oral condition. She denied experiencing fatigue but complained of dry mouth of eight months’ duration and dry eyes of 12 to 15 months’ duration. The patient denied having any other systemic abnormalities. The clinician (M.T.B.) performed an extraoral examination, which revealed bilateral angular cheilitis. The intraoral examination revealed a well-restored dentition and no obvious signs of acute infection. The clinician expressed clear saliva from all four major salivary gland orifices except for the Stensen duct of the left parotid gland. The dorsal surface of the tongue had a generalized white coating with areas of erythema, and the tissues appeared dry (Figure 1). The clinician found no other soft-tissue abnormalities. Burning tongue and lips