White Tongue as a Manifestation of Diverse Skin Diseases

Background: The mouth, along with tongue, represent a site for important dermatologic disorders and could be the earliest involved site in many systemic conditions.

Objective: To delineate and evaluate the possible etiologies in patients presenting with white tongue, early or during the course of their predisposed diseases and providing a path for dealing with this condition.

Patients and Methods: In this observational descriptive study that was carried out during the period from 2013 to 2021, twenty three patients with white tongue were included. Full history and clinical, systemic and cutaneous, examination were performed aiming to delineate the specific diagnosis. Additional general investigations and skin biopsy were done when it was needed.

Results: Twenty three patients, 13 (56.5%) males and 10 (43.5%) females, suffering from white tongue were enrolled in the present study. Their age at presentation was ranged from 16-50 years with mean 37.4±9 years. Symptomatic white tongue was the presenting complaint in 19 (82.6%) patients and the symptoms ranged from mild oral discomfort to sever oral burning and soreness that interferes with oral functions. This study highlighted that lichen planus was the major disease predisposed to the white tongue in (56.52%) of patients followed by Behcets disease (13.04%), psoriasis (8.7%), oral candidiasis (8.7%), acrodermatitis enteropathica (8.7%) and pemphigus in (4.34%) cases. Associated cutaneous lesions were found in 78.3% of patients where in many of them, the rash was mild and discovered accidently on routine examination.

Conclusion: White tongue is not uncommon complaint with possible important and serious underlying causes. The current study showed that lichen planus , Behcets disease ,psoriasis, oral candidiasis, acrodermatitis enteropathica and pemphigus can manifested as white tongue either initially and/or during the course of the disease. Hence, dermatologists and oral physicians should be aware for this distinguished clinical observation.