Median Rhomboid Glossitis

If you have Red Patch on the Midline of the Back side of the Tongue then it can be described as Median Rhomboid Glossitis.

This is a poorly understood condition that affects the tongue dorsum. It is characterized by a chronic, atrophic, erythematous, depapillated patch in the posterior midline of the tongue dorsum typically measuring between 0.25 and 2.0 cm in diameter.

mrgMedian rhomboid glossitis with a well-defined depapillated patch in the posterior midline of the tongue dorsum with normal surrounding tissue.

Sign and Symptoms: 
While many cases are never symptomatic, mild discomfort may develop specifically in the area of atrophic change. If so, symptoms tend to come and go and rarely persist for long.

Biopsy Findings: 
Because tissue biopsy often demonstrates superficial candidal colonization and an inflammatory infiltrate in the underlying connective tissue, there is some thought that median rhomboid glossitis is mediated by chronic candidal colonization. The tissue may be particularly susceptible to recurrent fungal infection due to the reduced thickness of the epithelium.

when a patient develops symptoms of tongue discomfort in the presence of median rhomboid glossitis, first-line treatment consists of topical or systemic antifungal therapy. If symptoms persist following an appropriate course of antifungal therapy, topical corticosteroid therapy should be instituted. If this is also ineffective and all other potential etiologies have been excluded, the discomfort should be managed as a neuropathic pain disorder. 

Diagnostic tests: None routinely. A positive fungal culture or cytological smear may or may not represent a true infection. This may be clinically useful to determine baseline status prior to initiating antifungal therapy.
Biopsy: No, except for atypical presentations.
Treatment: None in most cases. When symptomatic, initial therapy should consist of a 1-week course of either clotrimazole troches or fluconazole. Be sure to consider other causes of tongue discomfort, such as geographic tongue or burning mouth syndrome. If there is no improvement following 1 week of antifungal therapy, treatment with high potency topical corticosteroid gels (fluocinonide 0.05% or clobetasol 0.05%), two to three times daily, should be initiated.
If this is also ineffective, consider treating as a neuropathic condition.
Follow-up: None if asymptomatic, otherwise patients should be re-evaluated after 1 week of antifungal therapy.

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