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Live Blog: Vulvar Dermatoses Part Two: Knowing What to Do When You Have to Look ‘There.’ Faculty: Rochelle Torgerson, MD, PhD, and Alison Bruce, MBChB

In this live blog from the Annual Fall SDPA Conference in Orlando, FL, Alison Bruce, MBChB, co-presented a lecture called “Vulvar Dermatoses Part Two: Knowing What to Do When You Have to Look ‘There,’” with Rochelle Torgerson, MD, PhD. Here are some of the highlights of Alison Bruce’s portion covering mucus membrane diseases found “upstairs.”

In this lecture, Bruce touched on different mucus membrane diseases in the mouth. Bruce explained that a proper oral exam looks at the lips, both outside and inside the lips. Bruce presented a variety of cases with helpful visuals and then spoke on diagnosis and treatment steps. Here are some of the pearl conditions Bruce mentioned.

Geographic tongue affects 2-10% of population. It presents as bald patches that can change by the day. A patient may complain of pain and burning particularly in atrophic areas. Geographic tongue can present itself on the tongue, but other areas of the mouth as well (under the surface of the tongue and inside the cheeks).

Mucocele and fibroma are two conditions that present bumps as on the oral membrane. These bumps can also be partnered with pyogenic granulomas. Bruce suggested health care professionals look and see if there is an infection driving that (for example, a recent root canal).

Furred tongue is swollen tongue tissue. Furring of the tongue is a benign tongue variant that can be due to fever, smoking or mouth breathing. It can occur in someone who is sick, hasn’t been brushing, is a smoker, or hasn’t been eating. Furred tongue can be distinguished from candida by noting the absence of a cheesy, bubbling substance that is symptomatic to candida. Furred tongue can also present itself as black, which can happen from smoking, medication or bacterial build-up.

Herpetic geometric glossitis present as very sharp geographic straight lines on the tongue. It is herpes on the tongue often present in immunocompromised patients.

Median rhomboid glossitis can also present itself in immunocompromised patients. Most cases are thought to be due to candida. Bruce’s take-home message to health care professionals for these patients is to culture those patients because you may find chronic herpes or chronic candida symptoms of immunosuppression.

Angina bullosa hemorrhagica are benign black blisters likely induced by trauma. Bruce emphasized the importance that health care providers make a patient aware that they have the condition. Bruce recommended that patients carry a medical alert just in case in the future, if a health care professional is alarmed by the unrecognizable blister(s), they will know the blister is benign.

Image: Villa Amor

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