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DISEASES OF THE LIPS ICD-10: K13.0

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ANGULAR CHEILITIS (PERLÈCHE)

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  • Associated with increased moisture at commissures, salivation (at sleep).

  • Predisposing factors: Thumb sucking in children; sagging face and loss of teeth in older persons; candidiasis in immunocompromised persons; Staphylococcus aureus in atopic dermatitis and isotretinoin treatment.

  • Findings: Erythema and maceration at commissures (see Fig. 33-1).

  • Diagnosis: KOH for candidiasis; culture for S. aureus, Candida.

  • Management: Identify and treat causes.

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Figure 33-1

Angular cheilitis Mild erythema and scaling in bilateral commissures. (Used with permission from Dr. Nathaniel Treister.)

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ACTINIC CHEILITIS

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  • Actinic/solar keratoses, usually of the lower lip. Rule out squamous cell carcinoma in situ (SCCIS) or invasive if papule or nodule or ulcer occurs (see Section 11).

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CONDITIONS OF THE TONGUE, PALATE, AND MANDIBLE ICD-10: K14

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FISSURED TONGUE

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  • Normal variant in up to 11% of population. Asymptomatic.

  • Findings: Multiple folds with anterior-posterior orientation on the dorsal surface of the tongue (Fig. 33-2).

  • Associated disorders: Psoriasis, Down syndrome, acromegaly, and Sjögren syndrome.

  • Synonyms: Lingua fissurata, lingua plicata, scrotal tongue, grooved tongue, furrowed tongue.

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Figure 33-2

Fissured tongue Deep furrows on the dorsum of the tongue are asymptomatic.

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BLACK OR WHITE HAIRY TONGUE

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  • Pathogenesis: Defective desquamation of filiform papillae resulting in hair-like projections on the dorsum of the tongue.

  • Associations: Heavy tobacco use, mouth breathing, systemic antibiotic therapy, poor oral hygiene, general debilitation, radiation therapy, chronic use of bismuth-containing antacids, or lack of dietary roughage.

  • Findings: Furry plaques on dorsal tongue (Fig. 33-3). Candidiasis may occur secondarily.

  • Management: Eliminate predisposing factors; good oral hygiene.

  • Synonym: Lingua villosa (nigra).

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Figure 33-3

(A) Hairy tongue Defective desquamation of filiform papilla noted in posterior aspect of tongue. Tongue has a white surface caused by retained keratin. (Used with permission from Dr. Nathaniel Treister.) (B) Black hairy tongue In this example, chrormogenic bacteria have stained the tongue black.

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ORAL HAIRY LEUKOPLAKIA

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  • Pathogenesis: Epstein–Barr virus infection; low CD4 cell counts (See Section 27).

  • Findings: White corrugated plaques on lateral aspects of tongue (see Fig. 27-66). Does not occur in successfully treated HIV/AIDS.

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MIGRATORY GLOSSITIS ICD-10: K14.1

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  • Irregular areas of dekeratinized and desquamated filiform papillae (red in color) are surrounded by elevated whitish or yellow margins (Fig. 33-4).

  • Etiology: Unknown; possible link with psoriasis. Incidence: Common; usually asymptomatic.

  • Synonym: Geographic tongue.

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