Chronic Lingual Papulosis in a Pediatric Patient

Abstract

An 8-year-old male presented with fissuring of the tongue and occasional burning sensation over the tongue while eating of two years duration. On examination, multiple pinkish translucent non-tender papules of uniform size with multiple linear fissures were seen on the dorsum and lateral border of the tongue [Figure 1]. The rest of the oral mucosa and systemic examination were within normal limits. A diagnosis of chronic lingual papulosis (CLP) associated with fissured tongue was arrived at based on classical clinical presentation and the lack of any systemic/syndromic features. The patient was counselled regarding the benign nature of the disease and was given topical benzocaine gel for mild episodic burning sensation. After 1 year of follow-up, the patient reported no change in the severity of the symptoms or lesions.Figure 1: Multiple pinkish translucent papules of uniform size with multiple linear fissures over the dorsum of the tongueCLP is a hyperplastic response of filiform and fungiform papillae, most commonly seen as focal or diffuse enlargement of numerous pinkish to pale translucent papules of uniform size over the dorsum and tip of the tongue. It usually has an adult onset; however, pediatric cases have also been described. The etiology is possibly developmental rather than inflammatory and, therefore, it would be logical to refer to the childhood-onset cases as “congenital CLP” or “developmental CLP.”[1] The common differential diagnoses of translucent papules over the tongue are CLP and transient lingual papillitis (TLP). TLP is most commonly seen in its classic form as painful enlarged papillae due to acute or chronic local irritation or trauma and compulsive tongue movement. The exact etiology of TLP is unknown and probably multifactorial, as it can be hypothesized by the variable and non-specific histological findings.[2] A painless papulo-keratotic variant has also been reported.[2,3] TLP can be differentiated from CLP by the presence of transient lesions in the former. CLP usually does not require a histopathological confirmation of diagnosis unless associated with atypical features or associated systemic features and does not require active management unless secondarily infected by Candida. Recognizing this benign entity is important for dermatologists to avoid unnecessary investigations and interventions. Declaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.