A White Patch on the Tongue: JAMA case report
An 80-year-old white woman presented with an asymptomatic white patch affecting the tongue of 1 month’s duration. She had a 15-year history of oral lichen planus (OLP) managed with betamethasone dipropionate, 0.05%, gel twice daily and clotrimazole troches, 10 mg, 3 times daily as needed for symptomatic OLP flares.

Medical history revealed stage 1A mycosis fungoides/cutaneous T-cell lymphoma affecting the right calf and left thigh managed primarily with halobetasol, 0.05%, cream owing to intolerance of narrowband UV-B therapy and mechlorethamine, 0.016%, gel. Immunosuppression or history of infectious diseases, including human immunodeficiency virus (HIV), was not reported.

A 1.5 × 1.0-cm nonremovable white, plaquelike lesion was observed on the left lateral tongue (Figure 1A). Biopsy specimens were obtained with a 3-mm punch instrument at 3 different sites, which demonstrated similar microscopic findings (Figure 1B and C).

Microscopic analysis of all specimens demonstrated hyperkeratosis and acanthosis with a band of cells characterized by lightly stained cytoplasm (balloon cells). The superficial cells contained nuclei with peripheral chromatin margination or nuclear beading typical of Epstein-Barr virus–infected oral keratinocytes and consistent with oral hairy leukoplakia (OHL).

The patient was prescribed valacyclovir 1 g 3 times daily, which she discontinued taking after 3 days owing to medication adverse effects. On re-examination, the tongue lesion had completely resolved (Figure 2).

Read more here: https://jamanetwork.com/journals/jamadermatology/article-abstract/2695082