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Hi Doctor, I Have White Thick Patches On My Side

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Posted on Mon, 8 Oct 2018
Question: hi Doctor,
i have white thick patches on my side of tounge since last 7 years. No major change in appearance. Initially it was treated with Fluconozole and one in 2013 i suffered from Herpes(Shingles) and administered Acyclovir. After that the patch disappeared but reoccur once the medicine stopped.I am 48 year old healthy male. Not Diabetic but having hypertension meds since long including diuretics and beta blockers. The patch can not be scrapped.I had an eye surgery prior to the appearance of the patch and had predinslone and other antiboitics for long. Please suggest a remady.
doctor
Answered by Dr. Dr. Kakkar (1 hour later)
Brief Answer:
Regarding white patch on tongue

Detailed Answer:
Hello and Welcome to Ask A Doctor service.
I have reviewed your query as well as the image and here is my advice.

It could be thrush/ oral candidiasis. It could also be oral leukoplakia. Is there any history of smoking or tobacco abuse? I suggest you to take Tab Fluconazole 50mg once a day for 2 weeks. In addition I suggest you to use a clotrimazole mouth paint (Candid mouth paint or Clotrin mouth paint), 2-3 times a day. If it doesn't resolve on this then I would suggest a biopsy in view of possibility of leukoplakia, which is a precancerous condition.

Take care.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Dr. Kakkar (1 hour later)
Thanks Doctor,I have following queries
1.Is biopsy necessary since it is same since last 7 years?
2.How to be sure that it is candida only since in early stage it was responding to anti fungal.

Still candid mouth paint improves but very slow.

Thanks and regards
doctor
Answered by Dr. Dr. Kakkar (25 hours later)
Brief Answer:
Regarding white patch on tongue

Detailed Answer:
Thank you.

Exactly because it has persisted for so long without any underlying predisposing factors or immunosuppression makes me think that it is leukoplakia. Anyways, along with the topical antifungal I also suggest you to take an oral antifungal e.g Fluconazole 50mg once a day for 14 days. If it doesn't resolve on this then you must consider a biopsy? Are there other white patches elsewhere?like on buccal mucosa?
Is there any history of smoking?tobacco chewing?

Thank you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Kakkar (22 minutes later)
Thanks again,There is no other patch and I haven't consumed tobacco at all since the apearance of patch i.e.last 7 years , Earlier also I had only now and then but not as an habit.I have read somewhere that it may be candidal leukoplakia.Will be glad to know your views.Thanks a lot for your consultation.
doctor
Answered by Dr. Dr. Kakkar (22 hours later)
Brief Answer:
Regarding white patch on tongue

Detailed Answer:
Hi.

Yes, it might be candidal hyperplastic leukoplakia. That is why I suggested you oral antifungal therapy. If it doesn't improve then I suggest you to go for a biopsy because a minority of candidal leukoplakia patients may progress to precancerous dysplasia and later carcinoma.

Take care
Hope I have answered your query
Let me know if you need any more assistance
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Dr. Kakkar (12 days later)
Dear Doctor,
As per your advise I had Flucozonole tablet for 14 days and also applied Candid mouth paint.The patch has reduced to 30 %, and thickness has also reduced greatly .I also had Supradyn multivitamin tablet along with.I am enclosing a photograph of patch both before and after medication.Should I continue with the medicine for some more time? Or dosage need to enhance?Is it interacting with my BP meds.Plz suggest further course of action.
Regards.
doctor
Answered by Dr. Dr. Kakkar (24 hours later)
Brief Answer:
I suggest mucosal biopsy

Detailed Answer:
Hi. thank you. Yes it has reduced significantly but not yet resolved.

I think a biopsy is a must to distinguish it from oral leukoplakia which could be a precursor of malignancy rather than just continuing with the antifungal therapy.

take care
Let me know if you need any more assistance.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Dr. Kakkar (32 minutes later)
Thanks, Should I stop antifungal medicine?
doctor
Answered by Dr. Dr. Kakkar (22 hours later)
Brief Answer:
Stop antifungals

Detailed Answer:
hi.

yes, 2 weeks is a fair trial period.

take care
Let me know if you need any more advice
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Dr. Kakkar

Dermatologist

Practicing since :2002

Answered : 9612 Questions

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Hi Doctor, I Have White Thick Patches On My Side

Brief Answer: Regarding white patch on tongue Detailed Answer: Hello and Welcome to Ask A Doctor service. I have reviewed your query as well as the image and here is my advice. It could be thrush/ oral candidiasis. It could also be oral leukoplakia. Is there any history of smoking or tobacco abuse? I suggest you to take Tab Fluconazole 50mg once a day for 2 weeks. In addition I suggest you to use a clotrimazole mouth paint (Candid mouth paint or Clotrin mouth paint), 2-3 times a day. If it doesn't resolve on this then I would suggest a biopsy in view of possibility of leukoplakia, which is a precancerous condition. Take care.