A white patch on the tongue

A man in his 40s presented with a white patch on his tongue that had enlarged progressively over the past three months.

Oral leucoplakia had been diagnosed at a stomatology department eight weeks earlier, and topical tretinoin had been prescribed. The patient said he had used the ointment intermittently, with little improvement.

The patient came to our department for further investigations, after searching online and being concerned about autoimmune bullous disease.

He had no risk factors for hepatitis C virus infection and no history of smoking, alcohol misuse, or long term medication use. He consumed about 500 g of spirits during social engagements each month.

Physical examination showed a painless, whitish, reticular lesion (Wickham striae) on the dorsum of the tongue (fig 1) and irregular erythema of the lower lip, with no involvement of buccal mucosa, skin, nail, or genitalia.