A 40-year-old woman came into the office with a 1-year history of painful red lesions with white striations on her tongue (Figure 1). The lesions caused burning after she ate spicy food and an increased sensitivity to mouthwash. She reported a slow, progressive onset and worsening of her condition, with intensifying symptoms during periods of emotional stress.
On physical examination, we observed an erythematous and cream-colored reticulated patch with a few small focal areas of erosion covering the dorsal tongue. The remainder of the oral mucosa appeared normal. She also had thinning and ridging of the toenails (Figure 2).
What is the most likely diagnosis? How would you manage this case?
FIGURE 1 Tongue with painful lesions
The patient’s painful tongue, with erythema, white patches, and erosions.
FIGURE 2 Thinning toenails
The same patient’s toenails, showing thinning and ridging.
