What is a Cracked tongue?

A cracked tongue is a benign condition with multiple small but furrows, fissures or grooves visible on the dorsal of the tongue. The fissures or grooves vary in sizes and can either be deep or shallow and may be as deep as six millimeters. However, most fissures occur in the middle of the tongue.

A cracked tongue can increase the risk of a fungal or bacterial infection in your mouth.

Other Names for Cracked Tongue:

• Fissured tongue
• Scrotal tongue
• Lingua plicata
• Plicated tongue
• Furrowed tongue

Prevalence

A cracked tongue is relatively a common condition. Health records indicate that tow to five percent of the general population report having cracked tongue. Reportedly, males are more affected compared to the females. Also, the condition affects older people as it becomes more accentuated as one age.

Symptoms of Cracked tongue

Below are various symptoms of cracked tongue

• The cracks only affect the tongue and not any other structure in the oral cavity including gums and cheeks
• Pain and a burning sensation
• Clefs, grooves or cracks visible on both the top and sides of the tongue
• Redness
• Difficulty in eating or swallowing
• A burning feeling while eating
• Irritation and mouth sores
• The cracks connect in a grooved pattern and divide the tongue into difference sections
• Bad breath

Causes of Cracked Tongue

Cracked tongues are often genetically inherited, and the exact cause is unknown. The condition is also apparent at birth as a result of an incomplete fusion of the two parts of the tongue. Other than aging and environmental factors, fissured tongues may appear along with other conditions that include:

Geographic tongue

Also referred to as Benign migratory glossitis or tongue abnormality, geographic tongue shows up along with a cracked tongue. It makes the filiform papillae of the tongue go away and instead creates bald purchase on the surface of your tongue. It may cause mild or no symptoms including sensitivity to spicy or hot foods and drinks.

Melkersson-Rosenthal syndrome

Although considered to be rare, this benign condition causes a fissured tongue as well as paralysis in the face.

Down syndrome

80 percent of children diagnosed with Down syndrome are reportedly prone to fissured tongues. Down syndrome is also referred to as trisomy 21 syndrome.

Injury

In case you are repeatedly the dorsal surface or the lateral borders of the tongue, you are most likely to develop fissures. A broken tooth present in your oral cavity may also cause constant friction on the tongue resulting in a cracked tongue.

Deficiency of Biotin

Biotin is found in the Vitamin B family. Lack of Vitamin B in your body can increase the risk of developing a fissured tongue along with muscle pain, dry skin, and paleness. Biotin can be corrected by taking plenty cauliflower, chicken, egg yolks and chicken. You can also consult your physician to help you determine the proper diagnosis.

Oral thrush

A cracked tongue indicating an oral thrush is caused by the accumulation of the candida fungus in the oral cavity or the lining of the mouth due to a weak immune. A weak immune system can be as a result of vaginal yeast infection, cancer, and diabetes. Such a condition is characterized by loss of taste, mild pain and lesions on the tongue or any other part or your oral cavity. In such a case, your doctor may prescribe antifungal medications depending on the cause of your condition.

Sjogern’s syndrome

Sjogern’s syndrome causes your body to produce glands which can lead to dry mouth and cracked tongue. This disorder can also lead to joint pain, fatigue, as well as itching and burning eyes. Sjogern’s syndrome is caused by environmental factors, genetics, and an existing viral or bacterial infection in your body.

Other Common causes of cracked tongue:

• Spicy food
• Too much exposure to stress
• Grinding your teeth constantly
• Eating hard food
• Allergic reactions
• Drug reactions
• Over body heat
• Granulomatous disease
• Too much alcohol consumption
• Severe tobacco chewing
• Stress which often leads to chewing on the tongue unknowingly

In other cases, cancerous or pre-cancerous growth can often result in a cracked tongue. Fissured tongues from cancerous growth are characterized by severe pain and swelling, and it is recommendable to consult a physician immediately you notice the symptoms for quick diagnosis and treatment.

Cracked tongue Diagnosis

A cracked tongue can be observed as an incidental finding during a routine dental examination. The diagnosis can also be made using the clinical symptoms of the tongue. It is rare to need a biopsy to diagnose a fissured tongue.

Pictures of Cracked Tongue

Treatments for Cracked tongue

• Cracked tongues do not require any specific treatment. However, some guidelines to help you with the conditions include:
• Leaving it Alone – if the cracked tongue is not causing any discomfort, it is advisable to allow it to heal on its own.
• Keeping dental hygiene- brush your teeth regularly. You can also use a cleaner to get rid of any food from the cracks to avoid the growth of microorganisms and infections.
• In the case of severe pain, you can manage your comfort by drinking plenty of water to keep your tongue hydrated.

Home Remedies for Cracked tongue

• Spearmint – spearmint helps with the healing process of the cracked tongue and also neutralizes the pain.
• Baking soda – placing a bit of baking soda in the affected area eases the pain. You can also gargle to heal the cracks faster.

When to see a doctor

If the symptoms and the discomforts are severe, you should see a physician to help determine if there is a way to help with your discomfort. Also, if the cracks are swelling, see a doctor to find the cause of the swelling as it could be a serious condition such as tongue cancer. If the cracks are due to an infection or injury, the doctor will describe some antibiotics or topical soothing creams. In the case of halitosis, mechanical tongue cleansing is recommendable.

What is a Bartholin Cyst?

A Bartholin’s cyst occurs when the duct found in the Bartholin’s gland is blocked.  When this happens, a fluid filled cyst develops. Sometimes the cyst might be caused by an infection, but it is not exactly an infection. The Bartholin’s glands, known as major vestibular glands are a pair of glands that are located between the vagina and the vulva.

Picture of Bartholin cyst

Functions of the Bartholin glands

The main purpose of the glands is to produce lubrication after stimulation. Together with the vestibular glands, the Bartholin glands help in sexual intercourse by decreasing friction. The lubrication produced goes from the Bartholin’s glands ducts into the lower entrance of the vagina.  The tubes are 0.8 inches long.

When a blockage happens in the ducts, the lubrication accumulates, making the tubes expand, and the result is a Bartholin’s cyst. When someone gets the cyst, the chances of getting an infection in the area are high, and an abscess can also develop. According to the National Health Service in the United Kingdom, the condition affects about 1 in every 50 British women.

Who can get a Bartholin’s Gland Cyst?

Any woman is at risk of getting the cyst. However, the condition is common in women who are still in their reproductive age. Ladies who are aged 20 to 29 are the most affected.  Women who have not yet become pregnant or have had one pregnancy are also prone to the disease.

Bartholin cyst Symptoms

Women who have small and non-infected Bartholin’s cyst might not notice them.  When the cyst grows bigger, the patient starts feeling a lump or a big mass close to their vaginal opening. Most of the time these cysts are painless, but they can be tender. However, a full blown Bartholin cyst infection can develop in just a matter of days.  When the cyst becomes infected, the patient will experience the following:

• A tender and sometimes very painful lump close to  the vaginal opening
• A lot of discomforts when the patient is sitting and walking.
• Pain during sexual intercourse.
• Unexplained fever.
• Most of the time, the cyst occurs on only one side in the vaginal openings.

When to see a doctor

It is crucial for women to look out for any growths on their private parts. When they notice a painful lump that doesn’t go away in a day or two, it is crucial to consult a doctor.  The patient can try some self-care for a day like soaking the area in warm water.  If the pain doesn’t go away, the individual should visit the doctor immediately.

Women who are more than 40 years should visit the doctor immediately if they notice a lump near their vaginal opening.  Although lumps are very rare at that age, they can be a sign of a dangerous condition such as cancer.

Size of a Bartholin cyst

Cysts have different sizes. They can be as small as a lentil and as big as a golf ball.

Causes of Bartholin cyst

Research shows that the course of the Bartholin cysts is an accumulation of lubrication fluid. This generally happens when the glands become obstructed. The obstruction may be caused by an infection or an injury.

Sometimes the cyst might become infected, forming an abscess. Several bacteria can trigger the infection such an Escherichia coli. The bacteria responsible for sexually transmitted infections like chlamydia and gonorrhea can also trigger the growth of the cyst.

Preparing for your appointment

After you have noticed any painful lump in the vagina, it is important to call your doctor for an appointment. Your first appointment should be made with a qualified medical provider who specializes in women’s reproductive system. Here are some of the things a patient can do prepare for the appointment.

• Ensure that you have written down all the symptoms you are experiencing, even if they are not related to the condition.
• If you are taking any supplements, vitamins or any medication, write them down, along with the dosage.
• You should have a notebook while going to the checkup so that you can write down important information during the checkup.
• If you have anything that you would need to ask your doctor; it is important to list them down so that you do not forget any of them.

If you suspect a cyst, here are some of the possible questions you should ask your doctor.

• What is causing the symptoms?
• Are there any tests that I require?
• Will the cyst disappear on its own or will I need some treatment?
• After the treatment, how long will I wait before resuming my sex life?
• Are there some home care treatments to manage the symptoms?
• After the treatment, is there a possibility of getting the cysts back?
• Do you have some printed material about the condition that I can take home? What websites can I get information about my condition?

During your visit to the doctor, ensure that you have given the doctor all the information you have so that you can get the right diagnosis. Do not leave the appointment without getting the information you need.

What to expect from your doctor

During your appointment, the doctor must ask some questions too so that they know what you are suffering from.  Here are some of the questions you should expect during the appointment:

• For how long have you had the symptoms?
• Do you experience any pain during sexual intercourse?
• How severe are the symptoms you have?
• During your normal daily activities, do you get any pain?
• Is there anything that improves the symptoms?
• Are their activities that make the condition worse?

Tests and Diagnosis

To accurately diagnose a Bartholin’s cyst, the doctor might do the following:

• Ask important questions about your medical history.
• Conduct a pelvic examination.
• Get samples of your secretions from the cervix or the vagina to check for any sexually transmitted infections.
• If you are over 40 years, the doctor will recommend a biopsy to rule out the presence of cancer cells in the lump.

If the physician suspects the presence of cancer cells, you will be referred to a gynecologist who deals with cancer for special treatment.

Bartholin cyst Treatment

Most of the time, a Bartholin’s cyst doesn’t require any treatment, especially when you are not experiencing any symptoms. However, in cases where treatment is required, it will depend on the size of the lump, whether it’s infected and the comfort level of the patient.  If the cyst is infected, treatment should be done immediately to avoid the formation of an abscess.

Some of the treatment options the doctor may recommend are:

Sitz baths

The patient can soak the affected area with warm salt water several times a day. This treatment is very effective, and in two or three days, the cysts will rupture and drain on its own.

Surgical drainage

If the cyst is too large and infected, the doctor might consider performing surgery to remove the fluid. The procedure is done under local anesthesia. The doctor will them make a tiny incision on the cyst, allowing the fluid to drain. A small rubber tube can also be inserted to help drain the fluid.  The catheter can be left after the surgery to help keep the incision open and allow complete drainage.

Antibiotics

If the doctor determines that the cyst is infected, or the patient has a sexually transmitted infection, a dose of antibiotics will be prescribed. However, if the cyst is drained well, the patient doesn’t require the antibiotics. .

Marsupialization

Sometimes, the cyst might keep reoccurring, and the doctor might recommend a marsupialization. The procedure involves placing stitches on the sides of the drainage incision and creates a permanent opening. The small opening shouldn’t be more than 6 millimeters. A catheter can also be inserted to drain the fluid for a few days.

There are some rare and persistent cysts that cannot be treated by the above procedures. In such cases, the doctor will recommend surgery to remove the glands completely. The removal is done at the hospital under general anesthesia. This procedure is riskier, and a qualified doctor should do it. The patient can bleed a lot or get other complications during the surgery.

Home Remedies for Bartholin cyst

Treating a Bartholin cyst with simple home remedies is possible. The patient can soak the affected the area in warm water 3 or four times every day.  The infected cyst will rupture and drain on its own. After the patient has been treated, soaking in warm salty water will also be necessary.  This will help the area to heal fast and ensure that the area remains drained properly.  The warm salty water will also ease the discomfort experienced after surgery.  The patient can also take painkillers to get rid of the pain.

Prevention

Experts say that a Bartholin’s cyst cannot be prevented. However, women are advised to practice safe sex always using a condom and maintain good hygiene to help prevent infections that can cause a cyst or the formation of an abscess.

What does Lump in your Earlobe mean?

A lump or cyst in the earlobe is referred to as benign ear cyst. It can also be referred to as a bump, nodule or tumor. It is often non-cancerous and may signal a need for medication in the case of an infection. Rarely, these cysts are a sign of dangerous or life-threatening condition.

Lumps may also be found behind the ear and in the ear canal. Depending on the cause, an ear lump can be single or multiple, painful or painless, soft or firm.

Causes of lumps in the Earlobe

The exact cause of lumps in the earlobe is unknown. However, they may occur when the production of oils in a skin gland overwhelms the rate at which they are released from the gland.

Ear lumps caused by local infectious causes may appear as boils or abscesses. They are usually temporary and subside as the underlying conditions are treated. Those associated with a head injury may signal bleeding in the brain and are often life-threatening. As a result, it is advisable to seek immediate medical care if you have a lump near your ear resulting from a head injury.

Several conditions that may lead to lumps include:

Abscess

An abscess develops in the case of an infection of the tissue or cells in the earlobe, and it is often painful and warm to the touch. Biologically, your body can kill off the invading bacteria or virus causing an infection. The body generates white blood cells that begin accumulating in the damaged location and pus begins to develop from the dead blood cells resulting in cysts.

Sebaceous Cysts

Sebaceous cysts mainly develop around the sebaceous gland. Sebaceous gland produces oil that lubricates your skin as well as hair. This kind of cyst is not painful but may be uncomfortable and also irritating.

Lymphadenopathy

Lymphadenopathy causes the lymph nodes to swell as a result of an infection. Lymph nodes are tiny, organ line structures that are not only present behind the gears but also under the arms, in the neck, and the pelvis. Swollen lymph nodes can also be caused by inflammation or cancer.

Acne Vulgaris

Acne, a common condition of the skin, is caused by the clogging of hair follicles in the skin. The clogging of the hair follicles occurs as a result of dead skin cells and too much oil. With acne, pimple and solid bumps often grow to be large and are sometimes painful.

Throat infection

Throat infection occurs as a result of bacterial or viral infections and is classified into two types; strep throat and infectious mononucleosis. The infection can also be caused by various conditions including HIV/AIDs, measles as well as chicken pox. It is often characterized by a swelling in and around the neck.

Mastoiditis

An untreated ear infection may develop a more serious infection known as the mastoiditis. This type of infection affects the mastoid, the bony protrusion behind the ear. It is characterized by a pus-filled cyst, and one can feel the lumps behind the year.

Otitis Media

Otitis media is a synonym of an ear infection. It can either be bacterial or viral, and it is characterized by painful fluid buildup as well as a visible swelling behind the ear. This kind of infection can be treated using antibiotics.

Other causes include:

• Herpes virus infection
• Mononucleosis
• Upper respiratory virus infections such as common cold

Tumors that can result to ear lumps

• Fibroma
• Lipoma
• Lymphoma
• Melanoma
• Nevi
• Nonmelanoma skin cancer

Symptoms occurring with an ear lump

• Itching
• Pus or discharge
• Tenderness or pain
• Redness, warmth or swelling
• Ear discomfort

Other symptoms associated with an ear lump include

• Cough
• Fever and chills
• Headache
• Sore throat
• Sweating
• Joint stiffness and pain
• Sweating
• Unexplained weight loss
• Serious symptoms indicating a life-threatening condition

In various cases, an ear lump may be accompanied with other symptoms that may call for an emergency medical care. Such symptoms include:

• Unconsciousness or unresponsiveness
• Confusion, lethargy, hallucinations, delusions or delirium
• Profuse or uncontrollable bleeding
• Gradual hearing loss in one year
• Severe outer ear infections

Pictures of Lump in Earlobe

Images and Pictures of lump in earlobe…

Exams and tests

Lumps in the earlobe are often discovered during a routine ear exam including audiometry, a hearing test and tympanometry, a middle ear testing. The condition may also be found during Caloric stimulation and electronystagmography.

Diagnosis

During the diagnosis of an ear lump, the practitioner may ask:

• How long you have had the ear lump
• What symptoms you are experiencing
• If the ear lump is changing in size
• If you are experiencing some sorts of pain around the earlobe
• Potential complications resulting to ear lump

Long-term Complications

Left untreated, ear lumps due to cancer may have long-term consequences. Those caused due to abscesses or other serious infections may lead to widespread infections in the body. Other long term conditions include:

• Ear infection
• Spread of cancer
• Hearing loss
• Spread of the infection in the body

Treatment

In the case where the cyst does not cause pain or affect hearing, treatment may not be needed. However, if the cyst becomes painful and infected, the cyst may be removed.

There are two ways of removing the cyst: drainage and removal. Drainage involves draining the contents using a small incision in the skin that is usually made at the location of the cyst. In most cases, this option does not completely get rid of the cysts. The cyst may begin to retain the fluid after some time since the membrane of the cyst still remains in the skin.

Permanent removal of ear lumps involves surgery. Surgery is often recommended if the benign tumor is painful, leads to frequent ear infections or interferes with hearing. It involves the permanent removal of the contents of the cyst and also its membrane from a small incision.
In some cases, surgery may be complicated by profuse bleeding, infection of an allergic reaction to the anesthetic. Other side effects likely to arise from the surgery include hearing impairments, vertigo, and damage to the facial nerve or perforation of the eardrum

After care

Once the treatment is done, a patient is given corticosteroid and antibiotics to help with the healing of the skin. The ear canal is also packed with materials and ointments to enhance the healing process.

Hearing tests can also be done for two to three months to monitor the condition.

Definition

Hairy Leukoplakia (HL) or Oral hairy Leukoplakia is a distinctive white coloured lesion of the oral mucosa.

Picture of Hairy Leukoplakia

Image source- Harrison’s principles of Internal Medicine

When the disease was first described in the 1980s, it was initially thought to be restricted and hence pathognomonic of HIV related immune suppression. The view held strong till 1990s when HL cases started to be reported in HIV seronegative patients as well. Now it is known that about 20% of lesions are seen in patients who are immunocompromised due to other reasons. But of late its occurrence has significantly decreased in relation to HIV because patients are now treated with aggressive antiretroviral chemotherapy.

Etiology and Pathophysiology

Hairy Leukoplakia has no established racial or age related predilection and is most commonly observed in homosexual HIV positive men.

Recent studies have frequently detected the presence of Ebstein-Barr virus (EBV) in immunofluorescence stained biopsy specimens from HL patients suggesting a causal association between the two. However the mere presence of EBV infection without significant immune compromise is not enough to cause hairy leukoplakia. Infection with Epstein Barr virus is quite widespread globally and the infection begins in the basal epithelial cells of the pharynx where the virus undergoes active replication and is then discharged into the saliva. As is typical of herpes viruses, it persists lifelong in the infected host. The virus initially remains dormant because though Cytotoxic T lymphocytes cannot eliminate the virus from the body; these prevent full blown disease. But when the immune system gets compromised, the number of EBV-specific Cytotoxic T lymphocytes declines allowing replication and resultant increase in number of circulating EBV-infected B cells. This finally leads to the development of HL.

In addition, HL biopsy tissues show a significant decrease or even absence of Langerhans cells (LC) which are the antigen-presenting immune cells required for an immune response to the viral infection their deficiency permits continued viral replication and hence EBV infection persists unchecked.

Diagram showing the EBV Replication cycle

In HIV positive patients, HL can be suspected when the CD4+ count is less than 500 cells/mm³ and the risk of developing this condition doubles with each 300 unit decrease in CD4+ count. High viral load is in itself has been linked to HL disease severity. Cigarette smoking (> 1pack/day) imparts a higher risk of HL in HIV positive homosexual men. Decrease in systemic immunity responsible for development of HL in non sero-positive patients can be due to cancer (including leukaemia) chemotherapy, post organ transplant immune-suppression and steroid therapy (e.g. in autoimmune conditions like Rheumatoid arthritis, SLE etc). Other less important risk factors for Hairy Leukoplakia include Behcet syndrome and Ulcerative Colitis.

Clinical features and Diagnosis of Hairy Leukoplakia

Hairy Leukoplakia is characterised by the presence of non-tender clusters of fluffy (hence the name “hairy”) hyperkeratotic thickening. These lesions may vary from smooth, flat, small lesions in mild cases to irregular ones of severe form which have vertical raised edges and prominent folds or projections (“corrugated /folded appearance”). The plaques are firmly adherent to the mucosa and not completely removable upon scraping (in contrast to Candidal Leukoplakia). Another distinguishing feature is the absence of underlying erythematic inflammation. Lesions may be either continuous or discontinuous, clustered along one or both sides of the tongue and they often are bilaterally asymmetrical unlike frictional keratosis. Less commonly other parts of the oral cavity may be involved. Extraoral manifestations are not seen.

Disease onset is usually missed by the patient due to lack of symptoms. The appearance may change daily and the lesions may appear or disappear spontaneously. Patients often consult doctor because of cosmetic disfiguration but few may experience symptoms like dysgeusia (alteration of taste sensation), dysesthesia (unpleasant sense of touch) and mild pain especially in the presence of concurrent Candida infection.

Before and while seeking medical attention, a patient should:

• Write down the most pressing questions that have to asked.
• Arrange the aid of another person to help ask questions and remember what the health-care provider advises including all important instructions regarding medicines and their dosage, tests and details of any follow-up appointment scheduled.
• The Contact details of the health-care provider may be obtained.

When a doctor encounters white lesion of oral mucosa, certain pertinent issues must be taken into consideration.

• The name Hairy “Leukoplakia” is a misnomer. HL is not a type of Leukoplakia. According to WHO Guidelines, Leukoplakia is diagnosed on the basis of exclusion i.e. all possible etiology for a white lesion of the mouth including HL have to be excluded. Furthermore, Leukoplakia is a pre-malignant condition while HL is benign with no documented risk for cancer and treatment for both is different.
• HL closely resembles few other conditions which need to be excluded before confirming the diagnosis.

In most circumstances, the diagnosis of HL is made on the basis of clinical findings as shown below.

If the clinical diagnosis still remains in question, the investigator may order a Gram’s stain or potassium hydroxide (KOH) stain to identify Candidal Leukoplakia and histopathological assessment along with demonstration of EBV infection to rule out other disease etiology and definitively establish the diagnosis of HL. Immune-histochemical and in situ hybridization kits are commonly used for this purpose and tissue biopsy is reserved for lesions that have atypical feature and/or indicative of cancer.

Commonly seen histologic features of Hairy Lekuloplakia are:

• Hyperparakeratosis of upper epithelial layer
• Acanthosis in stratum spinosum with ballooning koilocyte-like cells. The nuclei have a homogenous ground-glass appearance and may contain Cowdry type A intranuclear inclusions.
• Minimal or no inflammation in the epithelial and subepithelial tissues
• Histologically normal basal epithelial layer

Presence of the afore-mentioned histologic findings suggest HL but in themselves are not sufficient for diagnosis which also requires the demonstration of EBV DNA, RNA or protein within epithelial cells of the lesion.

Hairy Leukoplakia Treatment

Hairy Leukoplakia is benign, does not produce significant symptoms and usually remits spontaneously. Hence treatment usually focuses on improving patient’s immunity e.g. HAART for HIV positive.

When the disease is severe /symptomatic or for cosmetic purposes, specific therapy for HL may be started. But it should be remembered that HL is a chronic condition with high chance of recurrence after cessation of treatment.

Systemic antiviral therapy

• Oral acyclovir (800 mg 5 times/day), Valacyclovir (1000 mg 3 times/day) and famciclovir (500 mg 3 times/day)
• Side effects include rashes and mild GI upset

Topical therapy

• Podophyllin resin 25% solution: side-effects- local pain, discomfort, and alteration of taste
• Retinoic acid (tretinoin)
• Acyclovir ointment QID

Others

• Ablative therapy
• Cryotherapy
• Gentian Violet

Other considerations

• EBV serology plays no role in the management of HL.
• Concurrent or secondary infections with Candida should be treated with anti-fungals.
• Studies have shown that if a HIV positive HL patient does not continue antiretroviral therapy, then the risk of progression to AIDS is 48% by 16 months and 83% at 31 months. Also the mortality rate increases when AIDS patients develop this lesion. If these patients are concomitantly co-infected with hepatitis B virus, there is further risk of early progression to AIDS.

Hairy Leukoplakia Pictures