Differential Diagnosis for a Patch on the Tongue
- Single most likely diagnosis
- Geographic tongue: This condition is characterized by the appearance of single or multiple, well-demarcated, smooth, red patches on the tongue, resulting from the loss of filiform papillae. It is a common, benign condition that can be caused by stress, nutritional deficiencies, or hormonal changes.
- Other Likely diagnoses
- Oral thrush (candidiasis): A fungal infection that can cause white patches on the tongue and other parts of the mouth. It is more common in individuals with weakened immune systems, diabetes, or those who wear dentures.
- Leukoplakia: A condition where thick, white patches or lesions develop on the tongue or the inside of the mouth. It can be caused by chronic irritation or tobacco use and has the potential to become cancerous.
- Lichen planus: An autoimmune condition that can affect the mucous membranes inside the mouth, leading to white, lacy patches on the tongue and other areas.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Oral cancer: Although less common, a patch on the tongue could be a sign of oral cancer, especially if it is a persistent, non-healing ulcer or a red and white patch. Risk factors include tobacco use, alcohol consumption, and human papillomavirus (HPV) infection.
- Syphilis: The secondary stage of syphilis can cause mucous patches in the mouth, including on the tongue. These are usually painless but can be highly contagious.
- Rare diagnoses
- Median rhomboid glossitis: A rare condition characterized by a smooth, red, diamond-shaped patch in the middle of the tongue, often associated with a fungal infection.
- Hairy leukoplakia: Seen primarily in immunocompromised patients, especially those with HIV/AIDS, this condition causes white patches on the sides of the tongue that have a hairy appearance under microscopic examination.