What is the best course of treatment for a child or young adult with a tongue blister caused by eating candy, considering potential underlying conditions such as autoimmune disorders?

Treatment of Tongue Blister from Candy

For a child or young adult with a tongue blister caused by candy, apply white soft paraffin ointment to the affected area every 2 hours and use viscous lidocaine 2% (15 mL) before meals for pain relief, while monitoring for signs of secondary infection. 1, 2, 3

Immediate Management

First-Line Topical Treatment

• Apply white soft paraffin ointment every 2 hours to protect the compromised mucosal barrier and prevent further moisture loss 1, 4
• This creates a protective barrier over the blister and promotes healing without the dehydrating effects of petroleum-based products used long-term 4

Pain Control

• Use viscous lidocaine 2% (15 mL per application) for children 2 years and older, held in mouth for 1-2 minutes before spitting out 2, 3, 5
• Apply particularly before eating to allow comfortable food intake 2, 3
• Can be repeated every 3 hours as needed 3
• Avoid eating or drinking for 30 minutes after application for maximum effectiveness 2, 3

Supportive Oral Hygiene

• Clean the mouth daily with warm saline mouthwashes to prevent secondary infection 1, 3
• Use a soft toothbrush or oral sponge for gentle cleaning 1
• Maintain good oral hygiene after meals and before sleep 2

When to Escalate Treatment

Add Anti-Inflammatory Agents if No Improvement in 48-72 Hours

• Consider benzydamine hydrochloride oral rinse (anti-inflammatory) every 3 hours, particularly before eating 1, 2
• For severe inflammation, consider clobetasol propionate 0.05% mixed with Orabase applied directly to affected areas 2, 3

Monitor for Secondary Infection

• Watch for increased pain, spreading erythema, white patches, or purulent discharge 1
• If candidal infection suspected (white patches develop), add nystatin oral suspension 100,000 units four times daily for 1 week OR miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 2, 3

Important Caveats

Distinguish from Allergic Contact Dermatitis

• If blisters recur with specific candy types (particularly cinnamon-flavored or cola products), consider allergic contact dermatitis to balsam of Peru or cinnamic aldehyde 6
• This would require elimination of the offending agent rather than just symptomatic treatment 6

Rule Out Autoimmune Conditions

• While rare in children, recurrent oral blisters warrant consideration of autoimmune bullous diseases (pemphigus vulgaris, mucous membrane pemphigoid) 7, 8, 9
• Red flags requiring specialist referral: recurrent blisters without clear trigger, gingival involvement, skin lesions, or family history of autoimmune disease 7, 9
• These conditions require biopsy with direct immunofluorescence for diagnosis 7, 9

Age-Specific Considerations

• Children under 2 years: consult a dentist or physician before using topical anesthetics 5
• Children under 12 years: supervise use of topical anesthetic products 5

Dietary Modifications During Healing

• Avoid crunchy, spicy, acidic foods and hot beverages 2
• Offer soft, bland foods at room temperature 2
• Avoid citrus fruits and carbonated beverages that may irritate the lesion 2

Expected Timeline and Follow-Up

• Simple traumatic blisters from candy should show improvement within 3-5 days with conservative management 1
• If no improvement after 2 weeks, reevaluate the diagnosis to ensure this is truly a simple traumatic blister and not another condition 4
• Consider referral to dentistry or dermatology for persistent symptoms 2