Stomatodynies : intérêt de l’enquête allergologique dans une série rétrospective de 40 malades

Dysaesthetic penoscrotodynia: nomenclature, classification, diagnosis and treatment

Male patients can present with a genital skin burning sensation that bears similarities to vulvodynia. The classification of vulvodynia by International Society for the Study of Vulvovaginal Disease of vulvodynia provides a blueprint for nomenclature and classification of Dysaesthetic penoscrotodynia (DPSD). Recognizing DPSD as generalized, localized, provoked, unprovoked and mixed will enable precise and objective communication between practitioners. Learning from research on the aetiology and management of vulvodynia can improve the care of patients suffering with DPSD. Scope remains for better acknowledgement of DPSD within the medical profession and improvement in its public profile in order to enhance patient care.

"Burning tongue" and "burning tip": the diagnostic challenge of the burning mouth syndrome

OBJECTIVE

To investigate the clinical features of burning mouth syndrome (BMS) in a large cohort of patients and to correlate them with the results of tongue biopsy.

METHODS

We screened 98 patients complaining of oral burning pain for at least 6 months. Forty-two patients were excluded after screening for contact sensitivity to dental materials, food allergies, tongue injuries, malignancies, connective tissue and metabolic disorders, oral infectious diseases, vitamin deficiencies, and other systemic diseases known to cause neuropathy. Fifty-six patients underwent neurologic examination and assessment of pain intensity, depression, anxiety, quality of sleep, and quality of life. Tongue biopsy with the quantification of epithelial nerve fibers (ENF) was performed in 51 patients.

RESULTS

Compared with 9 healthy participants (4.13+/-1.85 SD), epithelial innervation density was significantly reduced in 38 patients (1.35+/-1.46 SD; P<0.0001) and normal in 13 patients (6.1+/-2.19 SD). The clinical features differed in the two groups: patients with reduced ENF density complained of pain in the whole tongue, lips, hard palate, and alveolar ridges, reported dysgeusia and xerostomia in 29% of cases (P<0.001), and 24% of them were depressed. Patients with normal innervation complained of pain on the tip of the tongue, reported dysgeusia and xerostomia in 7.7% of cases, and 54% of them were depressed (P<0.017).

DISCUSSION

The diagnostic criteria for BMS are not defined yet and the relationship with depression and anxiety is debated. We proposed a biopsy-supported approach for the diagnosis. Our study shows that BMS can present with two distinct clinical pictures and that tongue biopsy can contribute to the assessment of the diagnosis. Mood disorders occur frequently and should be considered when approaching patients and treatment options. These observations could help physicians in identifying patients with BMS and addressing them with the appropriate diagnostic work-up and treatment.