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Tuesday, March 11, 2014
Shingles of the Tongue
I have recently been diagnosed with shingles of the tongue. I am taking a course of aciclovir and regular diclofenac and paracetamol, but I am still really struggling with the pain and burning sensation of my tongue. Is there anything else that I can take that will help with the pain?
I am first wondering how the diagnosis of tongue shingles was established. Were tongue sores or ulcers observed and were they limited to one side of the tongue? Was a smear or a biopsy taken from these sores or ulcers and subsequently examined under a microscope?
If a biopsy was taken, was a special test called immunohistochemistry used to confirm the presence of varicella zoster virus (VZV, the virus that causes chickenpox as well as shingles)?
These questions are relevant because while shingles (recurrent VZV) can occur in the mouth, it often affects all branches of the infected nerve, which in the case of the surface of the tongue would be the trigeminal nerve (cranial nerve V).
Assuming the trigeminal nerve is involved, the skin overlying the lower jaw and extending to the lower lip on the same side as the tongue sores is quite often (but not always) also affected with sores that closely resemble chicken pox.
A correct diagnosis is very important for you, because the antiviral drug you are taking (acyclovir) will only help if you truly have a recurrent VZV infection limited to the tongue. If the diagnosis has been confirmed, you may ask your doctor about alternative medications for pain since each patient responds uniquely to the multitude of pain medicines available.
If however the diagnosis of shingles is only based upon pain or burning sensations, then I would be more inclined to consider the diagnosis of burning mouth syndrome. You can find additional information about this annoying, but not life-threatening condition at the links below.
John R Kalmar, DMD, PhD
Clinical Professor of Pathology
Associate Dean of Dentistry Administration
College of Dentistry
The Ohio State University