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Geographic Tongue THE CLINICAL PICTURE CEENA NEENA JACOB, MD TENY MATHEW JOHN, MD, DNB JAYAPRAKASH R., MD Department of Dermatology, Government Department of Internal Medicine, Professor and Head, Department of Medical College, Kottayam, Kerala, India Cleveland Clinic General Medicine, Travancore Medical College, Kollam, Kerala, India Geographic tongue previously healthy 35-year-old woman pre- A sented with reddish discoloration of her tongue for the past 7 days, accompanied by mild soreness over the area when eating spicy foods. The lesion had also changed shape repeatedly. She denied any other local or systemic symptoms. Lingual examination showed clearly delineated ar- eas of shiny, erythematous mucosa on the dorsal and lateral aspects of the tongue, surrounded by white bor- ders (Figure 1). Examination of the throat and oral cavity were unremarkable. All other systemic exami- nations were normal. Laboratory testing showed a nor- mal hemogram, blood glucose, and metabolic profi le. These fi ndings were suggestive of geographic tongue, a benign, self-limiting infl ammation. The pa- tient was reassured of the benign nature of the condi- tion and was advised to avoid spicy food until resolu- tion of the lesion. A follow-up examination 1 month later showed complete healing of the lesion. ■ A COMMON, BENIGN, SELF-LIMITING MUCOSAL CONDITION Geographic tongue—also known as benign migratory glossitis and lingual erythema migrans—is commonly seen in daily practice, with a prevalence of 2% to 3% in the general population.1 In the United States, the condition is more prevalent in whites and blacks than FIGURE 1. Well-demarcated, maplike areas of in Hispanics, but has no association with age or sex. erythematous lingual mucosa with white borders, This condition is characterized by circinate, map- resembling islands of an archipelago. like areas of erythema surrounded by well-demarcated scalloped white borders, typically on the dorsum and 2 ■ POSTULATED TO BE AN INTRAORAL FORM the lateral borders of the tongue. The appearance, OF PSORIASIS which represents loss of fi liform papillae (depapil- lation) from the lingual mucosa, can change in size, The precise etiology remains obscure.2 Histopathologi- shape, or location in a matter of minutes or hours. The cally, geographic tongue is characterized by hyperpara- name “lingual erythema migrans” refl ects the changing keratosis and acanthosis resembling psoriasis. Hence, it clinical picture.3 Rarely, the labial or palatal mucosa is has been postulated that it represents a form of intra- affected. oral psoriasis.2,4 The condition is also associated with allergy, stress, diabetes mellitus, and anemia. Triggers include hot, spicy, and acidic foods and alcohol. Con- trary to previous belief, geographic tongue has been doi:10.3949/ccjm.83a.14011 found to have an inverse association with smoking.5 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 83 • NUMBER 8 AUGUST 2016 565 Downloaded from www.ccjm.org on September 27, 2021. For personal use only. All other uses require permission. GEOGRAPHIC TONGUE Although striking, the lesion rarely warrants the changing pattern of the lesions over time. further investigation. Also, candidal pseudomembranes can be eas- ily removed, leaving a painless red base. Eval- ■ REASSURANCE IS THE MAIN TREATMENT uations to rule out anemia, nutritional defi - Geographic tongue has a remitting and re- ciencies, and diabetes mellitus can be done lapsing course with no complications or per- if these conditions are suspected, as they are manent sequelae.3 The differential diagnosis associated with geographic tongue. includes oral candidiasis, leukoplakia, vitamin Reassurance is the main treatment. Topi- defi ciency glossitis, lichen planus, systemic cal corticosteroids and local anesthetics may lupus erythematosus, drug reaction, and re- provide symptomatic relief in mild forms of the current aphthous stomatitis. The condition is disease. Topical tacrolimus and systemic cyclo- differentiated from oral candidiasis by its pres- sporine have been reported as useful in severe ence in an otherwise healthy person and by cases.6 ■ ■ REFERENCES tongue and geographical tongue in psoriatic patients. 1. Masferrer E, Jucgla A. Images in clinical medicine. Geo- Clin Exp Dermatol 2006; 31:192–195. 5. Shulman JD, Carpenter WM. Prevalence and risk factors graphic tongue. N Engl J Med 2009; 361:e44. associated with geographic tongue among US adults. 2. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Oral Dis 2006; 12:381–386. Benign migratory glossitis or geographic tongue: an 6. Ishibashi M, Tojo G, Watanabe M, Tamabuchi T, Masu T, enigmatic oral lesion. Am J Med 2002; 113:751–755. Aiba S. Geographic tongue treated with topical tacroli- 3. Scully C, Hegarty A. The oral cavity and lips. In: Burns T, mus. J Dermatol Case Rep 2010; 4:57–59. Breathnach S, Cox N, Griffi ths C, editors. Rook's Textbook of Dermatology. 8th ed. West Sussex, UK: Wiley-Black- ADDRESS: Teny Mathew John, MD, DNB, Department of well; 2010:69–100. Medicine, Government Medical College, Gandhinagar P O, 4. Zargari O. The prevalence and signifi cance of fi ssured Kottayam, Kerala, 686008 India; [email protected] 566 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 83 • NUMBER 8 AUGUST 2016 Downloaded from www.ccjm.org on September 27, 2021. For personal use only. All other uses require permission..
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