Chapter 40: Geographic Tongue

PATIENT STORY

A 23-year-old male medical student presents to the physician's office complaining of his tongue's "strange appearance." He denies pain or discomfort and is unsure how long the lesions have been present. The lesions seem to change areas of distribution on the tongue. The examination reveals large, well-delineated, shiny and smooth, erythematous spots on the surface of the tongue (Figure 40-1). The diagnosis is geographic tongue (benign migratory glossitis). The physician explains that it is benign and that no treatment is needed unless symptoms develop.

INTRODUCTION

Geographic tongue is a chronic, benign, usually asymptomatic, inflammatory disorder of the mucosa of the dorsum and lateral borders of the tongue. Geographic tongue is characterized by circinate, irregularly shaped erythematous patches bordered by a white keratotic band. The central erythematous patch represents loss of filiform papillae of tongue epithelium. Geographic tongue presents with a migratory pattern.

SYNONYMS

Benign migratory glossitis, geographic stomatitis.

EPIDEMIOLOGY

• Multiple studies have shown a prevalence ranging from 1% to 12.7% in the general population.¹

• Predilection for the second and third decades of life.¹

• No gender bias.¹

• Some studies have shown an increased frequency in patients with anxiety or increased stress, allergies, pustular psoriasis, type 1 diabetes, fissured tongue, or hormonal disturbances.²

ETIOLOGY AND PATHOPHYSIOLOGY

• Geographic tongue is a common oral inflammatory condition of unknown etiology.

• Studies shows that geographic tongue is the oral lesion most commonly associated with psoriasis based on the histologic appearance and the presence of a common genetic marker.^2,3

DIAGNOSIS

CLINICAL FEATURES

• The diagnosis is made by visual inspection and history of the lesion. The lesions are suggestive of a geographic map (hence geographic tongue) with pink continents surrounded by whiter oceans (see Figure 40-1).

• Geographic tongue consists of large, well-delineated, shiny, and smooth, erythematous patches surrounded by a white halo (Figure 40-2).

• Tongue lesions exhibit central erythema because of atrophy of the filiform papillae and are usually surrounded by slightly elevated, curving, white-to-yellow elevated borders (Figures 40-1 and 40-2).

• The condition typically waxes and wanes over time so the lesions appear to be migrating (hence migratory glossitis).

• Lesions may last days, months, or years. The lesions do not scar.

• Most patients are asymptomatic, but some patients may complain of pain or burning, especially when eating spicy foods.

• Suspect systemic intraoral manifestations of psoriasis or reactive ...