Geographic Tongue Clinical Presentation

  • Author: Robert D Kelsch, DMD; Chief Editor: William D James, MD   more...
 
Updated: Apr 16, 2012
 

History

Patients with geographic tongue may present with a burning sensation or an irritation of the tongue noted with hot or spicy foods. Patients may report that the discomfort waxes and wanes over time, and they routinely describe that the lesions affect different areas of the tongue at different times. Patients are occasionally concerned about the diagnosis of oral cancer, which prompts them to be evaluated, despite reporting that they have noted these lesions over many years.

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Physical

The tongue exhibits a well-demarcated area of erythema, primarily affecting the dorsum, and often extending to involve the lateral borders of the tongue. Within the area of erythema, the normal tongue architecture is effaced, with loss of the filiform papillae and atrophy of the overlying mucosa. Surrounding this area of erythema is a well-defined, hyperkeratotic, yellow-white border with an irregular serpiginous outline. Similar lesions may be present concurrently on other aspects of the tongue or other mucosal sites, including the floor of the mouth and cheek the mucosa.[14]

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Causes

A definitive cause has not been elucidated, but lesions are seen with increased frequency in patients with psoriasis. In a study of patients with psoriasis, geographic tongue occurred in 10% of the patients, in contrast to only 2.5% of age- and sex-matched controls.[15] A polygenic mode of inheritance has been suggested for geographic tongue.[16] No increased incidence of geographic tongue has been noted with medication use or environmental agents.

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Contributor Information and Disclosures
Author

Robert D Kelsch, DMD  Attending, Department of Dental Medicine, Division of Oral Pathology, NSLIJ Health System, Long Island Jewish Medical Center

Robert D Kelsch, DMD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Abdul-Ghani Kibbi, MD  Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  2. Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent. Mar 2005;15(2):89-97. [Medline].

  3. Cambiaghi S, Colonna C, Cavalli R. Geographic tongue in two children with nonpustular psoriasis. Pediatr Dermatol. Jan-Feb 2005;22(1):83-5. [Medline].

  4. Zargari O. The prevalence and significance of fissured tongue and geographical tongue in psoriatic patients. Clin Exp Dermatol. Mar 2006;31(2):192-5. [Medline].

  5. Zhu JF, Kaminski MJ, Pulitzer DR, Hu J, Thomas HF. Psoriasis: pathophysiology and oral manifestations. Oral Dis. Jun 1996;2(2):135-44. [Medline].

  6. Costa SC, Hirota SK, Takahashi MD, Andrade H Jr, Migliari DA. Oral lesions in 166 patients with cutaneous psoriasis: a controlled study. Med Oral Patol Oral Cir Bucal. Aug 1 2009;14(8):e371-5. [Medline].

  7. Hernandez-Perez F, Jaimes-Aveldanez A, Urquizo-Ruvalcaba Mde L, et al. Prevalence of oral lesions in patients with psoriasis. Med Oral Patol Oral Cir Bucal. Nov 1 2008;13(11):E703-8. [Medline].

  8. Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis. Jul 2006;12(4):381-6. [Medline].

  9. Yarom N, Cantony U, Gorsky M. Prevalence of fissured tongue, geographic tongue and median rhomboid glossitis among Israeli adults of different ethnic origins. Dermatology. 2004;209(2):88-94. [Medline].

  10. Dar-Odeh NS, Hayajneh WA, Abu-Hammad OA, et al. Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature. BMC Res Notes. Feb 17 2010;3(1):37. [Medline].

  11. Gonzaga HF, Torres EA, Alchorne MM, Gerbase-Delima M. Both psoriasis and benign migratory glossitis are associated with HLA-Cw6. Br J Dermatol. Sep 1996;135(3):368-70. [Medline].

  12. Fenerli A, Papanicolaou S, Papanicolaou M, Laskaris G. Histocompatibility antigens and geographic tongue. Oral Surg Oral Med Oral Pathol. Oct 1993;76(4):476-9. [Medline].

  13. Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract. Feb 15 2005;6(1):123-35. [Medline].

  14. Borrie F, Musthyala R, Macintyre D. Ectopic geographic tongue--a case report. Dent Update. Mar 2007;34(2):121-2. [Medline].

  15. Morris LF, Phillips CM, Binnie WH, Sander HM, Silverman AK, Menter MA. Oral lesions in patients with psoriasis: a controlled study. Cutis. May 1992;49(5):339-44. [Medline].

  16. Eidelman E, Chosack A, Cohen T. Scrotal tongue and geographic tongue: polygenic and associated traits. Oral Surg Oral Med Oral Pathol. Nov 1976;42(5):591-6. [Medline].

  17. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. Am J Med. Dec 15 2002;113(9):751-5. [Medline].

  18. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. Mar 1 2010;81(5):627-34. [Medline].

  19. Abe M, Sogabe Y, Syuto T, Ishibuchi H, Yokoyama Y, Ishikawa O. Successful treatment with cyclosporin administration for persistent benign migratory glossitis. J Dermatol. May 2007;34(5):340-3. [Medline].

  20. Sigal MJ, Mock D. Symptomatic benign migratory glossitis: report of two cases and literature review. Pediatr Dent. Nov-Dec 1992;14(6):392-6. [Medline].

 
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