eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa
Geographic Tongue
Updated: Oct 6, 2009
Introduction
Background
Geographic tongue (benign migratory glossitis) is a benign condition that occurs in up to 3% of the general population. Most often, patients are asymptomatic; however, some patients report increased sensitivity to hot and spicy foods. The etiology and pathogenesis of geographic tongue are still poorly understood. Geographic tongue affects males and females and is noted to be more prominent in adults than in children.1,2
The classic manifestation of geographic tongue is an area of erythema, with atrophy of the filiform papillae of the tongue, surrounded by a serpiginous, white, hyperkeratotic border. The patient often reports spontaneous resolution of the lesion in one area, with the return of normal tongue architecture, only to have another lesion appear in a different location of the tongue. Lesion activity in geographic tongue may wax and wane over time, and patients are occasionally free of lesions. If lesions occur at other mucosal sites, the condition is termed erythema migrans.
Pathophysiology
The most commonly affected site is the tongue; however, other oral mucosal soft tissue sites may be affected. Geographic tongue has been reported with increased frequency in patients with psoriasis3,4,5,6,7 and in patients with fissured tongue.8,9 Although geographic tongue is an inflammatory condition histologically, a polygenic mode of inheritance has been suggested because it is seen clustering in families. Associations with human leukocyte antigen (HLA)–DR5, HLA-DRW6, and HLA-Cw6 have also been reported.10,11
Frequency
United States
Geographic tongue has reportedly occurred in up to 3% of the general population in the United States.
International
International frequency rates for geographic tongue are similar to those reported in the United States.
Mortality/Morbidity
Geographic tongue is a benign condition.
Race
No racial or ethnic predilection is reported for geographic tongue.
Sex
Females have been reported to be affected twice as often as males.12 Exacerbations have been suggested to be related to hormonal factors.
Age
Geographic tongue can affect all age groups; however, it is more predominant in adults than in children.
Clinical
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.
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.13
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.14
- A polygenic mode of inheritance has been suggested for geographic tongue.15
- No increased incidence of geographic tongue has been noted with medication use or environmental agents.
Differential Diagnoses
| Burns, Chemical | Lichen Planus |
| Cancers of the Oral Mucosa | Psoriasis, Plaque |
| Candidiasis, Mucosal | |
| Contact Stomatitis | |
| Fissured Tongue |
Workup
Procedures
A biopsy is not usually necessary, given the characteristic clinical presentation of geographic tongue.
Histologic Findings
Geographic tongue is described as a psoriasiform mucositis.16 At the periphery, elongation of the rete ridges is noted with associated hyperparakeratosis and acanthosis. Toward the center of the lesion, corresponding to the erythematous area clinically, loss of filiform papillae with migration and clustering of neutrophils within the epithelium (spongiform pustule) is seen. The predominant inflammatory infiltrate in the lamina propria is neutrophils with an admixture of chronic inflammatory cells.
Treatment
Medical Care
No medical intervention is required because the lesion is benign and most often asymptomatic. However, Abe et al report successful treatment with cyclosporin,17 and Sigal and Mock reported treatment with topical and systemic antihistamines.18
Consultations
Consultation with an oral pathologist is indicated if a question exists about the diagnosis.
Follow-up
Prognosis
Geographic tongue is a benign condition.
Patient Education
Defining geographic tongue, describing its clinical appearance, and reinforcing its benign nature is usually all that is needed to educate patients and allay any concerns they may have about geographic tongue.
Miscellaneous
Medicolegal Pitfalls
Because geographic tongue is a benign condition and diagnosed on its characteristic clinical appearance, medicolegal issues are not an issue.
References
Kleinman DV, Swango PA, Pindborg JJ. Epidemiology of oral mucosal lesions in United States schoolchildren: 1986-87. Community Dent Oral Epidemiol. Aug 1994;22(4):243-53. [Medline].
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].
Cambiaghi S, Colonna C, Cavalli R. Geographic tongue in two children with nonpustular psoriasis. Pediatr Dermatol. Jan-Feb 2005;22(1):83-5. [Medline].
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].
Zhu JF, Kaminski MJ, Pulitzer DR, Hu J, Thomas HF. Psoriasis: pathophysiology and oral manifestations. Oral Dis. Jun 1996;2(2):135-44. [Medline].
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].
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].
Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis. Jul 2006;12(4):381-6. [Medline].
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].
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].
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].
Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract. Feb 15 2005;6(1):123-35. [Medline].
Borrie F, Musthyala R, Macintyre D. Ectopic geographic tongue--a case report. Dent Update. Mar 2007;34(2):121-2. [Medline].
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].
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].
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].
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].
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].
Keywords
geographic tongue, benign migratory glossitis, erythema migrans, stomatitis areata migrans, erythema areata migrans, increased sensitivity to hot foods, increased sensitivity to spicy foods, psoriasis, fissured tongue, burning sensation of tongue with hot foods, burning sensation of tongue with spicy foods, irritation of tongue with hot foods, irritation of tongue with spicy foods, loss of filiform papillae
Contributor Information and Disclosures
Author
Robert D Kelsch, DMD, Consulting Staff, Department of Dental Medicine, Division of Oral Pathology, 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.
Medical Editor
Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon
Disclosure: none None None
Pharmacy Editor
Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.
Managing Editor
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.
CME Editor
Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.
Chief Editor
Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.