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Photo Essay

An Atlas of Lingual Lesions, Part 3

Volume 59 - Issue 7 - July 2019

  • Geographic Tongue

    Geographic tongue, also known as benign migratory glossitis, is an inflammatory disorder of the mucosa of the tongue.1,2 The condition is characterized by a maplike distribution of one or more irregular bright red patches on the dorsum of the tongue due to the absence of filiform papillae.3,4 The lesion is usually surrounded by a slightly elevated, pale-yellow to white, circinate linear border.2

    The estimated prevalence ranges from 1% to 2.5% in the general population.1,2,5 The condition occurs more commonly in children (Figure 1) but may also occur in adults (Figure 2).1,2,5 While some studies have shown a female to male ratio of 1.5 to 2:1,1,5 other studies have reported similar rates by sex.6

    Fig 1
    Figure 1

    Fig 2
    Figure 2

    The exact etiology is not known and most cases are idiopathic.1 There is a genetic predisposition to the condition.6 Several conditions associated with geographic tongue have been reported, including allergy, fissured tongue, psoriasis, type 1 diabetes mellitus, seborrheic dermatitis, hormonal disturbances, pregnancy, use of oral contraceptives, anxiety, emotional stress, alcoholism, Crohn disease, Down syndrome, Aarskog syndrome, and Reiter syndrome.1,3,6,7

    Clinically, geographic tongue presents on the dorsum of the tongue as multifocal, circinate or irregular, smooth, well-demarcated, erythematous patches that represent atrophy or loss of filiform papillae and a thinning of the epithelium.1,4 Typically, the erythematous patch is surrounded by a serpiginous, slightly raised, white or pale-yellow, hyperkeratotic border (Figures 1 and 2).1,2,4 The white border is composed of regenerating filiform papillae and a mixture of keratin and neutrophil aggregates within the epithelium.6 These lesions tend to change in shape, size, and location over time, giving the tongue a variegated appearance. They heal spontaneously but reappear at another site, thereby accounting for the name “migratory.”2,4

    The condition is usually asymptomatic and is often discovered during routine oral examination.1,4 Affected individuals may experience discomfort, pain, stinging, or a burning sensation with hot, spicy, or acidic foods.4,8 The symptomatic areas tend to occur in the atrophic patches.

    Typically, the lesions affect primarily the dorsal surface of the tongue.2,4 Similar lesions have been described in other areas of the oral mucosa, and these have been referred to as geographic stomatitis.2 In rare cases, lesions may involve the ventral surface of the tongue.8

    The diagnosis is mainly clinical based on the history of a migrating pattern and the characteristic clinical appearance. No laboratory test is necessary.

    The condition is benign and self-limiting. No treatment is required apart from reassurance.2-4 Typically, the lesion resolves spontaneously without sequelae but tends to recur.

    REFERENCES:

    1. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. Am J Med. 2002;​113(9):751-755.
    2. Leung AKC. Red patches on a 10-year-old’s tongue. Consultant Pediatricians. 2013;12(8):362-364.
    3. González-Álvarez L, García-Pola MJ, Garcia-Martin JM. Geographic tongue: predisposing factors, diagnosis and treatment. A systematic review. Rev Clin Esp. 2018;218(9):481-488.
    4. Leung AKC. Geographical tongue. In: Leung AKC, ed. Common Problems in Ambulatory Pediatrics: Specific Clinical Problems. Vol 2. New York, NY: Nova Science Publishers; 2011:121-124.
    5. Nandini DB, Bhavana SB, Deepak BS, Ashwini R. Paediatric geographic tongue: a case report, review and recent updates. J Clin Diagn Res. 2016;​10(2):ZE05-ZE09.
    6. Khan S, Mujahid TA, Ishaq M, Bukhari SAR, Saeed I. Benign migratory glossitis. J Coll Physicians Surg Pak. 2018;28(2):175-176.
    7. Zadik Y, Drucker S, Pallmon S. Migratory stomatitis (ectopic geographic tongue) on the floor of the mouth. J Am Acad Dermatol. 2011;65(2):459-460.
    8. Menni S, Boccardi D, Crosti C. Painful geographic tongue (benign migratory glossitis) in a child. J Eur Acad Dermatol Venereol. 2004;18(6):737-738.

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