Geographic tongue

Geographic tongue is an inflammatory but harmless condition affecting the surface of your tongue. The tongue is normally covered with tiny, pinkish-white bumps (papillae), which are actually short, fine, hairlike projections. With geographic tongue, patches on the surface of the tongue are missing papillae and appear as smooth, red "islands," often with slightly raised borders.

These patches (lesions) give the tongue a maplike, or geographic, appearance. The lesions often heal in one area and then move (migrate) to a different part of your tongue. Geographic tongue is also known as benign migratory glossitis.

Although geographic tongue may look alarming, it doesn't cause health problems and isn't associated with infection or cancer. Geographic tongue can sometimes cause tongue discomfort and increased sensitivity to certain substances, such as spices, salt and even sweets.

signs and symptoms

Signs and symptoms of geographic tongue may include:

Smooth, red, irregularly shaped patches (lesions) on the top or side of your tongue
Frequent changes in the location, size and shape of lesions
Discomfort, pain or burning sensation in some cases, most often related to eating spicy or acidic foods

Many people with geographic tongue have no symptoms.

Geographic tongue can continue for days, months or years. The problem often resolves on its own but may appear again at a later time.

In health, the dorsal surface of the tongue is covered in tuft-like projections called lingual papillae (some of which are associated with taste buds), which give the tongue an irregular surface texture and a white-pink color. Geographic tongue is characterized by areas of atrophy and depapillation (loss of papillae), leaving an erythematous (darker red) and smoother surface than the unaffected areas. The depapillated areas are usually well-demarcated , and bordered by a slightly raised, white, yellow or grey, serpiginous (snaking) peripheral zone. A lesion of geographic tongue may start as a white patch before the depapillation occurs. In certain cases there may be only one lesion, but this is uncommon; the lesions will typically occur in multiple locations on the tongue and coalesce over time to form the typical map-like appearance. The lesions usually change in shape and size, and migrate to other areas, sometimes within hours. The condition may affect only part of the tongue, with a predilection for the tip and the sides of the tongue, or the entire dorsal surface at any one time. The condition goes through periods of remission and relapse. Loss of the white peripheral zone is thought to signify periods of mucosal healing.

There are usually no symptoms other than the unusual appearance of the tongue, but in some cases persons may experience pain or burning, e.g. when eating hot, acidic, spicy or other kinds of foods (e.g. cheese, tomatoes, fruit).
Where there is a burning symptom, other causes of a burning sensation on the tongue are considered, such as oral candidiasis.

Causes

The cause of geographic tongue is unknown, and there's no way to prevent the condition. There may be a link between geographic tongue and psoriasis and between geographic tongue and lichen planus.

The cause is unknown . Geographic tongue does not usually cause any symptoms, and in those cases where there are symptoms, an oral parafunctional habit may be a contributory factor. Persons with parafunctional habits related to the tongue may show scalloping on the sides of the tongue (crenated tongue). Some suggest that hormonal factors may be involved, because one reported case in a female appeared to vary in severity in correlation with oral contraceptive use. People with geographic tongue frequently claim that their condition worsens during periods of psychologic stress. Geographic tongue is inversely associated with smoking and tobacco use Sometimes geographic tongue is said to run in families, and it is reported to be associated with several different genes . Vitamin B2 deficiency (ariboflavinosis) can cause several signs in the mouth, possibly including geographic tongue, although other sources state that geographic tongue is not related to nutritional deficiency. Fissured tongue often occurs simultaneously with geographic tongue, and some consider fissured tongue to be an end stage of geographic tongue.

In the past, some research suggested that geographic tongue was associated with diabetes, seborrheic dermatitis and atopy, however newer research does not corroborate these findings. Others suggest allergy as a major factor, e.g. to nickel sulphate. Some studies have reported a link between geographic tongue and psoriasis . although 90% of children who are diagnosed with geographic tongue do not develop psoriasis. Again however, modern research studies do not support any link between psoriasis and geographic tongue. Lesions that are histologically indistinguishable from geographic tongue may also be diagnosed in reactive arthritis (arthritis, uveitis/conjunctivitis and urethritis)

The differential diagnosis includes oral lichen planus, erythematous candidiasis, leukoplakia, lupus erythematosus, glossitis, and chemical burns. Atrophic glossitis is usually distinguished from benign migratory glossitis on the basis of the migrating pattern of the lesions and the presence of a whitish border, features which are not present in atrophic glossitis, which instead shows lesions which enlarge rather than migrate. Rarely, blood tests may be required to distinguish from glossitis associated with anemia or other nutritional deficiencies. Since the appearance and the history of the condition (i.e. migrating areas of depapillation) are so striking, there is rarely any need for biopsy. When biopsy is taken, the histopathologic appearance is quite similar to psoriasis:

psoriasis .

When to see a doctor

Geographic tongue is a minor — although sometimes uncomfortable — condition. However, lesions on the tongue may indicate other more-serious conditions of the tongue or diseases affecting the body in general. If you have lesions on the tongue that don't resolve within 10 days, see your doctor or dentist.

Risk factors

Studies of factors that may be associated with an increased risk of geographic tongue have produced mixed results. Factors that are likely associated with an increased risk include:

Family history. Some people with geographic tongue have a family history of the disorder, so inherited genetic factors may increase risk.
Fissured tongue. People with geographic tongue often have another disorder called fissured tongue, which has the appearance of deep grooves (fissures) on the surface of the tongue.

Complications

Geographic tongue is a benign condition. It doesn't pose a threat to your health, cause long-term complications or increase your risk of major health problems.

However, anxiety about the condition is fairly common because:

The appearance of the tongue may be embarrassing, depending on how visible the lesions are
It may be difficult to be reassured that there is, in fact, nothing seriously wrong

Treatment

Since most cases cause no symptoms, reassuring the person affected that the condition is entirely benign is usually the only treatment.

When symptoms are present, topical anesthetics can be used to provide temporary relief. Other medications that have been used to manage the symptoms include antihistamines, corticosteroids or anxiolytics, but these drugs have not been formally assessed for efficacy in geographic tongue. If some foods exacerbate or trigger the symptoms, then cutting these foods out of the diet may benefit. One uncontrolled trial has shown some benefit in controlling the symptoms of geographic tongue.

Geographic tongue