Geographic tongue

Published on 18/03/2015 by admin

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Last modified 22/04/2025

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[level-membership-for-dermatology-category]

Geographic tongue

Jennifer K. Chen and Janellen Smith

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

(From Daniels, T.E., 2012. In: Goldman, L., Schafer, A.I. (Eds.), Goldman’s Cecil Medicine, 24th ed. Philadelphia, Saunders, pp. 2449–2454.)

Geographic tongue is a reactive mucosal inflammatory condition characterized by arcuate or annular alternating hypertrophic or atrophic filiform papillae producing a geographic pattern. Synonyms include benign migratory glossitis and glossitis areata migrans. Geographic tongue may be an asymptomatic incidental finding. Similar changes may occur in oral sites other than the tongue (geographic stomatitis or benign migratory stomatitis).

Management strategy

Geographic tongue is a common glossitis that affects 2% of the population. There is no racial predilection and the condition may be seen in patients of all ages, more often children than adults. If asymptomatic, no treatment is necessary other than reassurance that the condition is benign and usually not a sign of systemic illness. Geographic tongue often will remit spontaneously, but may persist for years. Occasionally, patients may complain of a burning discomfort, particularly in atrophic areas. Effective therapy can be challenging.

Geographic tongue has been associated with psoriasis (especially pustular psoriasis), reactive arthritis, pityriasis rubra pilaris, atopic diathesis, Down syndrome, nutritional deficiency, diabetes, hormonal changes, and medications such as lithium, oral contraceptives, and bevacizumab. The clinician should also consider acute or chronic atrophic candidiasis.

For symptomatic patients, measures that may be considered include the avoidance of hot, spicy, or acidic foods; gentle brushing of the tongue; avoidance of harsh antibacterial mouthwashes, chewing gum, and breath mints; and soothing rinses with saline solutions. Occasionally, the topical application of fluorinated corticosteroids or diphenhydramine elixir after meals and at bedtime may be recommended. Topical anesthetic rinses or gels provide temporary relief. Anti-yeast treatments may be palliative.

First-line therapies

image Avoidance of spicy food, mouthwashes, chewing gum, and breath mints D
image Topical corticosteroids (e.g., fluocinonide 0.05% gel, dexamethasone elixir) C
image Topical antihistamines (e.g., diphenhydramine elixir 12.5 mg/5 mL diluted 1 : 4 with water) C
image Anti-yeast therapy E

Second-line therapies

image Topical anesthetics C
image Topical tretinoin E
image Discontinue dentifrices and other oral flavoring agents D
image Topical tacrolimus E

[/level-membership-for-dermatology-category][not-level-membership-for-dermatology-category]

Geographic tongue

Jennifer K. Chen and Janellen Smith

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

(From Daniels, T.E., 2012. In: Goldman, L., Schafer, A.I. (Eds.), Goldman’s Cecil Medicine, 24th ed. Philadelphia, Saunders, pp. 2449–2454.)

Geographic tongue is a reactive mucosal inflammatory condition characterized by arcuate or annular alternating hypertrophic or atrophic filiform papillae producing a geographic pattern. Synonyms include benign migratory glossitis and glossitis areata migrans. Geographic tongue may be an asymptomatic incidental finding. Similar changes may occur in oral sites other than the tongue (geographic stomatitis or benign migratory stomatitis).

Management strategy

Geographic tongue is a common glossitis that affects 2% of the population. There is no racial predilection and the condition may be seen in patients of all ages, more often children than adults. If asymptomatic, no treatment is necessary other than reassurance that the condition is benign and usually not a sign of systemic illness. Geographic tongue often will remit spontaneously, but may persist for years. Occasionally, patients may complain of a burning discomfort, particularly in atrophic areas. Effective therapy can be challenging.

Geographic tongue has been associated with psoriasis (especially pustular psoriasis), reactive arthritis, pityriasis rubra pilaris, atopic diathesis, Down syndrome, nutritional deficiency, diabetes, hormonal changes, and medications such as lithium, oral contraceptives, and bevacizumab. The clinician should also consider acute or chronic atrophic candidiasis.

For symptomatic patients, measures that may be considered include the avoidance of hot, spicy, or acidic foods; gentle brushing of the tongue; avoidance of harsh antibacterial mouthwashes, chewing gum, and breath mints; and soothing rinses with saline solutions. Occasionally, the topical application of fluorinated corticosteroids or diphenhydramine elixir after meals and at bedtime may be recommended. Topical anesthetic rinses or gels provide temporary relief. Anti-yeast treatments may be palliative.