You are in: eMedicine Specialties > Dermatology > DISEASES OF THE ORAL MUCOSA Geographic TongueArticle Last Updated: Jan 24, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 9
  Author: Robert Kelsch, DMD, Clinical Assistant Professor, Department of Oral Biology and Pathology, State University of New York-Stony Brook; Consulting Staff, Department of Dental Medicine, Division of Oral Pathology, Long Island Jewish Medical Center Robert Kelsch is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and American Dental Association Editors: Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System Author and Editor Disclosure Synonyms and related keywords: 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 INTRODUCTIONSection 2 of 9
  BackgroundGeographic 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 are still poorly understood. The condition affects males and females and is noted to be more prominent in adults than in children. The classic manifestation 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 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. PathophysiologyThe most commonly affected site is the tongue; however, other oral mucosal soft tissue sites may be affected. It has been reported with increased frequency in patients with psoriasis and in patients with fissured tongue. Although this 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. FrequencyUnited StatesThis condition has reportedly occurred in up to 3% of the general population in the United States. InternationalInternational frequency rates are similar to those reported in the United States. Mortality/MorbidityGeographic tongue is a benign condition. RaceNo racial or ethnic predilection is reported for this condition. SexFemales have been reported to be affected twice as often as males. Exacerbations have been suggested to be related to hormonal factors. AgeGeographic tongue can affect all age groups; however, it is more predominant in adults than in children. CLINICALSection 3 of 9
History
Physical
Causes
DIFFERENTIALSSection 4 of 9
Burns, Chemical Cancers of the Oral Mucosa Candidiasis, Mucosal Contact Stomatitis Fissured Tongue Lichen Planus Psoriasis, Plaque WORKUPSection 5 of 9
Procedures
Histologic FindingsGeographic tongue is described as a psoriasiform mucositis. 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 (Munro abscesses) is seen. The predominant inflammatory infiltrate in the lamina propria is neutrophils with an admixture of chronic inflammatory cells. TREATMENTSection 6 of 9
Medical CareNo medical intervention is required because the lesion is benign and most often asymptomatic. ConsultationsConsultation with an oral pathologist is indicated if a question exists about the diagnosis. FOLLOW-UPSection 7 of 9
Prognosis
Patient Education
MISCELLANEOUSSection 8 of 9
Medical/Legal Pitfalls
REFERENCESSection 9 of 9
Article Last Updated: Jan 24, 2007 |
