Geographic tongue is a benign condition characterized by inflammation of the tongue (glossitis) that appears in a map-like (geographic) pattern. The normal tongue is covered by a layer of small bumps known as papillae. In affected individuals, certain areas of the tongue are missing these bumps. These affected areas usually appear as smooth, red or pink colored, degenerated (atrophic) patches. Geographic tongue tends to come and go - it usually heals without treatment, but will recur again usually affecting a different area of the tongue. Most cases are not associated with any symptoms (asymptomatic) and the condition usually goes away without treatment. Geographic tongue is not associated with any long-term health complications in healthy individuals. The exact cause of geographic tongue is unknown.
In many cases, geographic tongue does not cause symptoms (asymptomatic). Symptoms that have been reported in association with geographic tongue include general discomfort of the tongue or mouth and soreness or a burning sensation of the tongue, which is often worsened by spicy or acidic foods.
The characteristic lesion in geographic tongue is reddish (erythematous), degenerated (atrophic) patch or area on the tongue that is abnormally smooth because of the lack of the small bumps that normally cover the tongue. These patches may have a slightly elevated, yellowish or white border. These patches cover the tongue in an irregular pattern giving the tongue a characteristic map-like appearance. The patches may change in size, shape and location from day to day.
In some cases, pain may occur or the lymph nodes under the lower jaw (submandibular lymph nodes) may become enlarged. In rare cases, pain or discomfort may be persistent.
When these lesions affect areas in the mouth other than the tongue, the condition may be referred to with another name such as erythema migrans or geographic stomatitis. Such sites include the mucous membrane lining the inside of the cheek (buccal mucosa), the floor of the mouth, the roof of the mouth, and the gums (gingiva).
The exact cause of geographic tongue is unknown. The condition often runs in families suggesting that genetics may play a role in the development of the disorder. Geographic tongue is often associated with a fissured tongue, a condition with a strong genetic link further suggesting that heredity plays a significant role in the development of geographic tongue.
A fissured tongue a benign condition that characterized by numerous shallow or deep grooves or furrows (fissures) on the back (dorsal) surface of the tongue. The surface furrows may differ in size and depth, radiate outward, and cause the tongue to have a wrinkled appearance.
In addition to fissured tongue, geographic tongue has been associated with many other conditions especially psoriasis. Psoriasis a chronic, inflammatory skin disease characterized by dry, reddish (erythematous), thickened patches of skin that are covered with silvery-gray scales. These patches may be referred to as papules or plaques and most often affect the scalp, elbows, knees, hands, feet and/or lower back.
Additional conditions with that may occur in conjunction with geographic tongue include allergies, emotional stress, juvenile diabetes, Reiter's syndrome and hormonal disturbances. However, no definitive link has been established between geographic tongue and any of these conditions.
Some reports in the medical literature suggest that geographic tongue affects females slightly more often than males. It appears to occur with greater frequency in young adults. The prevalence of geographic tongue is unknown, but it is estimated to occur in approximately 3 percent of the general population.
Symptoms of the following disorders can be similar to those of geographic tongue. Comparisons may be useful for a differential diagnosis.
A variety of conditions can affect the tongue including infection with a harmless type of yeast (oral candidiasis), burning mouth syndrome, an inflammatory condition characterized, in part, by gray-white spots in the mouth (lichen planus) and oral cancers. Tongue cancer is a general term for two types of cancer - one that affects the portion of the tongue that can protrude from the mouth and one that affects the base of the tongue in the back of mouth. The first form is classified as a mouth (or oral) cancer and the second form is classified as an oropharyngeal cancer. Oropharyngeal cancer refers to cancer that occurs in area of the throat near the back of the mouth. Geographic tongue is not related to oral cancers and is not a premalignant condition. (For more information on these disorders, choose the specific disorder name as your search term in the Rare Disease Database.)
Diagnosis A diagnosis of geographic tongue is made based upon a thorough clinical evaluation, a detailed patient history and the characteristic appearance of the tongue lesions associated with this disorder. In most cases, surgical removal and microscopic study (biopsy) of affected tissue is not necessary because of the distinct appearance of the tongue.
Treatment Medical treatment is not required for this benign disorder. Some physicians advise patients to avoid irritants and substances that may sensitize the tongue. A bland or liquid diet, preferably cooled, is perhaps better. Meticulous oral hygiene is important, but care should be taken to preserve proper bacterial balance within the mouth
If pain or discomfort is persistent, some physicians may recommend anti-inflammatory drugs or painkillers that are applied directly to the affected areas (topical analgesics).
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
JOURNAL ARTICLES Abe M, Sogabe Y, Syuto T, et al. Successful treatment with cyclosporine administration for persistent benign migratory glossitis. J Dermatol. 2007;34:340-343.
Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis. 2006;12:381-386.
Pass B, Brown RS, Childers EL. Geographic tongue: literature review and case reports. Dent Today. 2005;24:56-57.
Femiano F. Geographic tongue (migrant glossitis) and psoriasis. Minerva Stomatol. 2001;50:213-217.
Flaitz CM. Ectopic erythema migrans in an adolescent with a skin disorder. Pediatr Dent. 2000;22:63-64.
FROM THE INTENET Kelsch R. Geographic Tongue. Emedicine Journal, January 24 2007. Available at: http://www.emedicine.com/derm/topic664.htm Accessed on: December 12, 2007.
Mayo Clinic for Medical Education and Research. Geographic Tongue. October 20, 2006. Available at: http://www.mayoclinic.com/health/geographic-tongue/DS00819 Accessed On: December 12, 2007.
Smell and Taste Center University of Pennsylvania 5 Ravdin Building 3400 Spruce Street Philadelphia, PA 19104 Tel: (215)662-6580 Fax: (215)349-5266 Email: helene.katz@uphs.upenn.edu Internet: http://www.med.upenn.edu/stc
NIH/National Oral Health Information Clearinghouse 1 NOHIC Way Bethesda, MD 20892-3500 USA Tel: (301)402-7364 Fax: (301)907-8830 TDD: (301)656-7581 Email: nohic@nidcr.nih.gov Internet: http://www.nohic.nidcr.nih.gov
MUMS (Mothers United for Moral Support, Inc) National Parent-to-Parent Network 150 Custer Court Green Bay, WI 54301-1243 USA Tel: (920)336-5333 Fax: (920)339-0995 Tel: (877)336-5333 Email: mums@netnet.net Internet: http://www.netnet.net/mums/
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