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Therapeutics in Dermatology
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Geographic tongue

10 May 2012, by RENAUD-VILMER C.

1 - GENERAL POINTS

Geographic tongue is a benign, inflammatory condition of the lingual mucosa. The condition was initially described by Rayer in 1831. It is also called glossitis areata migrans, but currently, the term benign migratory glossitis is the preferred term. Its prevalence in the general population is 1 to 2.5%, it affects persons of all ages but it is essentially reported in children with a frequency of 4.3 to 14% of children examined [1, 2, 6]. Local loss of filiform papillae leads to small erythematous lesions surrounded by whitish margins, demarcating the normal mucosa and forming a “geographic map” whose shape may change from day to day, hence the use of the term migratory in the name (Figure 1). The condition is diagnosed on clinical examination. Lesions may also occur in other places and in such cases the condition is referred to as benign migratory stomatitis [1]. Classifying the condition into four types (according to the extent of the lesions) as suggested by Hume is of no therapeutic or diagnostic relevance. While the condition is mostly asymptomatic, patients may note a metallic taste or a burning or stinging sensation after eating certain foods, with no specific significance.

The development of geographic tongue is chronic and unpredictable. Lesions form and resolve spontaneously over several weeks to several months. Remission may last several years.

It is not known what causes the condition. A positive family history suggests the possible implication of genetic factors. Some clinical and histological investigations indicate that geographic tongue might be an oral manifestation of psoriasis, particularly pustular psoriasis [5, 7]. However, geographic tongue has been associated with other conditions, particularly atopic dermatitis. In close to 50% of cases, geographic tongue is associated with fissured tongue, which is also often associated with psoriasis [4, 7].

Histological examination reveals epithelial atrophy in the central erythematous area of the lesion due to loss of filiform papillae, and peripheral epithelial acanthosis with spongiform pustules.

Geographic tongue must be differentiated from oral hairy leukoplakia when the lesions are localised on the lateral borders of the tongue and migrate slowly; in cases of doubt, patients must be screened for underlying HIV infection and diagnosis must be confirmed histologically.

The differential diagnosis includes chronic hyperplastic candidiasis, Reiter’s syndrome, which may be identified by its associated skin-genital lesions, and lichen planus or lupus erythematosus. In the absence of associated skin lesions, a histological examination will enable geographic tongue to be differentiated from the latter two conditions. The eruptive familial lingual papillitis essentially occurs in young children. Lesions are observed on the lateral borders of the tongue (hypertrophy of the fungiform papilla), but it can be diagnosed clinically by its sudden onset, the fact that it affects other members of the same family and the rapid and spontaneous regression (8 to 10 days).

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