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Clinical Image
Geographic tongue: A tongue that changes appearance
1 Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan
2 Department of Oral Pathological Science and Surgery, Tokyo Dental College, Tokyo, Japan
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Takeshi Onda
DDS, PhD, Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18, Kanda-Misakicho, Chiyoda-ku, Tokyo 101-0061,
Japan
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Article ID: 101344Z01TO2022
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Onda T, Hayashi K, Katakura A, Takano M. Geographic tongue: A tongue that changes appearance. Int J Case Rep Images 2022;13(2):134–136.ABSTRACT
No Abstract
Keywords: Erythema migrans, Geographic tongue, Migratory glossitis
Case Report
A 66-year-old female presented with a chief complaint of glossal erythema with daily changes in position and shape (Figure 1A and Figure 1B). She was anxious about the possibility of malignancy. Upon periodically self-inspecting her tongue using a mirror for one year, the patient noted gradually enlarging erythematous macules that fused to form larger patches and that moved from one area of the tongue to another. There was no noted pain or dysgeusia, and the patient had an unremarkable medical history. Based on its pathognomonic history and clinical features, the condition was diagnosed as geographic tongue. The patient was reassured that the lesion was benign. It improved after four weeks of proper dental hygiene with a toothbrush and tongue scraper.
Discussion
Geographic tongue is also referred to as benign migratory glossitis, erythema migrans, annulus migrans, and wandering tongue rash [1]. Geographic tongue is characterized by the loss of the filiform papillae, resulting in erythematous sections of the tongue [2]. Typically located at the border between the dorsal and the lateral edges of the tongue, these erythematous patches are surrounded by well-defined white borders and resemble a map. Geographic tongue is present in 1–2.5% of the general population and is slightly more common in females [1]. While the specific cause has not been determined, genetics, constitutional abnormalities, vitamin deficiencies, and mental or endocrine disorders may play a role in its pathogenesis [3]. This disease has also been reported in patients with psoriasis; some studies have even referred to geographic tongue as psoriasis of the oral cavity [4]. Since the signs and symptoms of geographic tongue are pathognomonic, a biopsy is not necessary [5]. If asymptomatic, geographic tongue does not require treatment. External corticosteroids, antihistamines, cyclosporine, vitamin A, zinc, acetaminophen, and external tacrolimus are reportedly effective treatment modalities for symptomatic lesions [1],[4].
Conclusion
Typically, geographic tongue is asymptomatic and does not require treatment. In addition, its characteristic history is sufficient to establish a diagnosis; a biopsy is not needed. It is important to reassure the patient that the condition is benign. If pain or discomfort develops due to inflammation, palliative treatments can be considered. Avoiding irritants and maintaining good oral hygiene are recommended to avoid the exacerbation of symptoms.
REFERENCES
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Shareef S, Ettefagh L. Geographic Tongue. 2021 Aug 3. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
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Ogueta CI, Ramírez PM, Jiménez OC, Cifuentes MM. Geographic tongue: What a dermatologist should know. Actas Dermosifiliogr (Engl Ed) 2019;110(5):341–6. [CrossRef]
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Khayamzadeh M, Najafi S, Sadrolodabaei P, Vakili F, Kharrazi Fard MJ. Determining salivary and serum levels of iron, zinc and vitamin B 12 in patients with geographic tongue. J Dent Res Dent Clin Dent Prospects 2019;13(3):221–6. [CrossRef]
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Jacob CN, John TM, Jayaprakash R. Geographic tongue. Cleve Clin J Med 2016;83(8):565–6. [CrossRef]
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Bakshi SS, Bhattacharjee S. Geographic tongue. J Allergy Clin Immunol Pract 2017;5(1):176. [CrossRef]
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SUPPORTING INFORMATION
Author Contributions
Takeshi Onda - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Kamichika Hayashi - Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Akira Katakura - Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Masayuki Takano - Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Takeshi Onda et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
