Typical Geographic Tongue
Geographic tongue is thought to be an oral manifestation of psoriasis, a dermatological condition which causes dry, flakey, itchy skin in patches on sites outside of the mouth. No one knows the exact cause, however it seems to be linked to stress, and appears to be genetically related (runs in families). It is more common in persons with eczema, asthma and numerous allergies, and is also about four times more common in persons with diabetes, although the presence of geographic tongue is not noted as a warning sign of diabetes.
It manifests by the loss of the filliform papillae on the dorsal (top) surface of the tongue, in irregular patches that may appear in a few hours, but heal over time and then reappear in different spots. The technical name for this condition is benign migratory glossitis, the term “migratory” denoting the apparent movement of the denuded spots from one place on the tongue to another. There are infrequent reports of the condition extending to the ventral (bottom) surface of the tongue, and even onto the buccal (cheek) and labial (lip) mucosa, in which cases it appears as red, desquaqmated lesions (sores) and is then known as migratory stomatitis.
The condition is considered benign (not dangerous), and is rarely treated, although the appearance of the tongue during outbreaks may alarm the patient. It is frequently seen in children, and causes some worry in their parents. If you see it in your child, don’t worry. It will not effect their growth or development . The sense of taste is not affected by geographic tongue, however it does temporarily reduce the sense of touch in affected areas. Geographic tongue is more common in persons who are sensitive to environmental allergens and persons with asthma. It is four times more common in persons with diabetes than in the population at large, although it is NOT known as an early warning sign of diabetes. Finally, young women taking birth control pills are more likely to experience an outbreak on day 17 of the cycle, suggesting that there is a hormonal component to the condition.
Recently, it has been noted that geographic tongue is seen more frequently in AIDS patients, however the presence of geographic tongue certainly does NOT mean that the patient has HIV.
In the image above, there are three areas of where the filliform papillae are partially denuded; two on the dorsal (top) surface, and one on left border of the tongue (the patient’s left). The redness seen on the tip of the tongue indicates that the patient has lately been rubbing the tongue over the lower teeth which suggests a nervous habit and could be indicative of the stress which may have stimulated this outbreak.
Troublesome symptoms are limited to burning of the denuded areas when the patient eats certain acidic, sharp or spicy foods. There is currently no known treatment for this condition, however some people report that it responds to rinsing with hydrogen peroxide several times a day for two or three days. It can also be treated temporarily with steroid mouth rinses. A patient suffering pain can gain temporary relief by rinsing with a mixture of equal parts of Milk of Magnesia mixed with Benedryl Elixir, both of which can be bought at a pharmacy without a prescription. (Do not swallow!)
The image above shows another case of geographic tongue. The white borders surrounding the denuded areas are called spongiosis. Spongiosis is defined as an inflammatory edema (swelling) of the epidermis (the outer layers of the skin or mucosa). In this case, the spongiosis consists of edematous (swollen) filiform papillae. Note the secondary lesion which formed inside of another denuded area. This represents simply another presentation of the more standard lesion seen in the image at the top of this page. Cases presenting with pronounced spongiosis are much less common than the case presented at the top of this page.
An idealized case.