What is a geographic tongue?
A benign inflammatory condition, often referred to as benign migratory glossitis (i.e., erythema migrans lingualis; . This is characterized by multiple, smooth, red, and glossy patches of glossitis, each surrounded by a serpiginous rim of a whitish/hyperkeratotic border. The patches resemble the islands of an archipelago (hence, the nickname of geographic), and primarily affect the tongue’s dorsum, even though they may often extend to the lateral borders.
Histologically, they are caused by atrophy of the filiform papillae and may even wax and
wane with time. Hence, the adjective of migratory. Eventually, they resolve spontaneously only to
reappear at different sites (if lesions occur in other mucosae, the condition is instead termed erythema
migrans). A geographic tongue often runs in families and is relatively common, being present in up to 3% of
the general population. It has no racial or ethnic predilection, but does affect adults more than children
and women more than males (2:1). In fact, exacerbations have often been linked to hormonal
factors. Still, unlike atrophic glossitis, a geographic tongue is not associated with nutritional deficiency, but
is instead idiopathic. A psychosomatic relation has even been suggested. Histologically, lesions are quite
similar to those of psoriasis, or to the mucocutaneous presentations of Reiter’s syndrome. In fact, a
geographic tongue is four times more prevalent in psoriatics. It remains, however, asymptomatic
(although some patients report increased sensitivity to hot and spicy foods), quite benign, and usually selflimited.
Differential diagnosis includes candidiasis, contact stomatitis, chemical burns, lichen planus, and
psoriasis. Given the typical clinical presentation, reassurance (and not biopsy) is the best management.
A benign inflammatory condition, often referred to as benign migratory glossitis (i.e., erythema migrans lingualis; . This is characterized by multiple, smooth, red, and glossy patches of glossitis, each surrounded by a serpiginous rim of a whitish/hyperkeratotic border. The patches resemble the islands of an archipelago (hence, the nickname of geographic), and primarily affect the tongue’s dorsum, even though they may often extend to the lateral borders.
Histologically, they are caused by atrophy of the filiform papillae and may even wax and
wane with time. Hence, the adjective of migratory. Eventually, they resolve spontaneously only to
reappear at different sites (if lesions occur in other mucosae, the condition is instead termed erythema
migrans). A geographic tongue often runs in families and is relatively common, being present in up to 3% of
the general population. It has no racial or ethnic predilection, but does affect adults more than children
and women more than males (2:1). In fact, exacerbations have often been linked to hormonal
factors. Still, unlike atrophic glossitis, a geographic tongue is not associated with nutritional deficiency, but
is instead idiopathic. A psychosomatic relation has even been suggested. Histologically, lesions are quite
similar to those of psoriasis, or to the mucocutaneous presentations of Reiter’s syndrome. In fact, a
geographic tongue is four times more prevalent in psoriatics. It remains, however, asymptomatic
(although some patients report increased sensitivity to hot and spicy foods), quite benign, and usually selflimited.
Differential diagnosis includes candidiasis, contact stomatitis, chemical burns, lichen planus, and
psoriasis. Given the typical clinical presentation, reassurance (and not biopsy) is the best management.