Background
Geographic tongue (benign migratory glossitis) is a benign condition that occurs in up to 3% of the general population. [1, 2] Most often, patients are asymptomatic; however, some patients report increased sensitivity to hot and spicy foods. The etiology and pathogenesis of geographic tongue are still poorly understood.
The classic manifestation of geographic tongue is an area of erythema, with atrophy of the filiform papillae of the tongue, surrounded by a serpiginous, white, hyperkeratotic border. (See the image below.) The patient often reports spontaneous resolution of the lesion in one area, with the return of normal tongue architecture, only to have another lesion appear in a different location of the tongue. Lesion activity in geographic tongue may wax and wane over time, and patients are occasionally free of lesions.
Geographic tongue. Image from Dimitrios Malamos (own work) via Wikimedia Commons.
Generally, medical intervention is unnecessary, because the lesion is benign and most often asymptomatic. However, there are some reports of benefit achieved with cyclosporine, antihistamines, retinoids, corticosteroids, or tacrolimus. (See Treatment and Medication.)
Pathophysiology
Other oral mucosal soft-tissue sites besides the tongue may be affected in patients with geographic tongue. Geographic tongue has been reported with increased frequency in patients with psoriasis [3, 4, 5] (though not all studies have supported this association [6] ) and in patients with fissured tongue. [7, 8] Both geographic tongue and fissured tongue have been reported in association with chronic granulomatous disease. [9]
Although geographic tongue is an inflammatory condition histologically, a polygenic mode of inheritance has been suggested on the grounds that the condition has been seen clustering in families. Associations with human leukocyte antigen (HLA)-DR5, HLA-DRW6, and HLA-Cw6 have also been reported. [10, 11]
Etiology
A definitive cause for geographic tongue has not been elucidated, but some studies have found this condition to be more frequent in patients with psoriasis. [3, 4] In one study of patients with psoriasis, geographic tongue occurred in 10% of the patients, in contrast to only 2.5% of age- and sex-matched controls. [12]
A polygenic mode of inheritance has been suggested for geographic tongue. [13]
No increased incidence of geographic tongue has been noted with medication use or exposure to environmental agents.
Immunologic and psychologic parameters have been associated with geographic tongue. [14]
It has been suggested that the lingual microbiota may play a role in geographic tongue. [1]
Epidemiology
Geographic tongue has reportedly occurred in up to 3% of the general population in the United States. International frequency rates for geographic tongue are similar to those reported in the United States.
Geographic tongue can affect all age groups; however, it is more predominant in adults than in children. [15, 16] Females have been reported to be affected twice as often as males. [17] Exacerbations have been suggested to be related to hormonal factors. No racial or ethnic predilection has been reported.
Patient Education
Defining geographic tongue, describing its clinical appearance, and reinforcing its benign nature are usually the only measures needed to educate patients and allay any concerns they may have about this condition.
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Geographic tongue. Image from Dimitrios Malamos (own work) via Wikimedia Commons.
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Irritant contact dermatitis of tongue.
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