What are the odd patches on this man's tongue?
What is your diagnosis?
A 29-year-old man reports a two-month history of odd patches on his tongue. He says they are essentially asymptomatic but sometimes he has a mild burning sensation when eating hot and/or spicy foods. He also reports that the patches tend to move around on a weekly if not daily basis. He also reports that his mother told him she had a similar condition approximately ten years ago that lasted a year. What's your diagnosis?
Geographic tongue (also known as :psoriasiform mucositis of unknown etiology", "Benign migratory glossitis," "Benign migratory stomatitis," "Glossitis areata exfoliativa," "Glossitis areata migrans," "Lingua geographica," "Stomatitis areata migrans," and "Transitory benign plaques of the tongue"). It presents with red, sharply marginated patches with scalloped thin white borders on the dorsal tongue. Geographic tongue is a common and harmless clinical condition of unknown etiology. The prevalence is approximately 2%. Most commonly it is asymptomatic; however, some patients, as this one reports, mild discomfort and burning with the ingestion of spicy and/or hot foods. The condition is self-limited and usually disappears on its own. Interesting to note that on biopsy the condition resembles pustular psoriasis. The actual redness from atrophy of the filiform papillae. Although there have been reports associating geographic tongue with a higher incidence in patients with psoriasis and/or fissured tongues, that has not been my experience clinically.
The most important treatment is reassurance that the condition is harmless and usually resolves within a year. If the patients are reporting significant discomfort, I recommend Kenalog in Orabase at bedtime to the affected areas nightly for one week at a time, repeat as needed. Once again, most patients are extremely relieved to know that it is harmless and self-limited.
Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology