Case of the Month

A man with a 3 year history of painless ‘spots’ on his tongue that seem to move around every few days.

What's Your Diagnosis?

Diagnosis: Geographic tongue.

Geographic tongue has several names including: annulus migrans, lingua geographica, transitory benign plaques of the tongue, glossitis areata exfoliativa, and benign migratory glossitis.

The condition is seen in the setting of psoriasis and atopic dermatitis. It is most commonly seen as a stand-alone condition.

The dorsal surface of the tongue is the site usually affected. Geographic tongue begins with a small depression on the lateral border or the tip of the tongue, smoother and redder than the rest of the surface. This spreads peripherally, with the There is a formation of sharply marginated annular or gyrate red patches, accompanied by a narrow yellowish-white border. The lesions, overall on the tongue, look like a ‘map’, hence the term geographic tongue. The presentation can change daily. Sometime they remain quiet for weeks-months, and at other times the lesions can become active. Most commonly, the lesions, except for the visual appearance, are asymptomatic. Mild glossodynia, at times, has been reported.

There are two clinical presentations of geographic tongue. In one type, discrete, annular “bald” patches of shiny red mucosa with no, or atrophic filiform papillae. Another type shows annular white raised lesions. Dermatopathologically, the lesions of geographic tongue are quite similar to pustular psoriasis. In fact, when geographic tongue occurs in the presence of pustular psoriasis, some have said the term annulus migrans should be used.

When a treatment is desired, a 0.1% solution of tretinoin, applied for 7 days, has been reported to be helpful.

Additional Comment:

A patient with a well-documented history of geographic tongue came and said: "I get the same spots on the insides of my cheeks, roof of my mouth and under my tongue, too. They move around and clear and reappear just like my tongue." This reminded me that geographic tongue is part of the spectrum called 'geographic stomatitis'. The lesions occur most commonly on the tongue, but they can also occur on the buccal mucosa and palate. The picture on the left is 'geographic buccal mucosa'.

Reference:

Andrew’s Diseases of the Skin