Photo Rounds

Lesions on the tongue

A 71-year-old woman complained to her family physician (FP) about her tongue’s “strange appearance.” She denied pain or discomfort and was unsure how long the lesions had been there. The patient also indicated that the distribution of the lesions seemed to change. The FP’s examination revealed large, well-delineated, shiny, smooth, erythematous spots on the surface of the tongue.

What's your diagnosis?


 

The FP concluded that the patient had geographic tongue (benign migratory glossitis). This is a recurrent, usually asymptomatic inflammatory disorder of the mucosa of the dorsum and lateral borders of the tongue. The lesions are suggestive of a geographic map, with pink continents surrounded by white oceans. The lesions exhibit central erythema (because of atrophy of the filiform papillae) and usually are surrounded by slightly elevated, curving, white-to-yellow borders. The condition typically waxes and wanes over time, so the lesions may appear to be migrating.

The lesions, which do not scar, may last for days to years. Most patients are asymptomatic, but some may complain of pain or burning, especially when eating spicy foods. Suspect systemic intraoral manifestations of psoriasis or reactive arthritis if the patient has psoriatic skin lesions or conjunctivitis, urethritis, arthritis, or skin involvement suggestive of reactive arthritis.

There are several proposed treatments for symptomatic patients, but there is no evidence to support their use. Topical steroids, such as triamcinolone dental paste, is one option; an oral supplement, such as zinc, vitamin B12, niacin, and riboflavin, is another. Antihistamine mouth rinses (eg, diphenhydramine elixir 12.5 mg per 5 mL diluted in a 1:4 ratio with water) also have been suggested as a treatment option.

In this case, the FP explained to the patient that her condition was benign and that she did not need treatment unless her tongue started to bother her.

Photo courtesy of Michael Huber, DMD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Valdez E, Usatine R, Gonsalves W. Geographic tongue. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:232-235.

To learn more about the Color Atlas of Family Medicine, see: http://www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking this link: http://usatinemedia.com/

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