From the Guidelines
Strawberry tongue in children is primarily caused by several infectious conditions, with scarlet fever and Kawasaki disease being the most significant causes, as noted in studies such as 1 and 1. This distinctive appearance, characterized by a bright red tongue with enlarged papillae resembling a strawberry, occurs when Group A Streptococcus bacteria infection leads to inflammation and desquamation of the tongue surface in the case of scarlet fever. Kawasaki disease, an acute febrile vasculitis affecting multiple systems, is another significant cause, as described in 1. Toxic shock syndrome, resulting from toxin-producing Staphylococcus aureus or Streptococcus pyogenes, can also produce strawberry tongue. Less commonly, allergic reactions to certain foods, medications, or environmental triggers may cause this symptom, as discussed in 1, 1, and 1. Vitamin deficiencies, particularly B12 deficiency, can occasionally present with strawberry tongue. When strawberry tongue is observed, prompt medical evaluation is essential as some underlying causes require specific treatment. For instance, scarlet fever requires antibiotic therapy (typically penicillin or amoxicillin for 10 days, or macrolides for penicillin-allergic patients), while Kawasaki disease needs immediate treatment with intravenous immunoglobulin and aspirin to prevent coronary artery complications, as recommended in 1. The appearance of strawberry tongue results from inflammation causing papillae enlargement and changes in the tongue's surface epithelium, creating the characteristic bumpy, bright red appearance. Some key points to consider in the diagnosis and management of strawberry tongue include:
- The importance of prompt medical evaluation to determine the underlying cause
- The need for specific treatment for certain causes, such as antibiotic therapy for scarlet fever or intravenous immunoglobulin and aspirin for Kawasaki disease
- The potential for allergic reactions or vitamin deficiencies to cause strawberry tongue
- The characteristic appearance of strawberry tongue, which can aid in diagnosis.
From the Research
Causes of Strawberry Tongue in Children
There are no research papers provided that directly discuss the causes of strawberry tongue in children. However, the studies provided do discuss the oral manifestations of nutritional deficiencies, which may be related to strawberry tongue.
Nutritional Deficiencies
- Iron deficiency was found in 62 patients (24.8%) in a study of 250 patients with oral manifestations of nutritional deficiencies 2
- Vitamin B12 or folic acid deficiency was found in 44 patients (17.6%) in the same study 2
- Deficiencies of hemoglobin, iron, vitamin B12, and folic acid were found to be associated with recurrent aphthous stomatitis in a study of 273 patients 3
Possible Relationship to Strawberry Tongue
- While the studies do not directly discuss strawberry tongue, they do suggest that nutritional deficiencies can cause oral manifestations such as changes in the appearance of the tongue 2, 3
- It is possible that strawberry tongue in children could be related to nutritional deficiencies, but more research would be needed to confirm this 2, 3