Differential Diagnosis for Geographic Tongue

• Single most likely diagnosis
  • Benign migratory glossitis (Geographic tongue): This is the most likely diagnosis due to the characteristic appearance of irregular, well-demarcated areas of depapillation on the tongue, which give it a "geographic" appearance. The condition is usually asymptomatic and resolves on its own.
• Other Likely diagnoses
  • Oral lichen planus: This condition can cause similar lesions on the tongue, but it often presents with a lace-like pattern and can be associated with other mucosal lesions.
  • Psoriasis: Although rare in the mouth, psoriasis can cause geographic tongue-like lesions, especially in patients with a history of psoriasis.
  • Erosive lichen planus: This variant of lichen planus can cause erosions on the tongue, which might resemble geographic tongue.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Oral cancer: Although rare, any persistent or changing lesion on the tongue should be evaluated for oral cancer, especially in patients with risk factors such as smoking or tobacco use.
  • Infections (e.g., histoplasmosis, blastomycosis): Fungal infections can cause oral lesions that might resemble geographic tongue, and missing these diagnoses could lead to severe consequences.
• Rare diagnoses
  • Pemphigus vulgaris: A rare autoimmune disease that can cause blistering lesions on the tongue and other mucous membranes.
  • Erythema multiforme: A rare condition characterized by target-like lesions on the skin and mucous membranes, which can occasionally affect the tongue.
  • Lupus erythematosus: Systemic lupus erythematosus can cause oral lesions, including those resembling geographic tongue, although this is a rare manifestation.