Geographic Tongue: Clinical Description
Geographic tongue (benign migratory glossitis) is a benign chronic inflammatory condition characterized by irregular erythematous patches with loss of filiform papillae, surrounded by elevated white or yellowish borders, creating a distinctive map-like appearance on the dorsal and lateral tongue surfaces. 1, 2
Clinical Appearance
Central erythematous patches appear as irregular red areas where filiform papillae have been lost, creating smooth, denuded zones on the tongue surface 1, 2
Elevated white or yellowish borders surround the red patches in a band-like pattern, giving the characteristic geographic or map-like appearance 1, 2
Lesions are dynamic, changing in location, size, shape, and pattern over days to weeks, hence the term "migratory glossitis" 1, 2
The condition primarily affects the dorsal and lateral aspects of the tongue, though ectopic presentations can occur on other oral mucosal surfaces including the floor of mouth, buccal mucosa, and palate 3
Clinical Course
Most patients are asymptomatic (50.8-90.8% of cases), requiring no treatment 4
When symptomatic, patients report burning sensation in 9.2-47% of cases, particularly when consuming spicy, acidic, or hot foods 4
The condition follows a chronic course with spontaneous periods of remission and exacerbation without scarring 1, 2
Prognosis is excellent with no malignant potential 1
Histological Features
Histological examination reveals nonspecific inflammation of the oral mucosa 1
There is loss of filiform papillae in the erythematous areas with epithelial thinning 1
The white borders show acanthosis and hyperkeratosis with inflammatory infiltrate 2
Diagnostic Approach
Diagnosis is primarily clinical in 98.81% of cases, based on the characteristic appearance and migratory pattern 4
Biopsy is rarely necessary unless the diagnosis is uncertain or lesions are atypical 4
Screen for associated conditions including psoriasis (strong association), fissured tongue (common coexistence), diabetes mellitus, and allergic/atopic conditions 1, 4
Assess for Candida superinfection (present in 7.6% of cases), which may require treatment 4
Important Clinical Pearls
Geographic tongue is age-related and more prevalent in young individuals, though it can occur at any age from 0-85 years 4
The condition may represent an oral manifestation of psoriasis, with histological similarities between the two conditions 1, 5
Ectopic geographic tongue (migratory stomatitis) can present on extra-lingual oral mucosa with identical clinical and histological features 1, 3
Associated factors include emotional stress, hormonal disturbances, zinc deficiency, and tobacco use, though causation is not established 1