It is a painless and harmless condition affecting the tongue. Normally, the tongue consists of small finger like projections on its ventral surface, known as papillae. When a person suffers from this condition, the papillae of a particular area on the tongue disappear, and the area appears “bald” or flat. The borders of the area may be slightly raised. These patches are harmless and disappear by themselves. These then reappear on some other area of the tongue; hence it is also known as benign migratory glossitis. These patches show red colour with smooth mucosa of the tongue, hence it is also known as oral erythema migrans. This condition has no association with the erythema migrans occurring in Lyme disease.
Less commonly, another similar lesion can be present in the oral cavity, characterised by the appearance of similar patches on other parts of the oral mucosa such as the cheeks or lips, soft palate, ventral surface of the tongue or floor of the mouth. This condition is known as stomatitis erythema migrans.
This condition is prevalent in about 1-3% of the population and can occur at any age. It is more common in women than men and generally appears in the middle aged ones.
The most important and easy feature of diagnosis is presence of irregular patches on the tongue. These patches show:
- Irregularity in their shape
- Show red colour in their base and the lining may be white or light-coloured.
- Can last upto a year
- Appear and disappear by itself and reappears in some other area.
- Varies in size and shape
About 10% of the people suffering from this condition may show a slight burning sensation in the patches or irritation to a particular substance like:
- Hot and spicy foods
Remissions and relapses of the condition are a common feature. When the white borders disappear, then it is assumed to be a healing sign for the lesion.
The exact cause of this condition is not exactly known. This condition may arise without any triggering factor. Researchers have found some relationship between psoriasis and geographic tongue. It is also postulated that this condition is less prevalent among smokers. Some parafunctional habits are also considered to be a precipitating factor. Some researchers say that this condition may also arise due to changes in hormonal levels. Some studies also show a relationship between nutritional deficiencies and geographic tongue, although no evidence is seen against this observation.
The factors which are known to increase the chances of getting this condition include:
- Family history: This condition is seen more commonly in people who have a familial history of having geographic tongue.
- Fissured tongue: This condition is characterised by the presence of various deep fissure and grooves on the ventral surface of the tongue. Geographic tongue is seen more commonly in people having fissured tongue.
Differential diagnosis includes erythematous candidiasis, lupus erythematosus, oral lichen planus, atrophic glossitis and chemical burns.
When to see a doctor
Consult a doctor when the condition persists for longer than 10 days. If you have a breathing or swallowing problem, or swollen tongue, then consult immediately.
Geographic tongue is an entirely benign condition and does not affect or harm your health in any other manner. This condition may temporarily cause a bit of irritation to some particular substances. Otherwise, it is completely harmless.
The diagnosis is done by clinical examination and history. The condition shows very striking features and rarely there is a need for biopsy. If a biopsy is done, then the following microscopic features are seen:
- T lymphocyte infiltration in the subepithelial layer
- Hyperparakeratinisation of the upper layer
- Sometimes granulocytes may migrate to the upper epithelial layer, resulting in the formation of microabscesses, similar to the ones in psoriasis
Hence, researchers find a connection between geographic tongue and psoriasis.
The condition usually resolves by itself and does not need any medication or any treatment. However, if it is causing any problem or discomfort, you can opt for some over-the-counter drugs. These drugs include:
- Pain killers to relieve you from the pain if it is causing serious discomfort.
- Anti-inflammatory drugs
- Mouth washes and rinses which can also contain anaesthetics
- Zinc supplements
- Topical corticosteroid
To get relief faster, try to avoid the foods which can cause irritation to the tongue. These substances may include some particular food or tobacco smoke or alcohol. Hot and spicy foods can also irritate the tongue and cause discomfort. These irritating substances can also aggravate the condition.
Geographic tongue is a comparatively rare condition, affecting only about 1-3% of the total population. Some other reports have shown the prevalence to be upto 14%. Females have more predilections in the ratio of 2:1 as compared to males.