GEOGRAPHIC TONGUE: CASE REPORT AND LITERATURE REVIEW
MAHREEN SHAHZAD, BDS, MSc (Oral Medicine)
1
2
ANAM SATTAR, BDS
3
SYED MOHAMMAD FARAN ALI, BDS, MSc (Oral Pathology)
ABSTRACT
Geographic tongue (Benign migratory glossitis, erythema migrans) is an asymptomatic inflam-
matory disorder of tongue of unknown etiology. This disease is characterized by erythematous areas
showing raised greyish or white circinate lines or bands with irregular pattern on the dorsal surface
of the tongue and depapillation. The objective in presenting the case report and literature review is to
discuss the clinical presentation, associated causative factors and management strategies of geographic
tongue.
Key Word: Geographic tongue.
INTRODUCTION
Geographic tongue (Benign migratory glossitis)
may be characterized by erythematous patches with
whitish margins across the surface of the tongue, with
periods of exacerbation and remission that confer the
typical migratory aspect of this entity.¹ The central
erythematous patch represents atrophy of the filiform
papillae. The white border is composed of regenerating
filiform papillae and a mixture of keratin and neutro-
phils. The fungiform papillae remain shiny, dark red
eminences. It is a benign condition commonly occurring
on the tip, lateral borders, and dorsum of the tongue;
lesions sometimes extend to the ventral portion as well.²
The etiology of geographic tongue is not well under-
stood.³ The diagnosis is based on history and clinical
presentation, characteristics of the lesion particularly
the migratory pattern on the dorsal surface of tongue.
Geographic tongue is an inflammatory disease usually
asymptomatic in nature but in some cases burning
sensation has been reported. Similar lesions may also
be seen in atrophic candidiasis, local trauma, drug
induced reactions, chemical burn, psoriasis, atrophic
lichen panus and erthyema migrans .⁴
The purpose of this study was to determine the
clinical presentation of geographic tongue, associated
etiological factors and treatment modalities.
Correspondence: Dr Mahreen Shahzad, 1Assistant Professor and
Head Oral Diagnosis & Medicine Department, Sir Syed Dental
Hospital, Karachi, Pakistan. DHA, Phase-7, Near KPT Interchange,
Korangi Road, Karachi. Residential Address: House No. 41, 1st
Street, Khayaban-e-Rahat, Phase-6, DHA, Karachi.
E-mail: mahreen_dimz@yahoo.com,
Contact: 35383241-35383978, Ext- 820
2
Demostrator, Oral Diagnosis & Medicine Department
3
Assistant Professor, Oral Pathology Department
Received for Publication: July 10, 2014
Revision Received: August 8, 2014
Revision Accepted: August 9, 2014
Pakistan Oral & Dental Journal Vol 34, No. 3 (September 2014)
CASE REPORT
A 13 year old male came to OPD with the complaint
of pain in lower left side, particularly in first molar. Pain
was severe and continuous in nature, radiated towards
head and was aggravated on eating food and relieved
by medicine. During intra oral examination lower left
first molar was found carious. Working diagnosis was
reversible pulpitis and a periapical radiograph was
taken. He was advised to have RCT followed by porce-
lain crown. Besides, on doing further oral examination
it was diagnosed that he has geographic tongue and
patient was not aware from it. His medical history
was unremarkable. Detailed history related to tongue,
that condition is mostly asymptomatic but rarely mild
burning sensation occurs on tongue on eating spicy
food and drinking acidic beverages. On examination
of tongue, groups of smooth, reddish-pink, atrophic, or
depapillated patches on the dorsum or lateral borders of
the tongue were noted. These patches frequently have
a slightly elevated, thin, yellow border (Fig 1 & 2). Just
to differentiate it from other similar oral lesion such
as psoriasis, Reiter syndrome, glossitis, lichen planus
and lupus erythematosus his scalp, hair, palms, nails,
soles and eye were examined but no abnormalities
were found. This patient was prescribed benzydamine
hydrocholride mouth wash for symptomatic relief. On
second visit there was improvement in his symptoms
and on observing the oral lesion in patient his parents
and siblings were called for detailed oral examination
but no such lesion were found among them.
DISCUSSION
A plenty of geographic tongue literature is avail-
able. One case is discussed here. The prevalence of
the appearance of geographic tongue is important and
it varies from region to region and studies conducted
in those regions. According to the study of Goswami
the prevalence of geographic tongue ranged from
1.0-2.5% in the study population.5 Darwazeh reported
the prevalence which was 4.8% in Jordanian popula-
409

Fig 1: Geographic Tongue in 13 years old male
Fig 2: Irregular erthyematous patches bounded by
slightly elevated keratotic bands on dorsal
surface tongue
tion.6 Investigations proved that there was no specific
racial predilection or gender difference observed in
their studies. Contrary to this, the study conducted
by Brian revealed that geographic tongue was highly
expressed in white and black population as compared
to Mexican Americans. In United States of America
geographic tongue prevalence range is from 1-14%.7
The most commonly affected site is the tongue; however,
other oral mucosal soft tissue sites may be affected.
The majority of affected patients are asymptomatic.
However, discomfort ranging from foreign body sensa-
tion to minimal itching to a severe burning sensation,
which may occasionally interfere with eating or sleep-
ing. Moreover, some patients implicate smoking and
seasoned or spicy foods as aggravating factors.8 The
etiology of geographic tongue is not well understood,
Pakistan Oral & Dental Journal Vol 34, No. 3 (September 2014)
Geographic Tongue
but various factors contribute in the pathogenesis of
this disease. Some researchers still consider it as an
anomaly of tongue and others mark it as hereditary
in origin.⁴ Geographic tongue has been reported with
increased frequency in patients with psoriasis9 and in
patients with fissured tongue. Geographic tongue and
fissured tongue have been reported in association with
chronic granulomatous disease .10 Previous studies have
shown the involvement of geographic tongue with vari-
ous systemic and psychological factors such as anemia,
emotional stress, Reiter’s syndrome, allergies, diabetes
and hormonal disturbances.² The histopathological
findings are parakeratosis and psoriasiform hyperplasia
with neutrophilic infiltration into the epithelium.¹¹ The
diagnosis of BMG usually is based on the history and
clinical presentation. When the lesion is asymptomatic
no medical intervention is required. Topical prednis-
olone can be used for the treatment of symptomatic
lesion. A topical or systemic antifungal medication
can be tried if secondary candidiasis is suspected.
Nevertheless, successful treatment with cyclosporine
and with topical and systemic antihistamines has been
reported. Patients are encouraged to brush the dorsum
of the tongue to eliminate debris that may serve as an
irritant, if the condition is symptomatic.5
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