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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 CASE REPORT

Geographic tongue (Benign migratory glossitis) A 13 year old male came to OPD with the complaint
may be characterized by erythematous patches with of pain in lower left side, particularly in first molar. Pain
whitish margins across the surface of the tongue, with was severe and continuous in nature, radiated towards
periods of exacerbation and remission that confer the head and was aggravated on eating food and relieved
typical migratory aspect of this entity.¹ The central by medicine. During intra oral examination lower left
erythematous patch represents atrophy of the filiform first molar was found carious. Working diagnosis was
papillae. The white border is composed of regenerating reversible pulpitis and a periapical radiograph was
filiform papillae and a mixture of keratin and neutro- taken. He was advised to have RCT followed by porce-
phils. The fungiform papillae remain shiny, dark red lain crown. Besides, on doing further oral examination
eminences. It is a benign condition commonly occurring it was diagnosed that he has geographic tongue and
on the tip, lateral borders, and dorsum of the tongue; patient was not aware from it. His medical history
lesions sometimes extend to the ventral portion as well.² was unremarkable. Detailed history related to tongue,
The etiology of geographic tongue is not well under- that condition is mostly asymptomatic but rarely mild
stood.³ The diagnosis is based on history and clinical burning sensation occurs on tongue on eating spicy
presentation, characteristics of the lesion particularly food and drinking acidic beverages. On examination
the migratory pattern on the dorsal surface of tongue. of tongue, groups of smooth, reddish-pink, atrophic, or
depapillated patches on the dorsum or lateral borders of
Geographic tongue is an inflammatory disease usually
the tongue were noted. These patches frequently have
asymptomatic in nature but in some cases burning
a slightly elevated, thin, yellow border (Fig 1 & 2). Just
sensation has been reported. Similar lesions may also
to differentiate it from other similar oral lesion such
be seen in atrophic candidiasis, local trauma, drug as psoriasis, Reiter syndrome, glossitis, lichen planus
induced reactions, chemical burn, psoriasis, atrophic and lupus erythematosus his scalp, hair, palms, nails,
lichen panus and erthyema migrans .⁴ soles and eye were examined but no abnormalities
The purpose of this study was to determine the were found. This patient was prescribed benzydamine
hydrocholride mouth wash for symptomatic relief. On
clinical presentation of geographic tongue, associated
second visit there was improvement in his symptoms
etiological factors and treatment modalities.
and on observing the oral lesion in patient his parents
and siblings were called for detailed oral examination
Correspondence: Dr Mahreen Shahzad, 1Assistant Professor and but no such lesion were found among them.
Head Oral Diagnosis & Medicine Department, Sir Syed Dental
Hospital, Karachi, Pakistan. DHA, Phase-7, Near KPT Interchange, DISCUSSION
Korangi Road, Karachi. Residential Address: House No. 41, 1st
Street, Khayaban-e-Rahat, Phase-6, DHA, Karachi. A plenty of geographic tongue literature is avail-
E-mail: mahreen_dimz@yahoo.com, able. One case is discussed here. The prevalence of
Contact: 35383241-35383978, Ext- 820 the appearance of geographic tongue is important and
2
Demostrator, Oral Diagnosis & Medicine Department it varies from region to region and studies conducted
3
Assistant Professor, Oral Pathology Department in those regions. According to the study of Goswami
Received for Publication: July 10, 2014 the prevalence of geographic tongue ranged from
Revision Received: August 8, 2014 1.0-2.5% in the study population.5 Darwazeh reported
Revision Accepted: August 9, 2014 the prevalence which was 4.8% in Jordanian popula-

Pakistan Oral & Dental Journal Vol 34, No. 3 (September 2014) 409
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
Fig 1: Geographic Tongue in 13 years old male 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
REFERENCES
1 Karuza Maria Alves Pereira1, Cassiano Francisco,Weege Non-
aka2, Pedro Paulo de Andrade Santos3, Ana Myriam Costa de
Medeiros4, Hébel Cavalcanti Galvão5, Unusual coexistence
of oral lymphoepithelial cyst andbenign migratory glossitis,
BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY 75
(2) MARCH/APRIL 2009
2 Jainkittivong A, Langlais RP. Geographic Tongue: Clinical
Characteristics of 188 Cases. J Contemp Dent Pract 2005
February;(6)1:123-35.
3 Honarmand M, Farhad ML, Shirzaiy M, Sehhatpour M. Geo-
graphic Tongue and Associated Risk Factors among Iranian
Dental Patients. Iran J Public Health. 2013; 42(2): 215-19.
4 Daud Mirza, Navid Rashid Qureshi, Kashif Naqvi, Benign
Migratory Glossitis, An Unusual Enigmatic Lesion, Pakistan
Oral & Dental Journal Vol 33, No. 3 (December 2013)
Fig 2: Irregular erthyematous patches bounded by 5 Goswami M, Verma A, Verma M. Benign migratory glossitis
slightly elevated keratotic bands on dorsal with fissured tongue. J Indian Soc Pedod Prev Dent. 2012 Apr-
Jun; 30(2): 173-75
surface tongue 6 Darwazeh AM, Almelaih AA. Tongue lesions in a Jordanian
population. Prevalence, symptoms, subject’s knowledge and
tion.6 Investigations proved that there was no specific treatment provided. Med Oral Patol Oral Cir Bucal. 2011 Sep
racial predilection or gender difference observed in 1;16(6): e745-49.
their studies. Contrary to this, the study conducted 7 Brian VR, Derby R, Bunt WC. Common tongue conditions in
primary care. Am Fam Physician. 2010 mar 1;81(5):627-34.
by Brian revealed that geographic tongue was highly 8 Igor T. Gavrilovic,A Yevgeniy Balagula,B Alyx C. Rosen,B Vijay
expressed in white and black population as compared Ramaswamy,C Maura N. Dickler,D Ira J. Dunkel,C Mario E.
to Mexican Americans. In United States of America Lacoutureb, Characteristics Of Oral Mucosal Events Related
To Bevacizumab Treatment, The Oncologist 2012;17:274–278
geographic tongue prevalence range is from 1-14%.7 Www.Theoncologist.Com
The most commonly affected site is the tongue; however, 9 Zargari O. The prevalence and significance of fissured tongue
other oral mucosal soft tissue sites may be affected. and geographical tongue in psoriatic patients. Clin Exp Dermatol
2006;2: 192‑95.
The majority of affected patients are asymptomatic. 10 Dar‑Odeh NS, Hayajneh WA, Abu‑Hammad OA, Hammad
However, discomfort ranging from foreign body sensa- HM,Al‑Wahadneh AM, Bulos NK, et al. Orofacial findings in
tion to minimal itching to a severe burning sensation, chronic granulomatous disease: Report of twelve patients and
review of the literature. BMC Res Notes 2010;3:37.
which may occasionally interfere with eating or sleep- 11 Masaya Ishibashi 1, Genichi Tojo2, Masahiko Watanabe3, Taka-
ing. Moreover, some patients implicate smoking and hiro Tamabuchi 4, Takashi Masu4,Setsuya Aiba2, Geographic
seasoned or spicy foods as aggravating factors.8 The tongue treated with topical tacrolimus, J Dermatol Case Rep
2010; 4: 57-59.
etiology of geographic tongue is not well understood,

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