PresentationCase Findings: This 22 year old man is complaining of a mild burning sensation on his tongue, and that he noticed some strange patterns on his tongue recently. He is otherwise healthy and hasn't changed any hygiene products like toothpaste or mouthwash.
1899% Migratory glossitis (geographic tongue)
565% Lichen Planus
154% Contact stomatitis
Migratory glossitis is a chronic relapsing-recurring inflammatory / immune-mediated condition of the oral cavity of unknown etiology. Although the tongue is the most common site of occurrence, it may affect other parts of the mouth. It may begin in childhood but also affects adults; females are twice as likely to be afflicted. Migratory glossitis is seen in approximately 1% to 2% of the population, and the condition often accompanies fissured tongue.
The lesional areas are most often asymptomatic, but some patients may complain of a burnt or raw sensation. Eating hot or spicy foods will increase these symptoms. As a result, patients tend to avoid acidic and spicy foods when the lesions are present. Migratory glossitis waxes and wanes and is present for decades.
Histopathologically, migratory glossitis is characterized by a psoriasiform mucositis, and several studies have suggested that the condition is somewhat more frequent in psoriatic patients. Atopic individuals may also have an increased prevalence of migratory glossitis.
What To Look For:
Look for red (not ulcerated) demarcated areas that show loss of the filiform papillae ("baldness") and are located on the tongue dorsum, usually in the lateral aspects. The red areas are surrounded either partially or completely by serpiginous or scalloped raised white linear borders. Resolving lesions often do not show the raised white borders.
Early lesions may appear as white plaques that enlarge centrifugally in a matter of hours to days, quickly sloughing the central portion, resulting in the typical smooth red center with an elevated linear white periphery. The labial mucosa, buccal mucosa, and floor of the mouth rarely may be affected, and terms such as erythema areata migrans, stomatitis areata migrans, migratory stomatitis, and ectopic geographic tongue have been used to describe this process.To see more than 20 images of Migratory glossitis (geographic tongue) with variations of disease, the differential diagnosis, management pearls and therapy options, sign into your account.
If you are not a VisualDx subscriber, sign up for a free trial.
VisualDx is a great way to save time and educate your patients in the office, directly from your iPad or desktop computer.