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TuulaSalo
MariaSiponen

Benign Lesions of the Tongue

Geographic tongue (benign migratory glossitis, oral erythema migrans)

  • Unknown aetiology. Might be associated atopy, asthma or psoriasis.
  • Prevalence is about 2-3% of population.
  • Reddened well-defined lesions of variable size on the surface of the tongue, often surrounded by a pale yellow marginal zone
    • Disappeared filiform papillae within the lesions with normal papillary structure in the surrounding tissue; pictures
    • The lesions change place and shape, sometimes fast, sometimes slower.
  • Often associated with furrowed tongue.
  • Lesions on other sites within the oral cavity are called erythema migrans of the mouth (also called ectopic geographic tongue or benign migratory stomatitis); not to be confused with erythema migrans of the skin caused by Borrelia infection.
  • The condition is usually asymptomatic but a burning sensation may occur particularly on contact with irritant substances (citrus fruit, spices, alcohol, tobacco). Secondary yeast infection may also cause a burning sensation.
  • Treatment
    • Reassure the patient about the benign nature of the lesions, and encourage avoidance of irritant substances. Symptomatic lesions may be treated with topical glucocorticoid or glucocorticoid+antifungal ointment.

Hairy tongue

  • Caused by hypertrophy and defective desquamation of the filiform papillae of the tongue.
  • The condition is thought to be caused by a change in the oral microbial flora, with e.g. antimicrobials, systemic glucocorticoids, smoking, poor oral hygiene, hydrogen peroxide mouthwashes or radiotherapy as predisposing factors.
  • The surface of the tongue is covered by white, pale brown or dark brown ”hair” (picture ).
  • Usually asymptomatic, but secondary yeast infection may cause a burning sensation. Associated halitosis may be present.
  • Might disappear spontaneously.
  • Treatment
    • Avoidance of predisposing factors, good oral hygiene, cleaning the tongue with a brush, a special tongue scraper (available from a chemist) or a tablespoon. If necessary, topical anti-yeast medication.

Furrowed tongue (fissured tongue, scrotal tongue)

  • Furrows of variable depth on the back of the tongue (picture )
  • Furrowed tongue is a familial condition, and may sometimes be associated with geographic tongue or with Down or Melkersson-Rosenthal syndrome.
  • Due to the furrowing the tongue may become infected and symptomatic. Treatment consists of brushing the tongue with a soft toothbrush or cleaning it with a tongue scraper.

Median rhomboid glossitis

  • Rare; usually seen in adults
  • A red, usually smooth-surfaced, lesion on the midline of the dorsum of the tongue anterior to the vallate papillae, with rhomboid or oval shape, may be elevated (picture ).
  • Chronic candida infection is considered as an aetiological factor. Predisposing factors for candidiasis include e.g. anti-asthmatic drugs, dry mouth, smoking and dentures.
  • Usually asymptomatic. If associated with tenderness, treat with topical anti-yeast medication. In addition, factors predisposing to candidiasis should be eliminated if possible.
  • Differential diagnosis: ectopic thyroid tissue, an ulcer attributable to tertiary syphilis or tuberculosis or deep fungal infection. Oral cancer is rarely seen in the midline of the dorsum of the tongue.

Lingual varices

  • Varicosities on the ventral surface of the tongue (picture )
  • Common in the elderly (prevalence over 50%)

    References

    • Mangold AR, Torgerson RR, Rogers RS 3rd. Diseases of the tongue. Clin Dermatol 2016;34(4):458-69. [PubMed]
    • Tarakji B, Umair A, Babaker Z et al. Relation between psoriasis and geographic tongue. J Clin Diagn Res 2014;8(11):ZE06-7. [PubMed]