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Geographic tongue


Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports

Geographic tongue is a reactive mucosal inflammatory condition characterized by arcuate or annular alternating hypertrophic or atrophic filiform papillae producing a geographic pattern. Synonyms include benign migratory glossitis and glossitis areata migrans . Geographic tongue may be an asymptomatic incidental finding. Similar changes may occur in oral sites other than the tongue (geographic stomatitis or benign migratory stomatitis).

Management Strategy

Geographic tongue is a common glossitis that affects 2% of the population. If asymptomatic, no treatment is necessary other than reassurance that the condition is benign and usually not a sign of systemic illness. Geographic tongue will remit spontaneously but may persist for years. Occasionally, patients may complain of a burning discomfort, particularly in atrophic areas. Effective therapy can be challenging.

Geographic tongue has been associated with psoriasis (especially pustular psoriasis); the two diseases share a strong association with human leukocyte antigen (HLA)-Cw6. It has also been associated with reactive arthritis; pityriasis rubra pilaris; atopic diathesis; Down syndrome; nutritional deficiency; diabetes; hormonal changes; and medications including lithium, oral contraceptives, and vascular endothelial growth factor or multikinase inhibitors such as bevacizumab, sunitinib, and sorafenib. The clinician should also consider acute or chronic atrophic candidiasis as a differential diagnosis.

For symptomatic patients, measures that may be considered include the avoidance of hot, spicy, or acidic foods; gentle brushing of the tongue; avoidance of harsh antibacterial mouthwashes, chewing gum, and breath mints; and soothing rinses with saline solutions. Occasionally, the topical application of fluorinated corticosteroids or diphenhydramine elixir after meals and at bedtime may be recommended. Topical anesthetic rinses or gels provide temporary relief. Antiyeast treatments may be palliative.

Specific Investigations

  • Culture for candidiasis

  • If symptomatic, consider complete blood cell count, iron panel, vitamin B 6 , vitamin B 12 , vitamin D, folate, and zinc levels; glucose; and hemoglobin A 1c

  • No investigation necessary in asymptomatic patients

Geographic tongue

Shareef S, Ettefagh L. [Updated 2020 Feb 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554466/ .

The topic and the differential diagnosis are reviewed. Patients without symptoms do not require additional studies.

Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation – a literature review

Picciani BL, Domingos TA, Teixeira-Souza T, et al. An Bras Dermatol 2016; 91: 410–21.

Review and discussion on how geographic tongue and psoriasis share clinical, histological, and genetic features.

First-Line Therapies

  • Avoidance of spicy food, mouthwashes, chewing gum, and breath mints

  • D

  • Topical corticosteroids (e.g., fluocinonide 0.05% gel, dexamethasone elixir, triamcinolone 0.1% in oral base)

  • C

  • Topical antihistamines (e.g., diphenhydramine elixir 12.5 mg/5 mL diluted 1:4 with water)

  • C

  • Antiyeast therapy

  • E

  • Swish-and-spit tacrolimus regimen twice daily (e.g., dissolve 1-mg tacrolimus capsule dissolved in 500 mL of water, swish for 2 minutes and spit)

  • C

Symptomatic benign migratory glossitis: report of two cases and literature review

Sigal MJ, Mock D. Pediatr Dent 1992; 14: 392–6.

Management with topical corticosteroids and topical antihistamines is discussed.

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