A 26-year-old woman presented reporting a sensation of burning and irritation of her tongue, particularly when she ate hot and spicy food. She had 3 well-defined erythematous patches on the lateral and dorsal aspects of her tongue that she said had developed over the past 6 months (Figure 1). The patient had no significant medical history.
The patient presented with 3 well-defined erythematous patches on the apex and lateral borders of the dorsum of the tongue.
Benign migratory glossitis and oral lichen planus were suspected, and a biopsy was performed to distinguish between them. The biopsy results showed parakeratosis and widened interpapillary processes with lymphocytes and polymorphonuclear cells in the lamina propria, confirming the diagnosis of benign migratory glossitis.
We advised the patient to avoid triggers such as spicy and acidic foods and alcohol. She has been without recurrences for 1 year.
BENIGN MIGRATORY GLOSSITIS, OR GEOGRAPHIC TONGUE
Also known as geographic tongue, benign migratory glossitis is a chronic inflammatory disorder that manifests on the tongue as smooth red patches circumscribed by a well-defined white or gray rim (the rim is absent in this patient).1 In some cases, the lesions give the tongue a map-like appearance. The lesions result from atrophy of the filiform papillae, leading to epithelial thinning.2 Periods of remission and exacerbation without scarring can occur.3
The prevalence of benign migratory glossitis is between 1% and 2% overall, and it is more common in children than adults.4 A predilection for women has been described in some reports.3
Fissured tongue and benign migratory glossitis are distinct entities that often coexist. Although this association is not diagnostic, it occurs in up to one-third of patients with benign migratory glossitis.5
Diagnosis and treatment
Benign migratory glossitis is usually diagnosed based on clinical features. However, a biopsy might be necessary to rule out other conditions when there are atypical or persistent lesions, another condition is suspected, or severe symptoms, such as intense pain or persistent ulcers, are present. The differential diagnoses include atrophic glossitis due to anemia, oral lichen planus, and psoriasis with oral involvement (Table 1).1,5–7
Clinical characteristics, histopathologic features, treatments, and prognoses of the differential diagnoses of benign migratory glossitis
Treatment typically is not needed for benign migratory glossitis if it is asymptomatic. Nonpharmacologic measures include avoiding triggers such as alcohol and hot, spicy, and sour foods, and maintaining good oral hygiene. For symptomatic patients, treatment options may include topical corticosteroids, antihistamines, cyclosporine, vitamin A, and zinc.2,5 Additionally, when symptoms are present, they may be associated with secondary infection with Candida albicans. Topical steroids, especially in combination with topical antifungal agents, are the treatment of choice.5 The decision to initiate treatment is based on the severity and persistence of symptoms.
DISCLOSURES
The authors report no relevant financial relationships which, in the context of their contributions, could be perceived as a potential conflict of interest.
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REFERENCES
- 1↵Horiuchi Y. Geographic tongue: what is this disease? J Dtsch Dermatol Ges 2023; 21(12):1465–1467. doi:10.1111/ddg.15226
- 2↵de Campos WG, Esteves CV, Fernandes LG, Domaneschi C, Júnior CAL. Treatment of symptomatic benign migratory glossitis: a systematic review. Clin Oral Investig 2018; 22(7):2487–2493. doi:10.1007/s00784-018-2553-4
- 3↵Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract 2005; 6(1):123–135. pmid:15719084
- 4↵García-Torres J. Geographic tongue: one case report. Sanidad Militar 2020; 76(4):235–238. Spanish.
- 5↵Siegel MA, Sollecito TP, Stoopler ET. Clinician’s Guide to Treatment of Common Oral Conditions. 8th ed. American Academy of Oral Medicine; 2018.
- 6Wu YH, Hwang MJ, Lee YP, Chiang CP. Atrophic glossitis in pernicious anemia patients can be treated to normal in two weeks by intramuscular injection of vitamin B12. J Dent Sci 2020; 15(4):558–559. doi:10.1016/j.jds.2020.06.007
- 7↵Villanueva-Sánchez FG, Escalante-Macías LH, Zambrano-Galván G, Cuevas-González JC, Maya-García IA. Liquen plano bucal. Reporte de un caso y revisión de la literatura [Oral lichen planus. Case report and literature review]. Rev Alerg Mex 2018; 65(4):424–430. Spanish. doi:10.29262/ram.v65i4.342
