Geographic tongue

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What is geographic tongue?

Geographic tongue, otherwise known as erythema migrans, is a common condition that can affect the tongue.

Your tongue

Our tongues are sensitive muscular organs. Covering the tongue are layers of papillae and taste buds which encase our mouths with a delicate balance of flora and mucus, working to keep the environment of the tongue, mouth and gums moist and bacteria-free, fighting infections. When our mouths get Infected either by having a viral/bacterial infection It is these papillae that start fighting off the infection.

What areas are affected?

The tops, sides, under surfaces of the tongue, and sometimes, the lips and inside of the cheeks can be affected. The parts affected usually develop irregular, smooth, areas which can quite often resemble a map. Next to the red patches there will probably be white wavy lines that will outline them. These patches will heal over and new ones will form in new parts of the areas affected.

Does it hurt?

In most cases geographic tongue does not hurt and just appears unslightly and does not cause any discomfort whatsoever. Unfortunately, in some affected individuals it can hurt and become very sensitive, sometimes causing a burning sensation in the mouth. This can be due to many reasons, as the red patches can be thin and raw, loss of the tiny papillae on the tongue becoming lost.

The process of geographic tongue

The normal layer of the skin on the tongue does not shed evenly, and in some cases, the skin sheds too early and in turn leaves red sore areas with white outlines around the patches. The red areas can become infected, and sore, with oral thrush (candida) often diagnosed.

Geographic tongue can also be accompanied by deep fissures (cracks) on the tongue, which again are not serious, but like geographic longue can be seen alongside other skin conditions.

Who does it affect?

It can affect any age group (at least 1-2% of the population), including children, and it can also run in families. It is also often seen in those who have psoriasis. It Is not triggered by infection or other diseases, and it affects healthy people too. It is estimated that approximately 10% of those with psoriasis have been found to have geographic tongue.

It has also been reported in studies that patients have been seen with generalised pustular psoriasis, a high proportion, of these patients will have had heavily fissured tongues, which indicated that otherwise normal healthy individuals may possess the propensity to develop generalised pustular psoriasis.

What irritates geographic tongue?

Because the red patches can be sore, eating certain foods can make the process of eating quite painful, such as acidic foods like fruits or spicy or hot foods. Some toothpastes and mouthwashes can also aggravate the condition. It should be said that eating such foods will not worsen the condition, Just cause some discomfort. You will learn what foods and drinks aggravate your condition thus enabling you to avoid these or be prepared for the consequences for a while afterwards.

Smoking and alcohol can also aggravate the condition, and although not proven, it has been suggested that allergies can have some effect too. Other possible causes which should be ruled out by your doctor are vitamin deficiencies such as Vitamin B12.

Hormonal changes can also trigger flare-ups of geographic tongue, as can prolonged periods of stress.

Are there any tests to diagnose geographic tongue?

No, diagnosis is made by looking at the tongue's appearance. It is however essential that you get an expert diagnosis from your healthcare professional that it is geographic tongue and not some other condition.

How is geographic tongue treated?

There are as yet no specific treatments for geographic tongue but there are treatment options available regarding pain relief. If oral thrush has been diagnosed, then there are specific treatments for this. Episodes of geographic tongue given enough time usually settles and resolves itself within weeks or months, but has been known in some cases to take as long as a year or more, before the tongue reverts to its normal appearance.

Is geographic tongue cancerous?

No, nor will it become cancerous.

How to help yourself?

As it is a condition that can sometimes be life-long, waxing and waning in the discomfort that it can cause. Learning to accept it, recognising your own tongue's patterns and cycles will help you. Learning what triggers painful attacks, whether by episodes of stress, certain foods, drinks, ill-health will help in your understanding to deal with It in a relaxed way. If you are experiencing discomfort In your mouth, get this checked out by either your doctor or your dentist who will be able to give you advice and a correct diagnosis.

Article first published in Skin 'n' Bones Issue 28 2008