Geographical language

In particular, the tongue is covered with dark pink or red spots, which vary in size from a few millimeters to a few centimeters and are surrounded by a raised white or yellow border.

This disease is recurrent in the sense that it tends to heal, but, after some time, it may reappear in the same location or in other parts of the tongue. It can occur in both children and adults and mainly affects the female sex.

What is geographic language?

Geographic tongue is a benign inflammatory condition of the oral cavity that causes an irregular pattern on the tongue that resembles a geographic map. People with geographic tongue develop smooth, red patches on the tongue that lack the papillae typically found on the surface of the tongue.

These red spots are surrounded by white borders with larger bumps on the surface or sides of the tongue (however, map tongue may rarely affect other areas of the mouth).

Apart from the absence of papillae on the tongue, geographic tongue is mostly asymptomatic, although about one in ten sufferers show a special sensitivity to the consumption of spicy and acidic foods.

Geographic tongue affects 1-3% of the world's population and, despite its potentially alarming appearance, it is painless and not contagious. Geographic tongue is similar in appearance to another disorder, called lengua plicata or scrotal tongue, which produces irregular grooves on the tongue, so we recommend that you consult your physician for a proper diagnosis.

Geographic tongue is less common in children, but can develop at any age and affects women twice as often as men.

Causes

Although migratory glossitis was first described more than 150 years ago, to this day its underlying cause remains unknown.

However, some useful conclusions can be drawn from the research conducted:

• It is certainly an inflammatory disease.
• No correlation with bacterial, viral or fungal infection has been found.
• It is neither infectious nor contagious.
• It is not a precancerous lesion.

Some atopic individuals appear to be more at risk of developing migratory glossitis than others, especially under particular conditions of emotional stress, such as those suffering from:

• Seborrheic dermatitis.
• Reiter's syndrome.
• Diabetes mellitus.

The geographic language is likely to have a Genetic basis. People with a family history of glossitis migrans may also develop the disease. The reason lies in the transmission of certain genes that are likely involved in the development of the disease, some research has observed an increase in DR5 and DRW6 leukocyte antigens in patients with migratory glossitis.

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Symptoms

As with most diseases, symptoms vary from patient to patient, but obviously the distinguishing feature is the presence of the typical lesions on the tongue, which in some ways resemble those of psoriasis.

It is often possible to identify a red area of variable size surrounded, at least in part, by an irregular white border. In some patients, similar lesions are also seen elsewhere in the oral cavity, such as on the roof of the mouth, the cheeks, under the tongue or on the gums.

The patient may experience some discomfort after ingestion of alcohol or spicy, acidic, salty and/or spicy foods.

Other symptoms, rarely present, are:

• Numbness of the tongue.
• Sensation of bitterness or dryness in the mouth.
• Loss of flavor.

In cases of more severe inflammation, complications may arise such as:

• Difficulty chewing and/or swallowing.
• Difficulty in speaking.
• Difficulty breathing.

The latter, due to airway obstruction caused by severe swelling of the tongue, usually develops during anaphylactic shock glossitis and represents a medical emergency.

Treatment of geographic language

Geographic tongue usually does not require any treatment, as it is a benign and self-limiting condition; however, there is no specific cure and it is generally suggested to simply pay special attention to oral hygiene, with thorough cleaning of the teeth at the end of each meal and the use of a Mouthwash.

All foods that may promote the onset of discomfort, such as salty snacks, citrus fruits, foods spiced with pepper or chili, or drinks and foods that are too hot or too cold, should be avoided.

Tobacco and alcohol consumption should be avoided.

Food supplements may be prescribed in case of vitamin, zinc or iron deficiency.

In some cases, antibiotic mouthwashes, antiseptics, antihistamines and/or analgesics are suggested , but these therapies, as well as the use of corticosteroids, antifungals, immunosuppressants (cyclosporine) and vitamin A derivatives (retinoids), do not seem to offer satisfactory results, especially in terms of risk/benefit ratio.

Psychotherapy may be useful in patients who are under particular stressful conditions.