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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 27  |  Issue : 1  |  Page : 112-114

Benign migratory glossitis: A rare presentation of a common disorder


Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India

Date of Submission02-Nov-2014
Date of Acceptance14-Jul-2015
Date of Web Publication12-Oct-2015

Correspondence Address:
Tarun Kumar
Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.167128

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   Abstract 

Benign migratory glossitis, also known as geographic tongue, is a recurrent condition of unknown etiology characterized by loss of epithelium, particularly of the filiform papillae on the dorsum of the tongue. Clinically, it appears as multifocal, circinate, irregular erythematous patches bounded by slightly elevated, white-colored keratotic bands. The condition is very common in adults and older age groups. The present article describes a rare presentation of geographic tongue in a 2.5-year-old child.

Keywords: Benign migratory glossitis, burning, cancer, child, geographic tongue


How to cite this article:
Kumar T, Puri G, Aravinda K, Arora N. Benign migratory glossitis: A rare presentation of a common disorder. J Indian Acad Oral Med Radiol 2015;27:112-4

How to cite this URL:
Kumar T, Puri G, Aravinda K, Arora N. Benign migratory glossitis: A rare presentation of a common disorder. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2019 May 26];27:112-4. Available from: http://www.jiaomr.in/text.asp?2015/27/1/112/167128


   Introduction Top


Benign migratory glossitis, also known as geographic tongue, is a recurrent condition of unknown etiology characterized by loss of epithelium, particularly of the filiform papillae on the dorsum of the tongue. The clinical features include multifocal, circinate, irregular erythematous patches bounded by slightly elevated, white-colored keratotic bands. Although the condition is very common in adults and older age groups, the present article describes a rare presentation of geographic tongue in a 2.5-year-old child.


   Case Report Top


A 2.5-year-old female patient [Figure 1] was brought to the Department of Oral Medicine and Radiology of Swami Devi Dyal Hospital and Dental College, with the chief complaint of white patches on the tongue since 6 months. Her mother gave a history of change of size, shape, and site of these patches on the dorsum of the tongue since its development. The mother reported that the patches persisted for 5-7 days and then they regressed spontaneously with a remission period of 10-15 days. Medical and dental history was non-contributory. On general physical examination, the child showed no sign of systemic involvement.
Figure 1: Frontal profi le

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On intraoral examination, the child presented with two erythematous lesions, roughly ovoid in shape, measuring about 2.5 × 1.5 cm and 2 × 1 cm, respectively, in their maximum dimensions, covering almost the entire dorsum of tongue and the right lateral border of the tongue [Figure 2]. The lesions had raised whitish circinate borders with irregular margins surrounded by erythmatous halo around. The lesions showed areas of depapillation with loss of filiform papillae. The lesions did not show any visible discharge. On palpation, all the inspectory findings were confirmed. The lesions were non-tender and non-scrapable. Based on the history and clinical examination, a working diagnosis of benign migratory glossitis (BMG) was considered.
Figure 2: Clinical presentation of lesion

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Exfoliative cytology was performed to know the nature of the lesion. The cytological smear was prepared and Papanicolaou (PAP) staining showed presence of Candida in the smear. No sign of cellular dysplasia was found on cytological examination. Blood examination revealed no signs of neutropenia. The patient's mother was reassured about the nature of the condition and advised to have regular checkup done every 6 months [Figure 3].
Figure 3: Lesion showing regression

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   Discussion Top


Benign migratory glossitis or geographic tongue is a common benign disorder of unknown etiology. The epithelium of the tongue is affected with loss of filiform papillae leading to smooth ulcer like-lesions that rapidly change the color and size. The lesions commonly occur on the tip, lateral borders, dorsum of the tongue, and sometimes extend to the ventral portion of the tongue. [1] The prevalence rate is between 1.0% and 2.5%. [2] According to Jainkttivong and Langlais, the highest incidence of geographic tongue is in the 20-29 years age group. [3] A higher female preponderance is reported. [3] Jainkittivong and Langlais observed higher rates in females (1.5:1) aged between 9 and 79 years in a population in Thailand. [3] The present case is of a female patient aged only 2.5 years. The condition is very rare in this age group, though it is more common in females. The disease is characterized by periods of exacerbation and remission during which the lesions heal without residual scar formation. These periods of remission may last for days, months, or years. [1],[3]

Clinical presentation

The majority of the patients are asymptomatic, but some patients complain of pain and burning sensation and decreased taste sensation. The tenderness or burning sensation disrupts the functioning of tongue. During exacerbation, the lesions may be accompanied by oral discomfort, burning, foreign body sensation, or paroxysmal pain in the ears or ipsilateral submandibular lymph nodes. [3],[4] The characteristic lesions of geographic tongue are seen on the anterior two-thirds of the dorsal and lateral borders and less commonly over the ventral surface. [1],[3] The classical lesion of the geographic tongue is a raised white margin where filiform papillae appear to be swollen and almost fused together. This white margin is usually 1-2 mm wide, which surrounds an erythematous atrophic area where the filiform papillae are apparently lost. The size of the individual lesions varies from 0.5 cm to larger in diameter.

A process similar to geographic tongue occurring in other areas of oral mucosa is called "ectopic geographic tongue." This was first described by Cooke (1955) under the name "erythema migrans." [4] In the literature, several other names are also in use for this condition, such as geographic stomatitis, [5],[6] stomatitis areata migrans, [7] erythema migrans, [8] and migratory stomatitis. [9] It is emphasized that the ectopic geographic tongue is the same process as the geographic tongue involving other areas of the oral mucosa. [10]

Diagnosis

Diagnosis is based upon history and clinical examination. Routine laboratory tests are usually normal. Biopsy and histological examination of the lesions is usually not required considering the benign nature of the disease, but may assist in reassuring patients, more so with cancer phobia, of the benign nature of the disease. [1] Exfoliative cytology was done in the present case which showed candidal association of the lesion. It may be due to the reason that Candida albicans is a normal inhabitant of the oral cavity.

Differential diagnosis

Differential diagnosis includes candidiasis, psoriasis, Reiter's syndrome, leukoplakia, lichen planus, systemic lupus erythematosis, herpes simplex, and drug reaction. In children local trauma, chemical burn, and severe neutropenia should be excluded. [1],[11]

Treatment

Patients do not usually require treatment apart from reassurance. The topical factors that exacerbate patient's symptoms, such as very hot, spicy, or acidic food, and dried salty nuts, should be avoided. [1] Various symptomatic treatments have been tried and include fluids, acetaminophen, mouth rinsing with topical anesthetic agent, antihistaminics, anxiolytics, and steroids. [1] Helfman reported satisfactory results after treating three patients with topical tretinoin. Vitamin A therapy resulted in partial improvement in some patients. [12] Abe et al. reported marked improvement in a 54-year-old female suffering from persistent and painful BMG for about 5 years by systemic administration of cyclosporin. The systemic treatment of cyclosporin microemulsion pre-concentrate, 3 mg/kg/day, resulted in a satisfactory improvement. Two months later, patient was started on maintenance therapy with cyclosporin microemulsion pre-concentrate at a dose of 1.5 mg/kg/day. [13]


   Conclusion Top


Benign migratory glossitis or geographic tongue is a common benign disorder of unknown etiology. The clinical presentation may vary from asymptomatic to painful and burning ulceration. The condition should be considered in the differential diagnosis of red and white lesions even in the early age group. Management of geographic tongue depends upon the clinical presentation and should include reassuring the patients, more so with cancer phobia, about the benign nature of the disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: An enigmatic oral lesion. Am J Med 2002;113:751-5.  Back to cited text no. 1
    
2.
Kovac-Kovacic M, Skaleric U. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. J Oral Pathol Med 2000;29:331-5.  Back to cited text no. 2
    
3.
Jainkittivong A, Langlais RP. Geographic tongue: Clinical characteristics of 188 cases. J Contemp Dent Pract 2005;1:123-35.  Back to cited text no. 3
    
4.
Cooke BE. Erythema migrans affecting the oral mucosa. Oral Surg Oral Med Oral Pathol 1955;8:164-7.  Back to cited text no. 4
[PUBMED]    
5.
Hume WJ. Geographic stomatitis: A critical review. J Dent 1975;3:25-43.  Back to cited text no. 5
[PUBMED]    
6.
Donelli RA. Geographic stomatitis (tongue and mucosae). J Clin Stomatol Conf 1964;5:21-2.  Back to cited text no. 6
    
7.
Saprio SM, Shklar G. Stomatitis areata migrans. Oral Surg Oral Med Oral Pathol 1973;36:28-33.  Back to cited text no. 7
[PUBMED]    
8.
Rood JP. An unusual presentation of erythema migrans. J Dent 1974;2:207-8.  Back to cited text no. 8
[PUBMED]    
9.
Zingale JA. Migratory stomatitis: A case report. J Periodontol 1977;48:298-302.  Back to cited text no. 9
[PUBMED]    
10.
Grinspan D, Fernández Blanco F, Agüero S, Bianchi O, Stringa S. Ectopic Geographic tongue and AIDS. Int J Dermatol 1990;29:113-6.  Back to cited text no. 10
    
11.
Binmadi NO, Jham BC, Meiller TF, Scheper MA. A case of deeply fissured tongue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:659-63.  Back to cited text no. 11
    
12.
Helfman RJ. The treatment of geographic tongue with topical Retin-A solution. Cutis 1975;50:179-80.  Back to cited text no. 12
    
13.
Abe M, Sogabe Y, Syuto T, Ishibuchi H, Yokoyama Y, Ishikawa O. Successful treatment with cyclosporine administration for persistent benign migratory glossitis. J Dermatol 2007;34:340-3.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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