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Geographic Tongue

Overview

Geographic tongue causes island-shaped lesions that give your tongue a map-like appearance. The lesions can appear on the upper surface and sides of the tongue. They look ragged and uneven, and sometimes have white borders or edges.

The lesions are harmless. They’re not a sign of an infection, cancer, or other serious medical issue. Instead, the misshapen spots are a sign of inflammation affecting your tongue’s surface.

On a healthy tongue, tiny, finger-like extensions called papillae stick up and help you eat, swallow, and taste. If you have geographic tongue, those papillae disappear, leaving behind patches of your tongue that are bald, smooth, and red.

Geographic tongue is also known as erythema migrans tongue. This is a very different condition than erythema migrans (or erythema chronicum migrans), which is a rash that appears in people who have Lyme disease.

If the map-like spots begin appearing in other parts of your mouth, such as under your tongue or on the soft palate, you may have another condition called stomatitis erythema migrans. It has the same symptoms and signs of classic geographic tongue, but the lesions have spread beyond the tongue.

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Symptoms

Symptoms of geographic tongue

Geographic tongue does not always cause symptoms. Some people will not notice the change in appearance and only receive a diagnosis after a doctor’s exam. People who do notice symptoms may initially see signs on the tongue. These signs and symptoms are distinct. That often makes diagnosis easy for your doctor.

The symptoms of geographic tongue include:

  • irregular, island-shaped red lesions that are smooth and possibly sensitive
  • white or light-colored borders that may be slightly raised around the edges of the lesions
  • patches or lesions of varying sizes and shapes
  • patches or lesions that appear to “migrate” or move from one area of the tongue to another in a matter of days or weeks
  • patches that come and go very quickly
  • sensitivity to certain substances, including cigarette smoke, toothpaste, mouthwashes, sweets, sugar, and hot, spicy, or highly acidic foods
  • mild discomfort or burning sensations on the tongue or in the mouth

Symptoms can last as long as a year, and they may return at another point.

Some people who experience a geographic tongue will also develop a fissured tongue. These two conditions occur together frequently. A fissured tongue causes cracks and grooves in the surface of the tongue. These indentations can be irritating and sometimes painful.

Causes

Causes of geographic tongue

Researchers do not know exactly why geographic tongue develops, but certain people may be more likely to develop it than others. These people typically have a disease or condition that increases their risk.

Psoriasis

This common skin condition causes a build-up of skin cells on the surface of the skin. The overabundance of skin cells can turn into thick scaly patches that are frequently itchy and uncomfortable. People with psoriasis are more likely to develop geographic tongue, and some experts think geographic tongue is an oral form of psoriasis.

Lichen planus

This inflammatory condition causes bumps and lesions on the surface of the skin or inside the mouth. A geographic tongue may be the oral form of this condition.

Vitamin B deficiency

Having too little vitamin B can cause inflammation, swelling, and other symptoms on the tongue. People who are vitamin B deficient are more likely to have bald areas on the tongue. These areas are where the papillae have disappeared. People who do not have enough vitamin B may also develop geographic tongue.

Pregnancy

Pregnant women go through a lot of hormonal changes, and the growing fetus saps a lot of nutrients from the mother’s body. This can make a mother vitamin deficient, and she may experience symptoms like a geographic tongue.

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When to call your doctor

When to call your doctor

If you notice unusual lesions on your tongue and you begin experiencing breathing problems, difficulty speaking, or an inability to swallow or chew, seek emergency medical attention. You may be experiencing a more serious condition that is not geographic tongue.

A geographic tongue may be uncomfortable, but it’s not a sign of a larger or more serious problem. If you notice the telltale signs of the condition or begin developing irritation or pain, make an appointment to see your doctor. Most cases of geographic tongue will go away without treatment in a few days.

How long it lasts

How long does geographic tongue last?

Symptoms may appear for a few days and then disappear for several months. Likewise, the map-like appearance may be present for several months and then disappear for years. Doctors do not yet understand why some people have longer episodes, and they don’t have any way of knowing who will experience the condition later.

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Complications

Complications of geographic tongue

A geographic tongue is not a sign of a more serious condition, so you do not have to worry about it developing into something else. Some people with geographic tongue may experience anxiety and worry because of their tongue’s unusual appearance, but the condition is not serious. It’s also not contagious, so you cannot pass it to someone by kissing or sharing food utensils.

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Diagnosis

Diagnosis of geographic tongue

Geographic tongue is very distinct, so your doctor may only need to see your tongue to make a diagnosis. Still, your doctor may decide to rule out other possible conditions to make sure the lesions are not the result of another disease or problem.

To do this, your doctor may use blood tests to look for markers of inflammation, infection, or nutritional deficiencies. They may also use a lighted instrument to inspect the mouth, throat, and tongue for signs of other conditions. Rarely, a biopsy of skin may be necessary if the condition does not resolve in a few weeks.

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Treatment options

Treatment options

Geographic tongue does not have a treatment or cure. Most lesions and symptoms will disappear in a few days or weeks. Still, some treatments may help reduce symptoms:

  • OTC medicine: Any pain or discomfort caused by the lesions may be treated with an over-the-counter pain medicine like ibuprofen or naproxen sodium.
  • Prescription medicine: Your doctor may prescribe a corticosteroid rinse to help reduce the inflammation. A mouth rinse with a mild anesthetic may also help reduce pain and irritation.
  • Avoid problem foods: If you experience greater irritation with certain foods, avoid them. Foods that commonly cause irritation or a burning sensation include hot or spicy foods, acidic foods, salty foods, and sweet foods.
  • Avoid flavored toothpaste: Toothpastes that are highly flavored or have added astringent cleaning ingredients may irritate your tongue.
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