87 Geographic tongue Jennifer K. Chen and Janellen Smith Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports (From Daniels, T.E., 2012. In: Goldman, L., Schafer, A.I. (Eds.), Goldman’s Cecil Medicine, 24th ed. Philadelphia, Saunders, pp. 2449–2454.) Geographic tongue is a reactive mucosal inflammatory condition characterized by arcuate or annular alternating hypertrophic or atrophic filiform papillae producing a geographic pattern. Synonyms include benign migratory glossitis and glossitis areata migrans. Geographic tongue may be an asymptomatic incidental finding. Similar changes may occur in oral sites other than the tongue (geographic stomatitis or benign migratory stomatitis). Management strategy Geographic tongue is a common glossitis that affects 2% of the population. There is no racial predilection and the condition may be seen in patients of all ages, more often children than adults. If asymptomatic, no treatment is necessary other than reassurance that the condition is benign and usually not a sign of systemic illness. Geographic tongue often will remit spontaneously, but may persist for years. Occasionally, patients may complain of a burning discomfort, particularly in atrophic areas. Effective therapy can be challenging. Geographic tongue has been associated with psoriasis (especially pustular psoriasis), reactive arthritis, pityriasis rubra pilaris, atopic diathesis, Down syndrome, nutritional deficiency, diabetes, hormonal changes, and medications such as lithium, oral contraceptives, and bevacizumab. The clinician should also consider acute or chronic atrophic candidiasis. For symptomatic patients, measures that may be considered include the avoidance of hot, spicy, or acidic foods; gentle brushing of the tongue; avoidance of harsh antibacterial mouthwashes, chewing gum, and breath mints; and soothing rinses with saline solutions. Occasionally, the topical application of fluorinated corticosteroids or diphenhydramine elixir after meals and at bedtime may be recommended. Topical anesthetic rinses or gels provide temporary relief. Anti-yeast treatments may be palliative. Specific investigations Culture for candidiasis If symptomatic, consider complete blood cell count, iron panel, vitamin B, folate, and zinc levels, glucose, and hemoglobin A1c No investigation necessary in asymptomatic patients Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Cat scratch disease Mucoceles Tinea capitis Herpes genitalis Necrolytic migratory erythema Nevoid basal cell carcinoma syndrome Stay updated, free articles. Join our Telegram channel Join Tags: Treatment of Skin Disease Comprehensive Therapeutic Strategies Aug 7, 2016 | Posted by admin in Dermatology | Comments Off on Geographic tongue Full access? Get Clinical Tree
87 Geographic tongue Jennifer K. Chen and Janellen Smith Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports (From Daniels, T.E., 2012. In: Goldman, L., Schafer, A.I. (Eds.), Goldman’s Cecil Medicine, 24th ed. Philadelphia, Saunders, pp. 2449–2454.) Geographic tongue is a reactive mucosal inflammatory condition characterized by arcuate or annular alternating hypertrophic or atrophic filiform papillae producing a geographic pattern. Synonyms include benign migratory glossitis and glossitis areata migrans. Geographic tongue may be an asymptomatic incidental finding. Similar changes may occur in oral sites other than the tongue (geographic stomatitis or benign migratory stomatitis). Management strategy Geographic tongue is a common glossitis that affects 2% of the population. There is no racial predilection and the condition may be seen in patients of all ages, more often children than adults. If asymptomatic, no treatment is necessary other than reassurance that the condition is benign and usually not a sign of systemic illness. Geographic tongue often will remit spontaneously, but may persist for years. Occasionally, patients may complain of a burning discomfort, particularly in atrophic areas. Effective therapy can be challenging. Geographic tongue has been associated with psoriasis (especially pustular psoriasis), reactive arthritis, pityriasis rubra pilaris, atopic diathesis, Down syndrome, nutritional deficiency, diabetes, hormonal changes, and medications such as lithium, oral contraceptives, and bevacizumab. The clinician should also consider acute or chronic atrophic candidiasis. For symptomatic patients, measures that may be considered include the avoidance of hot, spicy, or acidic foods; gentle brushing of the tongue; avoidance of harsh antibacterial mouthwashes, chewing gum, and breath mints; and soothing rinses with saline solutions. Occasionally, the topical application of fluorinated corticosteroids or diphenhydramine elixir after meals and at bedtime may be recommended. Topical anesthetic rinses or gels provide temporary relief. Anti-yeast treatments may be palliative. Specific investigations Culture for candidiasis If symptomatic, consider complete blood cell count, iron panel, vitamin B, folate, and zinc levels, glucose, and hemoglobin A1c No investigation necessary in asymptomatic patients Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Cat scratch disease Mucoceles Tinea capitis Herpes genitalis Necrolytic migratory erythema Nevoid basal cell carcinoma syndrome Stay updated, free articles. Join our Telegram channel Join Tags: Treatment of Skin Disease Comprehensive Therapeutic Strategies Aug 7, 2016 | Posted by admin in Dermatology | Comments Off on Geographic tongue Full access? Get Clinical Tree
