Unusual tongue markings

Well-demarcated, map-like tongue markings are consistent with migratory glossitis, also called geographic tongue, and can be recognized by its distinct clinical appearance. If performed, a biopsy would show psoriasiform mucositis.

Migratory glossitis is an uncommon condition found mostly in adults and occasionally in children. The prevalence may be as high as 2.5% globally and it may occur in conjunction with psoriasis, sharing some histologic features.¹ (On close inspection, this patient was noted to have plaques on his elbows that were consistent with psoriasis.) While an immunogenic cause is suspected, the exact etiology is unknown.

Patients may develop these clinical findings quickly and just as quickly they may resolve. Discomfort and taste disturbances rarely occur. Hot, spicy, or acidic foods may be a contributing trigger. Tobacco-use appears to be protective. The presence of ulceration should prompt evaluation for a different diagnosis, such as erosive lichen planus, leukoplakia, candidiasis, or Behçet syndrome.

With minimal symptoms, treatment is rarely needed. Patients with any discomfort can be treated with topical lidocaine 2% swish and spit mouthwash, topical tacrolimus, or topical steroids.

The patient in this case was reassured that the diagnosis was not concerning and he was observed without active treatment. His psoriasis was treated with topical clobetasol ointment 0.05%. He has continued to have intermittent flares that he has yet to associate with any specific dietary causes.

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Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

Well-demarcated, map-like tongue markings are consistent with migratory glossitis, also called geographic tongue, and can be recognized by its distinct clinical appearance. If performed, a biopsy would show psoriasiform mucositis.

Migratory glossitis is an uncommon condition found mostly in adults and occasionally in children. The prevalence may be as high as 2.5% globally and it may occur in conjunction with psoriasis, sharing some histologic features.¹ (On close inspection, this patient was noted to have plaques on his elbows that were consistent with psoriasis.) While an immunogenic cause is suspected, the exact etiology is unknown.

Patients may develop these clinical findings quickly and just as quickly they may resolve. Discomfort and taste disturbances rarely occur. Hot, spicy, or acidic foods may be a contributing trigger. Tobacco-use appears to be protective. The presence of ulceration should prompt evaluation for a different diagnosis, such as erosive lichen planus, leukoplakia, candidiasis, or Behçet syndrome.

With minimal symptoms, treatment is rarely needed. Patients with any discomfort can be treated with topical lidocaine 2% swish and spit mouthwash, topical tacrolimus, or topical steroids.

The patient in this case was reassured that the diagnosis was not concerning and he was observed without active treatment. His psoriasis was treated with topical clobetasol ointment 0.05%. He has continued to have intermittent flares that he has yet to associate with any specific dietary causes.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).

Well-demarcated, map-like tongue markings are consistent with migratory glossitis, also called geographic tongue, and can be recognized by its distinct clinical appearance. If performed, a biopsy would show psoriasiform mucositis.

Migratory glossitis is an uncommon condition found mostly in adults and occasionally in children. The prevalence may be as high as 2.5% globally and it may occur in conjunction with psoriasis, sharing some histologic features.¹ (On close inspection, this patient was noted to have plaques on his elbows that were consistent with psoriasis.) While an immunogenic cause is suspected, the exact etiology is unknown.

Patients may develop these clinical findings quickly and just as quickly they may resolve. Discomfort and taste disturbances rarely occur. Hot, spicy, or acidic foods may be a contributing trigger. Tobacco-use appears to be protective. The presence of ulceration should prompt evaluation for a different diagnosis, such as erosive lichen planus, leukoplakia, candidiasis, or Behçet syndrome.

With minimal symptoms, treatment is rarely needed. Patients with any discomfort can be treated with topical lidocaine 2% swish and spit mouthwash, topical tacrolimus, or topical steroids.

The patient in this case was reassured that the diagnosis was not concerning and he was observed without active treatment. His psoriasis was treated with topical clobetasol ointment 0.05%. He has continued to have intermittent flares that he has yet to associate with any specific dietary causes.

‌

Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).