December 2002

Case submitted by Youn W. Park, MD, and Philip Gilcrest, MD

		CASE: A 32-year-old woman discovers abnormal patches on her tongue during a self-examination prompted by mild discomfort. She is a nonsmoker and reports no other symptoms. WHAT IS YOUR DIAGNOSIS?
		Migratory glossitis or erythema migraines, commonly called geographic tongue, is noted in 1% to 6% of the population. It occurs most often in adult women and in the elderly (rarely in children). Typically, the dorsum of the tongue shows a white margin of desquamating epithelium of varying size and shape surrounding a red, slightly depressed area. These patches disappear and reappear in different areas throughout the patient's life. The cause is unknown. Histopathologic findings include superficial erosion and inflammation. Fissured tongue ("scrotal" tongue) is frequently associated with this condition. Since geographic tongue remains mostly asymptomatic and no malignant degeneration has been reported, treatment is not required. However, if pain develops on the eroded areas, triamcinolone acetonide dental paste or lidocaine jelly may be applied for symptomatic relief.

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Dr. Park is a clinical professor of otolaryngology at Northeastern Ohio Universities College of Medicine and an attending physician in the section of otolaryngology at Akron General Medical Center, Akron, Ohio. Dr. Gilcrest is an attending physician in the department of family practice at Akron General Medical Center.