GEOGRAPHIC TONGUE

Geographic tongue (GT), also known as benign migratory glossitis, is characterized by annular red and white lesions on the tongue.

• It is much more common in patients with psoriasis.
• It often goes unnoticed by the patient. Some however note soreness, especially when eating.

Clinical

Two clinical presentations are seen. In one, discrete, bald, red patches are seen. In the second, raised, annular white lines predominate. The condition may be asymptomatic or the patient may complain of soreness usually when eating.

Differential Diagnosis

Always consider Candidiasis which can often present similarly.

Treatment

No treatment is needed. For symptomatic patients, swish and spit tacrolimus can be safe and effective with 70% of patients reporting improvement [JAMA Derm 2018;154;1481]. The contents of a 1 mg tacrolimus capsule are dissolved into 500 mL of water. Patients are to swish the oral solution for 2 minutes before spitting the solution for disposal. This should be done 2/day. A topical steroid, e.g. fluocinonide gel 0.05% may be applied TID to acutely inflamed or eroded areas. Some patients have had benefit from gabapentin (100-200 mg) at bedtime for continued burning or discomfort.

RegionalDerm

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