MISCELLANEOUS LESIONS
Geographic Tongue
Geographic tongue (erythema migrans, benign migratory glossitis, erythema areata migrans, stomatitis areata migrans) is a common benign condition affecting primarily the dorsal surface of the tongue. Its incidence varies from slightly over 2% in the US population to 11 to 16% in other populations.
The condition is usually asymptomatic, but in one study of patients who experienced burning in the mouth, the burning was associated with geographic tongue in 24% of the patients. Tongue lesions are occasionally associated with similar-appearing ectopic lesions on the palate, buccal mucosa, or gingiva (Figure 5-42); this is called erythema circinata migrans or ectopic geographic tongue. Both conditions feature annular, circinate, or serpiginous lesions of the tongue with slightly depressed atrophic centers (devoid of filiform papillae) and raised white borders(Figure 5-43).Geographic Tongue
Geographic tongue (erythema migrans, benign migratory glossitis, erythema areata migrans, stomatitis areata migrans) is a common benign condition affecting primarily the dorsal surface of the tongue. Its incidence varies from slightly over 2% in the US population to 11 to 16% in other populations.
ASSOCIATION WITH PSORIASIS
There may be an association between certain types of psoriasis (especially pustular psoriasis) and geographic tongue.
However, there is controversy over whether the psoriasis patients who manifest geographic tongue actually have intraoral psoriasis. A report of two patients with concurrent pustular psoriasis and mucosal lesions having the characteristic picture of geographic tongue seems to support this hypothesis.Both skin lesions and oral lesions responded positively and in a parallel manner to systemic retinoid treatment, and both had identical histopathologic features. Further support for this association is seen in report of an unusual case of mucositis with features of psoriasis.In that case, a patient had skin psoriasis including crusted lesions of the upper lip and diffuse erythematous lesions of the labial and buccal mucosa and denture-bearing palatal mucosa. Classic geographic tongue and ectopic geographic tongue were also seen. Importantly, all the lesions had multiple pustules. These references seem to suggest an association between geographic tongue and psoriasis in some cases. Furthermore, both psori-
asis and benign migratory glossitis are associated with human leukocyte antigen (HLA)-Cw6 and HLA-DR5.
Also, stomatitis areata migrans was found in 5.4% of patients with psoriasis and in 1% of control patients whereas benign migratory glossitis was found in 10.3% of patients with psoriasis and in 2.5% of control patients.This association between these disorders gives supporting evidence that geographic tongue may be a manifestation of psoriasis.However, another study found that 10% of psoriasis patients had oral lesions histologically suggestive of psoriasis but that only 1% had classic geographic tongue.
Also, stomatitis areata migrans was found in 5.4% of patients with psoriasis and in 1% of control patients whereas benign migratory glossitis was found in 10.3% of patients with psoriasis and in 2.5% of control patients.This association between these disorders gives supporting evidence that geographic tongue may be a manifestation of psoriasis.However, another study found that 10% of psoriasis patients had oral lesions histologically suggestive of psoriasis but that only 1% had classic geographic tongue.
OTHER ASSOCIATED CONDITIONS
Ectopic geographic tongue is frequently associated with similar tongue lesions. This is especially true in patients with atopy.There is a significant increase in the prevalence of ectopic geographic tongue in atopic patients who have intrinsic asthma and rhinitis versus patients with negative skin test reactions to various antigens.Also, patients with geographic tongue have a significantly greater personal or family history of asthma, eczema, and hay fever, when compared to control populations.Benign migratory glossitis is seen with a fourfold increase in frequency in patients with juvenile diabetes, possibly due to an increased frequency of elevated amounts of the HLA-B15 tissue type.Importantly, this tissue type also has a higher prevalence in atopic individuals.
Geographic tongue has also been seen with increased frequency in patients with pernicious anemia (this often appears as an erythematous form of geographic tongue) (Figure 5-44) and in pregnant patients, in whom it is possibly associated with folic acid deficiency or hormonal fluctuations. Association with the latter condition is supported by one report in which the severity of geographic tongue appeared to vary with hormonal levels.Lesions that are histologically indistinguishable from those of geographic tongue can also be seen in Reiter’s syndrome. The development of geographic tongue has also been associated with the administration of lithium carbonate.
Ectopic geographic tongue is frequently associated with similar tongue lesions. This is especially true in patients with atopy.There is a significant increase in the prevalence of ectopic geographic tongue in atopic patients who have intrinsic asthma and rhinitis versus patients with negative skin test reactions to various antigens.Also, patients with geographic tongue have a significantly greater personal or family history of asthma, eczema, and hay fever, when compared to control populations.Benign migratory glossitis is seen with a fourfold increase in frequency in patients with juvenile diabetes, possibly due to an increased frequency of elevated amounts of the HLA-B15 tissue type.Importantly, this tissue type also has a higher prevalence in atopic individuals.
Geographic tongue has also been seen with increased frequency in patients with pernicious anemia (this often appears as an erythematous form of geographic tongue) (Figure 5-44) and in pregnant patients, in whom it is possibly associated with folic acid deficiency or hormonal fluctuations. Association with the latter condition is supported by one report in which the severity of geographic tongue appeared to vary with hormonal levels.Lesions that are histologically indistinguishable from those of geographic tongue can also be seen in Reiter’s syndrome. The development of geographic tongue has also been associated with the administration of lithium carbonate.