An Overview of Geographic Tongue

Benign migratory glossitis, also called geographic tongue, is a harmless condition affecting the tongue's mucous membrane. It causes discolored bald spots on the tongue's surface that often appear in island-like patches, making the tongue's surface look like a map.

This article explains what geographic tongue is and how to tell if you have it. It explains how geographic tongue is diagnosed and what you can do to manage symptoms.

Symptoms

Geographic tongue is fairly common, and you may be alarmed by how your tongue appears. However, the condition is benign, meaning harmless. In fact, some people may not even realize they have an issue with their tongue until it's noticed by a doctor such as during a routine dental exam.

Common characteristics of geographic tongue include:

• Bald patches or lesions on the tongue's surface
• Discoloration of the tongue, usually white, pink, or red patches
• Raised areas on the tongue with a defined border
• Occasionally, lesions that appear in other mucosal areas of the body such as the labia (outer lips that protect the vagina)
  

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People who experience geographic tongue may have periods when the symptoms disappear, but the lesions may return. In addition to coming and going at random, lesions may change size or shape, change location, or change color (usually they appear as white, yellow, pink, or red). It's possible that only one area of the tongue may be affected, or several areas might have patches and lesions.

Lesions may change slowly over the course of several days, but sometimes geographic tongue lesions can change over the course of a single day or even within a few hours.

For most people, the condition is painless. However, some people who experience geographic tongue report sensitivity to hot or spicy foods, acidic food like citrus fruit, alcohol, and tobacco.

Causes

The exact cause of geographic tongue isn't known. However, there are many theories associated with the disorder.

Many people with the condition say that it appears during times of stress. It also seems to run in families, implying there's a possible genetic or environmental cause. One study exploring the possible connection with psoriasis did identify a possible genetic link. Specifically, people with geographic tongue may have a variant on a protein coding gene known as interleukin-1 beta (IL-1B).

In some cases, certain habits such as teeth grinding have been linked to the development of geographic tongue. Additionally, people who have grooves along the surface of the tongue, a condition known as fissured tongue, may be more likely to develop geographic tongue.

Other potential causes of geographic tongue include:

• Diet-related causes (food sensitivities and nutrient deficiencies)
• Allergies (metals and environmental material)
• Hormone-related causes (use of oral contraceptives)
• Dermatologic conditions (psoriasis and eczema)
• Autoimmune disorders and other inflammatory conditions
• Chronic diseases (diabetes)
• Hereditary disorders (chronic granulomatous disease, a genetic disorder that causes abnormal white blood cells)
  

Diagnosis

Geographic tongue is often diagnosed accidentally when a doctor or dentist notices the condition during a routine exam.

However, some people specifically seek treatment for their tongue because they're worried that the symptoms they see are a sign of a serious health problem such as an infection or cancer.

Before diagnosing geographic tongue, a doctor will visually examine your mouth and ask questions such as "When did the lesions appear?" or "Are the lesions causing you pain?"

Doctors usually do not need to order any specific tests to diagnose geographic tongue. If there is uncertainty about the diagnosis, or if doctors want to rule out another condition, they may take a tissue sample from the tongue for biopsy.

Other conditions that can look similar to geographic tongue include:

• Chemical burn
• Psoriasis
• Fungal infection such as candidiasis
• Lichen planus
• Contact stomatitis (sensitivities or allergic reactions to substances such as toothpaste)
• Oral cancers (rare)
  

Treatment

Geographic tongue does not require any treatment because it's benign, resolves on its own, and usually doesn't cause pain. If someone with the condition notices sensitivity to certain foods, drinks, or substances (such as tobacco or toothpaste), they may want to take note of what irritates the lesions and avoid them when the condition is present or flaring up.

In some instances, allergy medication (antihistamine) might help. However, if you experience geographic tongue as a result of a chronic health condition (such as psoriasis), you'll need to treat the underlying condition in order to heal the lesions.

Summary

Geographic tongue usually causes mild symptoms or possibly no symptoms. Your tongue may have changes in appearance that come and go, but these don’t cause permanent damage to the tongue. There are no long-term health consequences associated with geographic tongue. 

While there are theories about why people develop geographic tongue, none have been proven. Your doctor can diagnose the condition based on symptoms. However, they may need to do further testing to be sure that tongue lesions and other symptoms aren't related to an underlying condition that needs to be treated.

A Word From Verywell

Since most people who have benign migratory glossitis don't realize they have it, finding painful lesions in the mouth can be alarming. The condition usually doesn't require medication, but if you're in pain, talk to your doctor. They can recommend treatments such as topical steroids, antihistamines, or soothing mouth rinses. More importantly, geographic tongue may be a sign that you have a more serious condition. Getting a thorough examination and an accurate diagnosis is important to solve the problem.