Exfoliation areata linguae K14.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 11.07.2022

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Synonym(s)

Benign migratory glossitis; Benign migratory stomatitis; Exfoliatio linguae et mucosae oris; exfoliation areata dolorosa; Exfoliative linguae et mucosa oris; Exfoliatives areata dolorosa; exudative glossitis areata; geographic tongue; glossitis exfoliativa marginata; Glossitis geographica; Glossitis migrans; Hiking plaques; lingua geographica; Stomatitis areata migrans; Tongue of the map; Wandering rash of the tongue

Definition
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Self-limiting, chronic exfoliative, superficial epithelial detachments migrating over the mucosa of the tongue and forming anular or polycyclic figures ("wandering rash; wandering plaques").

In rare cases, other sites of the oral cavity may also be affected. These changes are called exfoliatio areata mucosae oris or stomatits geographica.

Occurrence/Epidemiology
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In dental collectives, prevalences between 0.6 and 9.8% are reported. Other prevalence figures are reported as 1 - 3%. No confirmed sex preference (w>m?).

Etiopathogenesis
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Unexplained. Gastric anacidity, gastritis, nutritive factors, and psychogenic, neurohumoral, and genetic factors are discussed.

Combination with lingua plicata is common. Versch. Authors consider migratory plaques as a precursor stage of lingua plicata.

Glossitis mediana rhombica is considered a variant of wandering plaques.

Also seen in streptococcal infections or Candida infections.

Commonly seen in patients with psoriasis(pustular psoriasis - Dreyer LN et al. 2012).

Furthermore, lingua geogrpahica is a partial manifestation of Reiter syndrome.

It is observed more frequently in Down syndrome.

Not infrequently, migratory plaques are observed as side effects in the context of oral toxicity of tyrosine kinase inhibitors .

Manifestation
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For toddlers, teenagers and young adults.

Clinical features
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Migrating exfoliation of the upper epithelial layer of the mucous membrane of the tongue. This leads to anular, garland-shaped or map-shaped, plaque free (rejection of the hypertrophic papillae of the tongue surface), deep red (naked) plaques which are bordered by a raised and whitish swollen, ragged rim. After several months of latency the rejected papillae regenerate again. The tongue surface appears normal again. Possibly tongue burning. It is not uncommon for the lingua geographica to be associated with a lingua plicata.

Histology
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Epithelial narrowing in the centre of the flock, epithelial widening in the peripheral area. Edema, inflammatory cell infiltrates with numerous epitheliotropic neutrophil granulocytes, more rarely spongiform pustules are detectable; loss of elastic fibres.

Differential diagnosis
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Glossitis in pernicious anaemia; anulus migrans in psoriasis pustulosa generalisata.

Therapy
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Not necessary, education about harmlessness of the findings. In case of burning sensations mouth rinses with camomile extract (Kamillosan), salviathymol or dexpanthenol R066. Avoid strongly spiced dishes, citrus fruits, pineapple. If streptococci or Candida are detected, antimicrobial treatment.

Progression/forecast
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Although harmless, the disease is extremely annoying and characterized by occasional tongue burning. Spontaneous healings are frequent, lifelong persistence is possible.

Literature
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  1. Ching V et al (2012) Increased prevalence of geographic tongue in burning mouth complaints: a retrospective study. Oral Surg Oral Med OralPathol Oral Radiol 114:444-448.
  2. Dreyer LN et al (2012) Oral manifestations of psoriasis. Clinical presentationand management. N Y State Dent J 78:14-18
  3. Gupta T et al (2014) Medical image. A benign glossal lesion. Geographic tongue.N Z Med J 127:88-90
  4. Jainkittivong A et al (2005): Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract 6:123-135.
  5. Pass B et al (2005) Geographic tongue: literature review and casereports. Dent Today 54: 56-57
  6. Prinz H (1927): Wandering rash of the tongue. The Dental Cosmos 69 (4):272-275
  7. Sibaud V et al (2014) Oral toxicity of targeted anticancer therapies. Ann Dermatol Venereol 141:354-363
  8. Tarakji B et al.(2014) Relation between psoriasis and geographic tongue. J Clin Diagn Res 8: ZE06-07.

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 11.07.2022