Exfoliation areata linguae K14.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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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 through the mucous membrane of the tongue, which form into anular or polycyclic figures ("wandering rash; wandering plaques").

Occurrence/Epidemiology
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In dental collectives, prevalences between 0.6 and 9.8% are reported. Other prevalence figures are given as 1 - 3%. No established gender preference.

Etiopathogenesis
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Unsolved. Gastric anaemia, gastritis, nutritive factors as well as psychogenic, neurohumoral and genetic factors are discussed.

Combination with lingua plicata is frequent. Versch. Authors regard the migrating plaques as a precursor stage of lingua plicata.

Glossitis mediana rhombica is considered to be a variant of the migrating plaques.

Also in cases of streptococcal infections or candida infections.

Commonly occurring in patients with psoriasis(Psoriasis pustulosa - Dreyer LN et al. 2012).

It is not uncommon for migrating plaques to be observed as side effects 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 Surgery Oral Med Oral Catholic Oral Radiol 114:444-448
  2. Dreyer LN et al (2012) Oral manifestations of psoriasis. Clinical presentation and 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. Pass B et al (2005) Geographic tongue: literature review and casereports. Dent Today 54: 56-57
  5. Sibaud V et al (2014) Oral toxicity of targeted anticancer therapies. Ann Dermatol Venereol 141:354-363
  6. 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: 29.10.2020