March 27, 2020
Years published: 1987, 1988, 1989, 2002, 2009, 2012, 2020
NORD gratefully acknowledges Martha Ann Keels, DDS, PhD, Adjunct Associate Professor, Department of Pediatrics, Duke University and Esther L. B. Childers, DDS, Chair, Department of Diagnostic Services; Professor, Oral and Maxillofacial Pathology, Howard University College of Dentistry, for assistance in the preparation of this report.
Geographic tongue is a benign condition characterized by inflammation of the tongue (glossitis) that appears in a map-like (geographic) pattern. The normal tongue is covered by a layer of small bumps known as papillae. In affected individuals, certain areas of the tongue are missing these bumps. These affected areas usually appear as smooth, red or pink colored, degenerated (atrophic) patches. Geographic tongue tends to come and go it usually heals without treatment, but will recur again usually affecting a different area of the tongue. Most cases are not associated with any symptoms (asymptomatic) and the condition usually goes away without treatment. Geographic tongue is not associated with any long-term health complications in healthy individuals. The exact cause of geographic tongue is unknown.
In many cases, geographic tongue does not cause symptoms (asymptomatic). Symptoms that have been reported in association with geographic tongue include general discomfort of the tongue or mouth and soreness or a burning sensation of the tongue, which is often worsened by spicy or acidic foods.
The characteristic lesion in geographic tongue is reddish (erythematous), degenerated (atrophic) patch or area on the tongue that is abnormally smooth because of the lack of the small bumps that normally cover the tongue. These patches may have a slightly elevated, yellowish or white border. These patches cover the tongue in an irregular pattern giving the tongue a characteristic map-like appearance. The patches may change in size, shape and location from day to day.
In some cases, pain may occur or the lymph nodes under the lower jaw (submandibular lymph nodes) may become enlarged. In rare cases, pain or discomfort may be persistent. Pain typically arises from acidic foods that burn the lesions. Avoiding acidic drinks and foods will help alleviate the discomfort.
When these lesions affect areas in the mouth other than the tongue, the condition may be referred to as another name such as erythema migrans or geographic stomatitis. Such sites include the mucous membrane lining the inside of the cheek (buccal mucosa), the floor of the mouth, the roof of the mouth, and the gums (gingiva).
The exact cause of geographic tongue is unknown. The condition often runs in families suggesting that genetics may play a role in the development of the disorder. Geographic tongue is often associated with a fissured tongue, a condition with a strong genetic link further suggesting that heredity plays a significant role in the development of geographic tongue.
A fissured tongue is a benign condition that is characterized by numerous shallow or deep grooves or furrows (fissures) on the back (dorsal) surface of the tongue. The surface furrows may differ in size and depth, radiate outward, and cause the tongue to have a wrinkled appearance.
In addition to fissured tongue, geographic tongue has been associated with many other conditions especially psoriasis. Psoriasis a chronic, inflammatory skin disease characterized by dry, reddish (erythematous), thickened patches of skin that are covered with silvery-gray scales. These patches may be referred to as papules or plaques and most often affect the scalp, elbows, knees, hands, feet and/or lower back.
Additional conditions with that may occur in conjunction with geographic tongue include allergies, emotional stress, juvenile diabetes, Reiter’s syndrome and hormonal disturbances. However, no definitive link has been established between geographic tongue and any of these conditions.
Some reports in the medical literature suggest that geographic tongue affects females slightly more often than males. It appears to occur with greater frequency in young adults. The prevalence of geographic tongue is unknown, but it is estimated to occur in approximately 1-3 percent of the general population.
A diagnosis of geographic tongue is made based upon a thorough clinical evaluation, a detailed patient history and the characteristic appearance of the tongue lesions associated with this disorder. In most cases, surgical removal and microscopic study (biopsy) of affected tissue is not necessary because of the distinct appearance of the tongue.
Medical treatment is not required for this benign disorder. Some physicians advise patients to avoid irritants and substances that may sensitize the tongue. A bland or liquid diet, preferably cooled, is perhaps better. Meticulous oral hygiene is important, but care should be taken to preserve proper bacterial balance within the mouth.
If pain or discomfort is persistent, some physicians may recommend anti-inflammatory drugs or numbing agents that are applied directly to the affected areas (topical analgesics).
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Gonzalez-Alvarez L, Garcia-Martin JM, Garcia-Pola MJ. Association between geographic tongue and psoriasis: A systematic review and meta-analysis. J Oral Pathol Med. 2019; 48(5):365-372.
Dafar A, Cevik-Aras H, Robledo-Sierra J, Mattsson U, Jontell M. Factors associated with geographic tongue and fissured tongue. Acta Odontol Scand. 2016; 74:210-216.
Abe M, Sogabe Y, Syuto T, et al. Successful treatment with cyclosporine administration for persistent benign migratory glossitis. J Dermatol. 2007;34:340-343.
Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis. 2006;12:381-386.
Jainkittivong A,Langlais RP. Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract. 2005;6:123-135.
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Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Peadiatr Dent. 2005;15(2):89-97.
Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. Am J Med. 2002 Dec 15;113(9):751-5.
Flaitz CM. Ectopic erythema migrans in an adolescent with a skin disorder. Pediatr Dent. 2000;22:63-64.
Sigal MJ, Mock D. Symptomatic benign migratory glossitis: report of two cases and literature review. Pediatr Dent.1992 Nov-Dec;14(6):392-6.
Kelsch R. Geographic Tongue.Medscape. Updated: May 14, 2018. Available at: http://www.emedicine.com/derm/topic664.htm Accessed Jan 13, 2020.
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