- An acute or chronic inflammation of the tongue, either as primary disease or a symptom of systemic disease
- Common forms:
- Atrophic glossitis (AG) or Hunter glossitis or smooth tongue
- Benign migratory glossitis (BMG) or geographic tongue (GT) or erythema migrans or annulus migrans
- Median rhomboid glossitis (MRG)
- Herpetic geometric glossitis (HGG)
- System(s) affected: gastrointestinal (GI)
Predominant age: all ages; predominant gender: male > female (3:1, MRG)
Many patients with glossitis caused by nutritional deficiencies are postmenopausal or elderly.
Varies; usual reported range: 1–14%; higher with nutritional deficiencies
Etiology and Pathophysiology
- Nutritional deficiencies (e.g., vitamin B12, folic acid, ascorbic acid)
- Anemia (pernicious, iron deficiency)
- HIV (opportunistic infections such as candidiasis [MRG], herpes simplex virus [HSV]; or HIV-associated changes such as loss of papillae)
- Broad-spectrum antibiotics
- Topical or inhaled corticosteroids
- Various other medications (e.g., captopril, clarithromycin, enalapril, lansoprazole, lithium, metronidazole, NSAIDs)
- Infections (e.g., HSV, Epstein-Barr virus, candidiasis)
- Trauma (ill-fitting dentures, piercings, burns, convulsive seizures)
- Primary irritants (alcohol, tobacco, hot foods, spices, excessive peppermint, citrus)
- Sensitization with chemical irritants (e.g., dyes, mouthwash, toothpaste, systemic drugs)
- Malignancy (95% are squamous cell)
- AG: atrophy of filiform papillae
- BMG: erythematous, yellow-white lesions (dorsum)
- MRG: atrophic filiform, plaque-like lesions (midline)
- HGG: linear fissures (dorsum)
- Familial history may be present with BMG.
- GT and psoriasis share a common genetic marker.
- One recent small study has suggested that some GT cases may be true oral psoriasis, whereas others are only GT.
- Poor nutrition
- Allergic background (e.g., asthma, eczema, hay fever)
- Smoking, smokeless tobacco
- Anxiety, stress
- Hormonal disturbances
- Oral contraceptives
- Advancing age
- Immunocompromised state
- Evaluation of nutritional status, including vitamin B deficiencies, anemias
- Cessation of tobacco use (including smokeless)
- Assess for irritation from teeth, dentures, or piercings.
Commonly Associated Conditions
- Fissured tongue (BMG)
- HIV infection (rare)
- Reiter syndrome (rare)
- Down syndrome (rare)
- Crohn disease (rare)
- Celiac disease (possible correlation)
- Psoriasis (possible correlation)
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