• 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)

Geriatric Considerations
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

  • Systemic
    • 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)
  • Local
    • 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)
  • Tongue
    • 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.

Risk Factors

  • Poor nutrition
  • Dentures
  • Piercings
  • Allergic background (e.g., asthma, eczema, hay fever)
  • Smoking, smokeless tobacco
  • Alcoholism
  • Anxiety, stress
  • Depression
  • Hormonal disturbances
  • Oral contraceptives
  • Advancing age
  • Immunocompromised state

General Prevention

  • 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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