Geographic tongue

Geographic tongue (erythema migrans) is a benign condition affecting up to 5% of the population. It manifests as migratory red lesions and usually involves the dorsal surface of the tongue, but sometimes extends to the floor of the mouth and buccal mucosa. The red patches have a central atrophic and depapillated zone, which, in the most common presentation, is surrounded by elevated white or cream margins (see Geographic tongue lesion of the right lateral border of the tongue). Occasionally the central red patch is sensitive, but not painful. If pain or burning is present, investigate for other causes or seek specialist advice.

The cause of geographic tongue is unknown, but there may be a family history of the condition. Some patients have atopic allergies, or can relate the lesions to particular foods or stress. Histologically, the lesions are psoriasiform, but geographic tongue is not related to a specific condition.

Management of geographic tongue is not required beyond correct diagnosis and reassurance. If any 'red flag' features of oral mucosal disease are present, refer to an appropriate specialist.