Map Tongue

Symptoms

Map tongue is a benign, inflammatory change of the tongue surface in which round to oval, ulcerated, reddened islands (exfoliations) with white margins appear on and around the tongue. In the center, the fungal papillae (papillae fungiformes) are recognizable as enlarged red dots, the filiform papillae are lost and become more keratinized in the marginal area. The localization, size and shape of the lesions change continuously. Map tongue may be asymptomatic – no symptoms occur except for the spots on the tongue. A burning sensation or burning pain often occurs because the lesions cause increased sensitivity to certain substances, such as spicy, hot, and acidic foods. Map tongue often occurs in combination with puckered tongue, a single or multiple furrowing of the tongue. It is likely that the same genes are involved in its development. Folded tongue itself is usually benign, but can also lead to burning of the tongue. Other images The course is chronic with periods of improvement and worsening. The lesions may always be present or may temporarily disappear completely without scarring.

Causes

There are numerous hypotheses regarding its origin, but the actual cause remains unknown. Probably it is an inherited change of the tongue. Accordingly, map tongue would not be a disease, but a normal tongue variant and not treatable. The map tongue is non-infectious, i.e. there is no transmission, for example, when coming into contact with saliva or when kissing. What is certain is that foods play an important role in the progression, especially spicy, acidic and histamine-rich foods (see below).

Risk factors

Heredity plays a central role. Family members, i.e., parents, children, or siblings, are often affected as well. Psychosomatic factors appear to negatively influence the course. The symptoms worsen with emotional stress. In some studies, map tongue has been found to cluster at a young age and may improve with age, presumably because the tongue surface thickens with age. Other risk factors have been found in some studies but have not been confirmed in others. Cases have been described in the literature in which map tongue disappeared after some time. For example, in one woman, the tongue appeared only during pregnancy and disappeared after delivery. Pregnancy and oral contraceptives appear to be risk factors.

Diagnosis

The diagnosis should ideally be made by a dermatologist. Similar medical conditions such as candidamycosis (oral thrush), leukoplakia, wrinkled tongue, psoriasis, Reiter’s syndrome, lichen planus, lupus erythematosus, herpes simplex, oral thrush, anemia, local trauma, black hair tongue, iron deficiency, folic acid deficiency, and vitamin B12 deficiency must be excluded.

Complications

It is important to provide good education to affected individuals, who may be greatly distressed by the condition. It is a benign change/variant of the tongue surface and a disease that is not contagious. Map tongue is primarily an aesthetic and psychosocial problem. Although it is described as benign and harmless in most publications and also by health professionals. However, it can affect the quality of life of those affected because they are ashamed of their tongue, the burning of the tongue is bothersome and painful, and some foods have to be avoided in private or social settings. Other possible complications include poor oral hygiene, tooth decay and gingivitis (because harsh oral hygiene items exacerbate tongue burning), and weight loss due to the diet.

Nonpharmacologic treatment

Tongue burning and lesions are triggered or exacerbated primarily by spicy and acidic foods or substances. Avoiding these triggers can significantly reduce tongue burning and improve symptoms. The strongest triggers include:

  • Nuts – also trigger aphthae.
  • Mature cheese, parmesan, feta (!)
  • Red wine
  • Alcoholic beverages
  • Sausage
  • Hot spices
  • Garlic
  • Acids, e.g. lemon, orange juice, numerous fruits.
  • Vinegar in salad dressings (choose French instead of Italian).
  • Pineapple
  • Fresh onions
  • Tomatoes
  • Cayenne pepper, ginger
  • Sharp toothpastes or mouthwashes, fluoride tooth gels applied weekly.

Of these, many are histamine-rich foods (see there). When fasting, there may be an improvement in symptoms already within a few days, because there is no longer irritation by food. However, a complete renunciation of the above foods is usually not necessary. Good regular oral hygiene with a mild toothpaste also has a beneficial effect. Especially after contact with irritating substances, the oral cavity should be rinsed quickly with water and possibly the teeth brushed. Sharp toothpastes and mouth rinses such as Listerine should be avoided at all costs. Since stress has a negative effect, relaxation techniques can help, stress should be avoided and reduced. Medication can also be used to treat it.

Drug treatment

Usually, no drug therapy is prescribed. The following medications may be tried. However, some are not approved for this indication and must be prescribed by a health care professional. There is no guarantee of success. They may be able to relieve symptoms but will not “cure” map tongue. Tannins:

  • Tannins have astringent (tanning, protein precipitating) and soothing effects and are found in many medicinal plants, such as black tea (steep for 10 minutes) or ratanhia. They can be prepared as tea and drunk slowly several times a day. Mouth rinsing is also possible. Black tea contains caffeine and should be dosed according to individual tolerance.

Anti-irritant mucilage:

  • Mucilages are also found in many medicinal plants, for example, mallow leaves, marshmallow roots or linden flowers. They can also be prepared as a tea and drunk several times a day.

Antihistamines:

  • Antihistamines are said to be effective when used topically or internally, according to some articles. Whether this is true is unclear. When used locally as a mouth rinse, systemic adverse effects such as fatigue must also be expected (see package insert). For example, solutions or lozenges are available on the market (spit out again or swallow). Possible drug interactions and contraindications must be observed.

Painkillers:

Anti-inflammatory agents:

  • Since there is an underlying inflammatory response, anti-inflammatory agents should theoretically be able to improve the symptoms. The literature mentions the use of local glucocorticoids.

Trace elements:

  • Iron can relieve tongue discomfort that occurs due to iron deficiency. In our view, this is a different clinical picture.

Probiotics lozenges:

Other anti-irritant medications can be tried. If map tongue is secondary to a disease, treatment of the underlying disease may also improve map tongue.