The tongue (lat. Lingua) of a healthy person should have a velvety surface, be pink in color and moist. Physiologically it does not show any discoloration or thick coating.
Changes in the tongue, such as red spots, can indicate a disease. This may be restricted to the tongue, but more often it is an expression of another underlying disease where the spots on the tongue are only a symptom and there is nothing wrong with the tongue itself. Traditional Chinese medicine makes use of this, which attempts to diagnose diseases of the body’s interior on the basis of the tongue and its pathological changes (tongue diagnostics). Each part of the tongue represents a projection for an internal organ and the change of a certain part of the tongue is therefore interpreted in Chinese medicine as an expression of a disease of the represented organ, for example the heart.
Causes
There are many different causes for red spots on the tongue, which occur with varying frequency depending on age and existing risk factors. The causes of red spots on the tongue also range from harmless mucous membrane injuries (aphthae) to malignant tongue tumors and should therefore be examined by a doctor if they persist for a longer period of time (more than three weeks). A common cause of red spots on the tongue is an infection.
This can either occur locally on the tongue, as is the case after injury and bacterial infection of the tongue. However, the infection can also be systemic, i.e. it can affect the whole body, and as one of the symptoms it can cause red spots on the tongue. This is the case with scarlet fever, for example.
Another cause of red spots on the tongue is a vitamin deficiency. Here, vitamin B12 deficiency in particular, and more rarely vitamin B9 or folic acid deficiency, causes burning pain in the tongue, which can be accompanied by red spots. Such a vitamin deficiency can occur on the one hand due to reduced vitamin intake, for example in cases of malnutrition or absorption disorders in the intestine, and on the other hand vitamin deficiency can also be caused by an increased need for the vitamin.
The so-called map tongue (Lingua geographica) also occurs frequently. Here, whitish or red spots appear on the tongue, which are interrupted by normal areas of the tongue and thus produce a map-like image on the tongue. The location of these red spots can typically change on the map tongue.
It is assumed that the map tongue has a genetic cause and is therefore inherited. The red spots are signs of a benign inflammation and can become symptomatic by burning or pain. The development of red spots on the map tongue can be caused by various foods and can be treated and improved by avoiding them.
Furthermore, red spots on the tongue also occur in allergic asthma. Here the allergenic substances can also cause reactions in the oral mucosa. Allergies can also directly affect the tongue in the form of contact allergies and thus lead to the red spots.
This happens for example with an incompatibility on a toothpaste or a mouthwash. Very rarely do red spots indicate a tongue tumor. The stains here are usually red, bleeding and they hurt.
Accompanying symptoms such as unintentional weight loss, difficulties in chewing and speaking or hoarseness point to the cancer or its preliminary stage, which is why long-standing red spots or hoarseness over three weeks should definitely be examined by an ENT specialist. If you present yourself to a doctor with red spots on the tongue, the doctor will first try to find out more information and indications of a possible underlying disease in your medical history. The doctor will ask, for example, how long the spots have existed and whether other accompanying symptoms such as fever or hoarseness have occurred.
In the subsequent examination, the doctor inspects the tongue and determines whether the spots on the tongue are caused by an injury, inflammation or tumor. The doctor also checks whether there are any symptoms, such as lymph node swelling (see: lymph node swelling in the lower jaw), which could be an indication of a systemic, i.e. a disease affecting the entire body.If a vitamin deficiency is suspected, a blood test is performed to confirm the suspected diagnosis. This often involves a burning sensation in the mouth.
In babies, a typical cause of red spots on the tongue is a mechanical injury to the tongue, caused for example by it getting caught in toys. A tongue that has been damaged in this way can easily become inflamed by bacteria colonizing the mucous membrane of the tongue, which otherwise serves as a natural protective barrier. This inflammation can then become visible in the form of red spots.
However, it heals on its own within a few days. Another possible cause of red spots on the baby’s tongue is an allergy, for example to a toy that the baby puts in its mouth. Another reason for red spots on a baby’s tongue can be a lack of vitamins, often vitamin B12.
This is usually due to an increased need for the vitamin, which is important for cell division and thus for the growth of the child. After a doctor has diagnosed a vitamin deficiency, the vitamin in question can be specifically replaced with preparations. Infections like scarlet fever can also lead to red spots.
Causes of red spots on the baby’s tongue differ only slightly from those of the baby. However, from infancy onwards, infections become the main cause of red spots on the tongue. Scarlet fever is particularly common here.
It is a contagious bacterial infection with streptococci that causes a systemic infection. In the beginning there is a high fever and the typical strawberry/raspberry tongue, which impresses with a strong redness and additional white coating of the tongue, which reminds of a raspberry pattern. A child suffering from scarlet fever also has a pronounced feeling of illness with sore throat, swollen lymph nodes, signs of a cold and a rash (exanthema) all over the body (see: Symptoms of Scarlet Fever).
Unlike most other typical childhood diseases such as chickenpox, scarlet fever can reappear after a scarlet fever infection. Therapeutically, antibiotics are used to prevent serious consequences of scarlet fever, such as inflammation of the heart (pericarditis). Another infectious disease that often occurs in childhood and can cause red spots in the mouth and tongue area is the so-called hand-foot-mouth disease, which is caused by viruses.
This disease can proceed without any symptoms, but can also be accompanied by fever, a feeling of illness and the typical burning blisters on the palm of the hand, the sole of the foot and in or on the mouth that give the disease its name. Since this infectious disease is very contagious, many children in kindergartens are often affected. The hand-foot-mouth disease has an uncomplicated course and heals on its own after about eight days.
If necessary, painkilling mouth gel can be used to relieve the burning sensation. During pregnancy, when hormonal changes occur and the susceptibility to infection is increased, red spots on the tongue often appear in the form of so-called aphthae. These are inflammations on the mucous membrane of the mouth and also on the tongue, which can be very painful to touch, for example when eating.
These aphthae heal by themselves within a few days. The hormonal change is also a risk factor for the development of the map tongue, which therefore occurs more frequently during pregnancy. Vitamin deficiency, especially the lack of vitamin B12, is of great importance during pregnancy due to the increased need and can manifest itself in the form of burning red spots on the tongue.
Red spots on the tongue and palate are alarm bells ringing for many people. Often harmless causes are hidden behind them! The simplest explanation can be a food allergy.
It is even estimated that up to six percent of our population suffer from it. Local reactions to individual foods (e.g. kiwi, apple, pineapple) can cause red spots on the tongue and palate. In addition, affected people often report a furry feeling in the tongue, itching or swelling of the lips.
Small burns around the palate also cause red spots. In children, red spots on the tongue and palate can be an indication of scarlet fever. Burning red spots on the tongue are often caused by a vitamin B12 deficiency.
Another cause is allergies, for example to the toothpaste used.Sensitive people can also suffer from burning and red spots on the tongue after excessive consumption of acidic foods (e.g. citrus fruits, sherbet). Occasionally it is a matter of so-called aphthae (see: aphthae tongue). They are small, sometimes very painful changes of the oral mucosa or tongue.
The sore spots are surrounded by a red, spotty seam. Especially when eating hot or strongly spiced food, the aphthae can hurt and burn. The cause is not yet sufficiently known.
It is suspected that stress and a weakened immune system play an important role. Mostly the annoying red spots heal by themselves. Anaesthetic gels for pain relief can be purchased in the pharmacy.
Very rarely, more complex diseases can be hidden behind them. For example, there is the phenomenon of the “map tongue” as a sign of a chronic inflammation of the tongue. Burning red spots can also be caused by diseases such as diabetes mellitus, whereby in addition to burning, there is often also a sensation of discomfort such as tingling or numbness.
Red spots on the tongue, which are accompanied by sore throat, are usually an expression of an infection such as scarlet fever. In addition to fever, a feeling of illness and a skin rash all over the body, swallowing difficulties and, in the case of bacterial colonization of the mouth and throat, bad breath often occur. If there is fever in addition to the spots on the tongue, this is a strong indication of an infection.
Typical examples of this are scarlet fever and hand-mouth-foot disease, both of which are common in childhood. In the vernacular, the fine, red spots on the tongue in scarlet fever are also known as “strawberry tongue”. Typically accompanied by severe sore throat, difficulty swallowing and fever.
The cause of the contagious infectious disease is bacteria (so-called streptococci). Children between the ages of 1 and 4 are mainly affected. In principle, however, adults can also fall ill with scarlet fever.
Contrary to widespread opinion, multiple infections with scarlet fever are also possible! Untreated, scarlet fever can cause dangerous complications (especially heart muscle inflammation). Therefore: Red spots on the tongue, accompanied by sore throat or fever, are always a reason for a visit to the doctor.
Your doctor can diagnose “scarlet fever” within a few minutes using a quick test. Under antibiotic therapy the disease heals without any problems in most cases. In addition, the risk of infection is reduced to a minimum within the first 24 hours of antibiotic treatment.
