AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

GEOGRAPHIC TONGUE: PATTERN OF PRESENTATION IN A SOUTH WESTERN NIGERIAN TEACHING HOSPITAL

E.O. Oyetola, A. Oluwande and E.T. Agho

Department of Preventive and Community Dentistry, Obafemi Awolowo University, Ile Ife, Nigeria


ABSTRACT

Background: Geographic tongue (GT) is one of the commonly seen lesions in Oral Medicine Clinic. It tends to show varying pattern of presentation. Excessive immune response and immune modulation has been implicated in the pathogenesis and this justified the use of steroid in the management.

Objective: This study describes the epidemiology, clinical presentations and treatment outcomes of the 21 cases of GT seen at the Oral Medicine Clinic of Obafemi Awolowo University Teaching Hospitals’ Complex, Ile Ife (OAUTHC) over a period of 10 years and compared the findings with the results from other parts of the world.

Methods: This was a retrospective cohort review of cases of geographic tongue seen in the Oral Medicine of OAUTHC over the period of 10 years of Oral Medicine practice in the center from May 2007 to May 2017. The diagnosis of GT was made based on its typical clinical presentation. Information retrieved from the case notes included age, sex, presenting complaints, clinical findings, treatment and treatment outcomes.

Results: Only 21 cases of GT were diagnosed during the study period, giving a prevalence of 2.1% consisting of 11males and 10 females with mean age of 29.5 +13.9 years. About half (10 cases) were diagnosed following routine oral examinations while burning tongue sensation, itchy sensation and taste impairment accounted for the presenting complaints among the symptomatic cases. Lesions were mostly seen in the anterior two-third of the tongue (9 cases). All patients responded well to topical steroids.

Conclusion: This study had shown that GT was more prevalent in younger age group with slight male predilection. More than half of patients presented with symptoms. Successes were recorded with topical steroids. 

Correspondence

Dr. E.O. Oyetola

Department of Preventive and Community Dentistry,

Obafemi Awolowo University,

Ile Ife, Nigeria

Email: phemyhoye12@yahoo.com


INTRODUCTION

Geographic tongue (GT) also known as benign migratory glossitis, erythema migrans andannulus migrans is a benign disorder of the tongue characterized with multiple, well-demarcated, erythematous, depapillated patches surrounded by a slightly elevated whitish border, and usually restricted to the dorsum of the tongue.1,2 Geographic tongue was first described by Rayer in 1831 as wandering rash of the tongue.3 These lesions may change in location, pattern and size, hence the name ‘migratory’.4 Lesion can occur in other sites apart from the tongue, then the term ectopic geographic tongue or erythema circinata migrans is employed as first coined by Crooke in 1955.3,5 

It is usually a transient and recurrent lesion of the tongue and may heal without treatment.3 GT is found in 1- 2.5% of the population, and it appears to be commoner among females in middle age group.3 The suggested etiology include emotional stress, Immunological factors, genetic factors, atopic or allergic tendency, emotional stress, tobacco consumption, hormonal disturbances, zinc deficiency, fissured tongue, psoriasis and diabetes mellitus.1,6,7

The common symptoms associated with symptomatic GT are burning sensation, taste impairment, tongue pain, cancer phobia or aesthetic concerns.2 In many cases, geographic tongue is asymptomatic. Treatment is usually required only in the symptomatic cases. There is no definitive treatment protocol or cure for this lesion but topical steroids (such as triamcinolone acetomide), retinoic acid, cyclosporine, antihistamine, tacrolimus and immune system regulators have been used in proposed treatment plans.2,6,8 Treatment is, however, not curative but modulate inflammatory and immunological responses, which is their chief mechanism of action.5

Although usually asymptomatic, the symptomatic cases could be quite disturbing and has been found to be associated with mental illness, stress and reduction in the quality of life of the affected patients.4,9 The pattern of presentation of GT, like any other lesion, shows variations especially as it relates to causative factors which will ultimately determine the specific management approach in each environment. Allergy has been implicated in the etiology, the allergens differ depending on the environment.6 Very few studies have documented associated clinical features and pattern of presentation of GT in the African population. The purpose of this study is to add to the body of knowledge of the research subject in the Nigerian population.