Centro Studi GISED

Glossitis and Stomatitis – Tongue

Geographic tongue (or glossite migrans) is the most common of all the manifestations that have been defined as glossitis.

I read with interest the other letters with symptoms similar to those of my 3 year old son. Since the age of 1 I have seen red marks, outlined with white on his tongue that didn’t seem to give him any discomfort and which I believed to be caused by him biting himself. Instead, a paediatrician told me that it was mycosis and prescribed... Upon the problem repeating itself I went back to the paediatrician to prescribe a new treatment, but more than that I was worried about the significance of this persistent mycosis (my son was and is strong and in optimum health generally), but the assistant paediatrician excluded absolutely mycosis, diagnosed a viral aphthous ulcer and prescribed vitamin supplements. More and more confused I went to see a third doctor who finally talked about “geographic tongue” and recommended vitamins again. Although the term “benign” migratory glossitis reassures me a bit, I don’t understand why my son has to the subject and how, if and when, he might be freed of it. I would be very grateful for some suggestions of more effective remedies or some nominative doctor in my area for a more precise visit. Thank you and best regards.

Dear Madam, unfortunately it’s very difficult to respond to you without having seen your son. Does your son Alberto have mycosis, an aphthous ulcer or geographic tongue? I believe the diagnosis more probable is that of geographic tongue. It’s a completely benign pathology that can be rather persistent. It doesn’t have symptoms and for this reason can be considered a problem of appearance of the tongue. Unfortunately, even with a definite diagnosis it’s not always possible to indicate an effective treatment, or predict how long it will last. As for a nominative doctor in your area, the person most suitable to indicate him to you I think would be your doctor. Dr Bruno Pansera – Specialist dermatologist - GISED

Dear Professor. I’m 70 years-old. For about the last 2 years I have had a feeling of wetness in the corner of my mouth that gives me a feeling of ill-being when I eat, making all food taste bitter. I would be grateful to receive some useful advice in order to improve my situation. Thank you.

Dear Mr (…), the real solution to the problem requires the removal of the cause itself. In your case a diagnosis appears problematic particularly basing it only on what you have said. Do you wear dentures? In the light of the small amount of data available I can only suggest that you try out a topical treatment to relieve the symptoms: try to treat the corners of your mouth morning and night with a light covering of zinc oxide paste. If you don’t get any benefits from that go and see your doctor who, if he isn’t in a position to make a diagnosis and prescribe a treatment, will certainly know who to refer you to in an attempt to arrive at a solution to your complaint. Dr Bruno Pansera – Specialist dermatologist - GISED

I have read about your studies and I find it interesting. I’m a 34 year-old lady and 5 months pregnant. Suddenly marks like little red blisters have appeared on my palate and tongue. The doctor has diagnosed it as stomatitis and has prescribed a mouthwash. I would like to ask you 2 questions: 1) Is it dangerous for my baby? 2) Is it contagious? (I mean if I kiss my husband). Thank you for your kind response.

Dear Madam, One could respond with certainty to your question only by knowing the nature (that is, how we medics say aetiology) of your stomatitis. In any case, whatever the nature of the stomatitis, dangers for the arriving baby appear very unlikely. As for kisses, I don’t see too many problems. Dr Bruno Pansera – Specialist dermatologist - GISED

I’m a man of 39 years. For about the last 10 years I have had a problem with my tongue. In the first 4 or 5 days I had the impression that I had eaten something strong that had left my tongue feeling burned and numb, but then little whitish growths appeared on top and underneath my tongue (and sometimes my tongue feels like I’ve eaten some kind of spicy cheese) that go away and then return later in the day. My tongue gets a bit swollen, so much so that, when resting teeth marks are clearly visible. My doctor has said that it could be connected to my stomach and digestive system. He’s advised me to take... For the last 2 days the symptoms have persisted and so I tried using... syrup which seems to irritate the mucous membrane even more. Perhaps it’s connected to the psoriasis on my scalp? What’s more, it’s also appeared under the nails on my feet. I would like some advice on what to do about it and the kind of diet that I should follow. Thank you.

Dear Sir, the problem with your tongue requires a diagnosis, indispensable in order to carry out a prognosis and treatment. No matter how much you complain it doesn’t resolve itself, the advice on “what to do” can’t be anything other than “dig deeper” (always under the guidance of your doctor) in order to arrive at a diagnosis. We know that the phenomenon is defined as “geographic tongue” and it’s associated to psoriasis. Dr Bruno Pansera – Specialist dermatologist - GISED

Dear GISED. I’m 32 and I have had a problem of the oral cavity for almost a month…on my tongue to be exact. A whitish-yellow coating has formed all over my tongue, principally localised around the part near my throat. I didn’t give it much importance at first, I rinsed my mouth with... then upon noticing that the problem was still persisting, my doctor advised me to treat it with antibiotics for a month to get rid of any possible bacteria present in my stomach. Outcome negative! I had a complete abdominal ultrasound but the results didn’t show anything in particular, only from a blood test did there seem to be abnormal readings for lymphocytes, leukocytes... the problem persists and actually I don’t know which cards to play. Thank you in anticipation.

It could be a case of “hairy tongue” (lingua villosa), characterised by the presence of a velvety, yellowish coating (that in some cases goes black due to the proliferation of bacteria) on the back of the tongue, owed to the hyperkeratosis of the filiform papillae. The causes can be numerous: imbalancing of the local bacteria flora, reduction of salivation, dehydration, digestive disorders etc. If all the tests have come back negative, I would advise you not to worry too much, to drink a lot of water, treat oral hygiene with mouthwash and finally, try (very delicately and progressively) to remove the coating with a toothbrush. Best regards, Dr Lorenzo Peli – GISED.

For a few months now I have been noticing little, white, circular blisters of about 2/3 mm on the inside of my cheek, that tend to remove themselves. They are almost completely asymptomatic, I only have the sensation of having a rougher mucous membrane in that area. My dentist says that, it’s because of the fact that I bite the inside of my cheek, but in my opinion, these little blisters aren’t only located in that area. Could it be a viral infection (Herpes or HPV)?

Dear Madam, thank you for your message. There can be various reasons for the little, whitish blisters that you describe. One of the most frequent causes is the so-called “Fordyce’s granules.” These are yellowish-whitish granulations of the mucous membrane of the mouth. Such granules are totally benign and don’t require any treatment. They are there because of the sebaceous glands becoming more prominent. Another cause found quite frequently is localised keratinisation of the cells in the oral mucous membrane following repeated trauma by biting or by friction from braces (leukoplakia). At times, atypical cells are found in association with this keratinisation of the mucous membrane (speaking, in this case, about leukoplakia) and it can be useful to have a diagnostic biopsy. Again, the whitish plaques that you observe in infections by Candida albicans (principally in small babies and aged patients in a state of deterioration) in some dermatological illnesses like Lichen Planus and in the case of infection by the human papilloma virus. If the problem persists, I think it would be useful to have a check up by your dermatologist. Best regards, Dr. Luigi Naldi. Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Dear GISED, I’m 24 and for a few months I have been noticing a problem of the oral cavity. The problem is that I have the continuous sensation of thirst and drinking water doesn’t help. This problem persists especially when I have an empty stomach. I always have an inflamed tongue with a sour taste and I have also noticed that I always have dry, reddened, itchy lips. Could it be possible that these little problems can be due to the fact that I suffer from gastritis? O is it simply an allergic reaction? Up ‘til now I didn’t attach any weight to this problem, thinking it would always disappear by itself, but I’m noticing that there is no improvement, could you kindly suggest some tests that I can do or advise me on a possible treatment? Waiting for your reply, yours sincerely.

Dear Madam, the symptoms that you are presenting are rather unspecific. I would exclude that there is a connection with you gastritis. It could be the so-called “burning mouth syndrome”. It’s a syndrome of unknown cause, which is associated with a sensation of burning in the oral cavity. At times the problem is connected with an allergic reaction and materials used for fillings. I think it would be useful to consult a dermatologist. Best regards Dr. Luigi Naldi. Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

For about 2 months I have been suffering from a problem of the oral cavity and tongue, the discomfort of which is gradually becoming more acute. Red patches on my tongue, mainly at the sides, followed by swelling. Also, I’ve started to salivate a lot with the sensation of having a considerable amount of placque (that in reality I don’t have) and a sour taste. There does happen to be a more than usual amount of tartar on my teeth (I think it’s tartar since it’s dark), over the last 20 days. It seems strange to me as my GP says that its stomatitis, but after having used... solution without results I used... because he then believed it was thrush/candida of the mouth and in short also gave me... to rule them out. My dentist says that although he doesn’t see the symptoms in my mouth it could be oral herpes. Could you kindly suggest which tests I can have to verify what’s happening? Thank you very much.

Dear Madam, I don’t really believe that you’ve contracted herpes simplex of the oral cavity. The first infection by herpes (more common in small babies) os characterised by erosions in the oral cavity that crop up acutely and can be accompanied by a fever. The infection reoccurs (due to reactivation of the virus) also accompanied by erosions and is localised, in general, to skin in the affected area (the aforementioned “fever”). Also, an infection by Candida albicans seems very improbable to me. It is, in this instance too, a problem very common in small babies (and in the aged in a state of deterioration). There are a few dermatological illnesses that can make their first appearance as lesions in the oral cavity (for example Lichen planus). The examination that I advise you to take is, therefore that of a thorough dermatological check up by a dermatologist. Keep us up-to-date. Best regards, Dr Luigi Naldi. Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Dear GISED, I’m a woman of 38 years and for about the last 21 months, after my second pregnancy, I started to have a problem with my tongue, the dermatologists didn’t have the knowledge to give me a complete answer. Periodically, marks appear on my tongue, more specifically small, round, reddened stains that render the part affected feeling slimy and without taste buds. The problem lasts about a week, disappears and then after about a month, reappears, not always in the same place. Tests have excluded Herpes and mycosis of the tongue. Yours faithfully.

Dear Mrs (…) it could be migratory glossitis. The cause is not known but it’s asymptomatic and manifests itself as bright-red patches in localised patches on the tongue, often with a whitish border. It can be associated with psoriasis as a variation called “geographic tongue.” It’s important to exclude pathologies like Candida and Herpes (as you have already done). Available treatments are scarce, but it is, realistically speaking, a phenomenon both benign and non-dangerous. I would advise you to treat it with good oral hygiene. Best regards. Dr Lorenzo Peli – GISED.

Hi, I’m a man of 30 years and about 3 months ago i discovered that I had oesophagitis with gastric reflux of the first degree. I wanted to know if it’s normal that my tongue is always covered with a white layer in the middle and back and where my throat starts I have white spots, like round blisters but without signs of inflammation. I wanted to know, since it’s a few months that it’s appeared and still hasn’t gone away, who should I go and see and what could be the cause? Please respond to the following address (…)

Dear Sir, the whitish covering on your tongue could be as a result of many different factors (feverish illnesses, stomatitis, glossitis, bad oral hygiene, digestive problems etc.) but it shouldn’t be directly related to light gastric reflux, especially if it’s already being treated. The lesions you describe at the base of your tongue could be simple papilla hypertrophy that doesn’t necessarily require treatment or instead it could be a small papilloma virus that would instead be removed. I would advise you to visit an ear, nose and throat specialist. Best regards Dr Lorenzo Peli – GISED.

Dear GISED, 5 months ago the following appeared: 1)White marks on oral mucous membrane; the dermatologist has diagnosed it as Fordyce’s Granules; 2) Plicae on the oral mucous membrane in the middle between both sides, in relation to my cheeks between my upper and lower jaw; a doctor has diagnosed it as probable mycosis…but after a course of treatment with antimycotic gel and various mouthwashes nothing has changed, the plicae are still there; 3) Thickening of the oral mucous membrane; 4) Stomatitis; 5) Small vesicles on my tongue at the sides at the back and under my tongue; All this appeared at the same time as the gastrointestinal problems I had for about a month, I mean diarrhoea, tympany, abdominal pains…actually I am taking trimebutine maleate for probable irritation of the colon as the abdominal pain was on the left side. What can I do to treat it, do you have some advice for me?...Maybe I should have a colonoscopy? Could it be a sexually transmitted disease? I also had an HIV test, which was negative! I would be grateful to receive any useful advice that would improve my state of health!

Dear Writer, the problems that you indicate of the oral mucous membrane are rather frequent and can be transitory and almost all people get it at least once in their life; moreover some aspects like a “thickened” mucous membrane or plicae can be fisiological and not representative of the real problem. If it’s an isolated episode and self-limiting I would advise you not to worry excessively and follow the advice of your doctor. The abdominal symptoms that you indicate seem comparable with an irritable colon (a pathology very frequent and benign, but very uncomfortable); even in this case the advice given by your doctor is fundamental, and the drugs that he has indicated can be recommended for such a pathology. With regard to sexually transmitted diseases, I would exclude them. With regard to a colonoscopy, you would need to know other details (age, family health, previous investigations); even so it’s not usually a standard procedure. Best regards, Dr Lorenzo Peli – dermatologist – GISED.