Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation - a literature review.

Geographic tongue is a chronic, inflammatory, and immune-mediated oral lesion of unknown etiology. It is characterized by serpiginous white areas around the atrophic mucosa, which alternation between activity, remission and reactivation at various locations gave the names benign migratory glossitis and wandering rash of the tongue. Psoriasis is a chronic inflammatory disease with frequent cutaneous involvement and an immunogenetic basis of great importance in clinical practice. The association between geographic tongue and psoriasis has been demonstrated in various studies, based on observation of its fundamental lesions, microscopic similarity between the two conditions and the presence of a common genetic marker, human leukocyte antigen (HLA) HLA-C*06. The difficulty however in accepting the diagnosis of geographic tongue as oral psoriasis is the fact that not all patients with geographic tongue present psoriasis. Some authors believe that the prevalence of geographic tongue would be much greater if psoriatic patients underwent thorough oral examination. This study aimed to develop a literature review performed between 1980 and 2014, in which consultation of theses, dissertations and selected scientific articles were conducted through search in Scielo and Bireme databases, from Medline and Lilacs sources, relating the common characteristics between geographic tongue and psoriasis. We observed that the frequency of oral lesions is relatively common, but to establish a correct diagnosis of oral psoriasis, immunohistochemical and genetic histopathological analyzes are necessary, thus highlighting the importance of oral examination in psoriatic patients and cutaneous examination in patients with geographic tongue.

Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation - a literature review

Abstract: Geographic tongue is a chronic, inflammatory, and immune-mediated oral lesion of unknown etiology. It is characterized by serpiginous white areas around the atrophic mucosa, which alternation between activity, remission and reactivation at various locations gave the names benign migratory glossitis and wandering rash of the tongue. Psoriasis is a chronic inflammatory disease with frequent cutaneous involvement and an immunogenetic basis of great importance in clinical practice. The association between geographic tongue and psoriasis has been demonstrated in various studies, based on observation of its fundamental lesions, microscopic similarity between the two conditions and the presence of a common genetic marker, human leukocyte antigen (HLA) HLA-C*06. The difficulty however in accepting the diagnosis of geographic tongue as oral psoriasis is the fact that not all patients with geographic tongue present psoriasis. Some authors believe that the prevalence of geographic tongue would be much greater if psoriatic patients underwent thorough oral examination. This study aimed to develop a literature review performed between 1980 and 2014, in which consultation of theses, dissertations and selected scientific articles were conducted through search in Scielo and Bireme databases, from Medline and Lilacs sources, relating the common characteristics between geographic tongue and psoriasis. We observed that the frequency of oral lesions is relatively common, but to establish a correct diagnosis of oral psoriasis, immunohistochemical and genetic histopathological analyzes are necessary, thus highlighting the importance of oral examination in psoriatic patients and cutaneous examination in patients with geographic tongue.

Geographic tongue and fissured tongue in 348 patients with psoriasis: correlation with disease severity.

Geographic tongue (GT) and fissured tongue (FT) are the more frequent oral lesions in patients with psoriasis. The aims of this study were to compare the prevalence of GT/FT between psoriasis group (PG) and healthy controls (HC) and investigate the correlation between GT/FT and psoriasis severity using the PASI and age of psoriasis onset. Three hundred and forty-eight PG and 348 HC were selected. According to the age of psoriasis onset, the individuals were classified as having early psoriasis and late psoriasis. The severity of vulgaris psoriasis was determined according to PASI. A follow-up was conducted in patients with psoriasis vulgaris (PV) with GT to evaluate the progression of oral and cutaneous lesions. The FT and GT were more frequent in PG than in HC. The incidence of GT was higher in patients with early psoriasis and that of FT in late-psoriasis. There is association between psoriasis intensity and GT; and a higher monthly decrease of PASI score in patients without GT. The presence of GT and FT is higher in PG than in the HC. GT is associated with disease severity and may be a marker of the psoriasis severity.

Fissured tongue: a sign of tongue edema?

Fissured tongue (FT) is a condition frequently seen in the general population. Clinically, FT is characterized by grooves that vary in depth and are noted along the dorsal and/or dorsolateral aspects of the tongue. Furthermore, FT presents many enlarged, smooth filiform papillae and subepithelial inflammatory infiltration. Despite of many studies, the etiology of FT remains obscure. FT is believed to be a congenital anomaly associated with several disorders and with geographic tongue (GT). We hypothesize that FT is not a congenital anomaly, and FT with swollen filiform papillae may represent edema in the subepithelial tissue of the tongue. According to the literature, the difference in prevalence among different age groups indicates that FT is not a congenital disorder. FT appears to occur more commonly in adults, and it is very rare or not at all in children younger than 10 years old. An association between FT and GT is well established in the literature, supporting the results of previous authors suggesting that FT might be a consequence of GT. The most remarkable finding in the region of swollen papillae of FT samples has been the subepithelial infiltrates of polymorphonuclear leucocytes and lymphocytes causing the subepithelial edema. The clinically visible grooves and large edematic papillae clustered on the region of the fissures might be caused by the inflammation and edema underneath the epithelium. In the future, FT and GT must be researched together as two different entities of the same disease so that GT is a prestage of FT. The diagnosis of FT must be taken to consideration whether the tongue surface have smooth and swollen papillae or normal-appearing filiform papillae.

Prevalence of fungi in cases of geographical and fissured tongue.

One of the most common malformations of the tongue is fissured tongue, very often, is accompanied by geographic tongue; the etiopathogenesis of them is not known. The aim of study was to evaluate the prevalence of fungi in cases of fissured and geographic tongue, and to determine their species and susceptibility to selected antifungal drugs. The study included 104 patients with fissured and/or geographical tongue. To determine fungi present in the tongue, the material was collected with a sterile swab for mycological examination. The procedure was conducted according to that used at our Department. The in vitro susceptibility of the strains to nystatin and miconazole was evaluated. In 45 (43%) cases fissured tongue, in 28 (27%) geographic tongue, and in 31 (30%) both conditions were diagnosed. Mycological examination revealed fungi on the tongue in 73 (70%) patients, including 31 patients (69%) with fissured tongue, 19 (68%) with geographic tongue, and 23 (74%) with concomitant changes. The most frequently detected was Candida albicans (detected in 48-66% of cases); in individual cases, other species of Candida species were found. The strains demonstrated greater sensitivity to nystatin than to miconazole. An analysis of reported symptoms based on the presence or absence of fungi on the tongue revealed that idiopathic pain and burning were significantly more frequently reported by patients with fungi on the tongue (p = 0.034174). Statistically significant differences exist between the presence and absence of fungi with regard to the signs, symptoms of changes on the tongue (p = 0.026015). Also, statistically significant differences (p = 0.00000) exist regarding the presence of fungi with regard to brushing a fissured tongue, or a fissured and geographic tongue; fungi are frequently present when brushing is absent. The prevalence of fungi is greatest in patients with geographic tongue, especially those who do not brush the surface of the tongue.

Granulomatous cheilitis of Miescher: the diagnostic proof for a Melkersson-Rosenthal syndrome.

BACKGROUND: The Melkersson-Rosenthal syndrome (MRS) is a very rare clinical entity and its classical form is being characterized by the following triad: facial nerve palsy, swelling of the lips and fissured tongue. However, the monosymptomatic form is more common and the typical manifestation is facial edema and/or enlargement of the lips. CASE REPORT: We report a case of monosymptomatic MRS with a positive biopsy of granulomatous cheilitis. CONCLUSIONS: In the daily practice as a pediatrician, it is not usual to diagnose a patient as having MRS. We consider that this is partly because of misdiagnosis. We therefore believe that this case report will supply additional information, in the scope of recurrent facial paralysis and orofacial edema in both children and adults.

Benign migratory glossitis with fissured tongue.

Symptomatic benign migratory glossitis (BMG) or "geographic tongue" is a rare occurrence in pediatric dentistry though asymptomatic BMG is comparatively common. BMG presents itself as an ulcer-like region on the dorsum of the tongue, which may recur at different sites on the tongue, creating a migratory appearance. Asymptomatic cases usually resolve on their own but symptomatic cases need treatment. Fissured tongue is a benign condition characterized by deep grooves on the dorsum of the tongue and, in many cases, is associated with geographic tongue. This article presents a case of symptomatic geographic tongue with fissured tongue with a history of asthma.

Orofacial granulomatosis: clinical study of 20 patients.

OBJECTIVES: The objective of this study was to analyze the clinical features of a series of patients with orofacial granulomatosis (OFG). STUDY DESIGN: Twenty patients diagnosed with OFG at Bellvitge Hospital (Barcelona, Spain) from 1985 to 2010 were included in the study. RESULTS: All of our patients (9 men and 11 women, median age 48.1 years) presented with labial swelling. Six patients presented with recurrent orofacial swelling, 12 with permanent swelling, and 2 with progressive swelling. Fissured tongue was observed in 9 cases, and 2 patients presented with recurrent episodes of peripheral facial paralysis. The median follow-up time was 65.1 months, ranging from 4 to 300 months. None of our patients developed sarcoidosis or Crohn disease. CONCLUSIONS: In the south of Europe, OFG does not appear to be as frequently associated with Crohn disease as in northern Europe. Although several treatments may achieve transient control of the orofacial swelling, there is no curative treatment for OFG and some patients may develop embarrassing lesions.

Prevalence of oral lesions and normal variants of the oral mucosa in 12 to 15-year-old students in Tehran, Iran.

OBJECTIVES: There are relatively few systematic studies, documenting the prevalence of mucosal disorders in children and adolescents. The purpose of this study was to determine the prevalence of oral lesions in 12- to 15-year olds living in Tehran and to assess the possible relationship between the occurrence of these lesions and gender. METHODS: A cross-sectional study was designed in which 1020 adolescents were participated. The sample size was based upon an expected oral lesion prevalence of 25%, a precision of 0.05 and a confidence level of 99. Epi-info version 6.0 was used for statistical analysis. RESULTS: Two hundred eighty-six adolescents (28.0%) were diagnosed with at least one oral mucosal lesion at the time of the examination. The prevalence of any oral mucosal lesion was 29.2% among the boys and 26.9% among the girls. With the exception of melanotic macules, there were no statistically significant differences in oral mucosal lesion prevalence by gender. CONCLUSION: More than 28% of the adolescents were found to have at least one oral mucosal lesion. Melanotic macule was found to be proportionally more common in boys than girls.

[Oral lesions in psoriasis]. / Manifestations buccales du psoriasis.

BACKGROUND: The literature contains little information about the incidence or prevalence of oral signs in psoriasis. The pustular forms are the most commonly incriminated, with geographic tongue being the most frequently cited oral sign. The aim of our study was to determine the various types of oral signs seen in a large population of psoriasis patients. PATIENTS AND METHODS: Four hundred psoriasis patients were recruited consecutively and a detailed oral examination performed by two clinicians. Similar examinations were performed over the same period in 1000 nonpsoriasis subjects comprising a control group in order to assess the incidence of the same oral signs in the general population. RESULTS: Comparing the two groups, fissured tongue was seen in 33.2% of psoriasis patients versus 9.9% of control subjects (P<0.0001). There was thus a highly significant (P<0.0001) correlation between geographic tongue and psoriasis (7.7% of psoriasis patients versus 1% of controls). In addition, a strong correlation was seen between the presence of pustular psoriasis and fissured tongue (83.3% of patients with pustular psoriasis versus only 30% of patients with other forms of psoriasis). DISCUSSION: Our study shows a strong correlation between psoriasis and fissured and geographic tongue, although these features are not pathognomonic for the disease. As regards geographic tongue, our results are consistent with the data in the literature. However, the prevalence of fissured tongue was considerably higher among our patients than in series published to date. These two types of sign involving the tongue, and which can occur in all forms of psoriasis, appear to be particularly strongly associated with pustular psoriasis. Patients are generally unaware of this sign and rarely complain of it.

Melkersson-Rosenthal syndrome revisited as a misdiagnosed disease.

PURPOSE: We aimed to attract our college's attention to the Melkersson-Rosenthal syndrome (MRS), which has been an infrequently encountered subject in otolaryngology journals during the last 10 years. MATERIALS AND METHODS: A retrospective review of the last 10 years' patient database was performed to find patients with MRS. The medical files, treatment charts, and radiological and histopathological records of these patients were reviewed. RESULTS: The study group consisted of 3 MRS patients who had been misdiagnosed for 9, 10, and 16 years. Two of them have had the symptoms since adolescence. All of them presented orofacial edema and fissured tongue, whereas first two also had recurrent facial paralysis. Characteristic histopathological features were noted in 1 patient. Electromyography (EMG) was done in 1 patient who underwent facial decompressiom. All patients responded to either systemic or intralesional corticosteroid treatment. CONCLUSIONS: In the daily practice of an otolaryngologist, it is not usual to diagnose a patient as having MRS. We consider that this is partly because of misdiagnosis. We therefore believe that this study will supply an additional aspect to otolaryngologists, in the scope of recurrent facial paralysis and orofacial edema in both children and adults.

Oral mucosa: variations from normalcy, part II.

This is the second article in a 2-part series on the variations of oral mucosa. We describe the following 5 conditions that deviate from normalcy: lateral soft palate fistulas, double lip, fissured tongue, racial gingival pigmentation, and geographic tongue.

[Glossitis granulomatosa--an unusual subtype of Melkersson-Rosenthal syndrome]. / Glossitis granulomatosa--ein ungewöhnlicher Subtyp des Melkersson-Rosenthal-Syndroms.

So-called "glossitis granulomatosa", described in 1952 by H. Schuermann as a peculiar manifestation of Melkersson-Rosenthal syndrome (MRS), is little known in oral medicine due to the paucity of cases published so far. During the past 25 years the author has observed eight definite cases of glossitis granulomatosa and confirmed its close connections with MRS. The recurrent inflammation tends to change into persisting macroglossia with considerable functional and sensory oral disturbances. The clinical diagnosis, histologically supported by biopsy, can definitely be established, yet the outcome of the mostly chronic macroglossitis (with danger of later tongue carcinoma) may be very doubtful. Knowledge of Schuermann's glossitis, a member of the group of etiologically unclarified lingual inflammations, is important for physicians involved in oral medicine because of its therapeutic and prognostic implications.