Diseases of the tongue

July 1, 2005

The tongue is often the site for choristomas, a condition where normal tissue is in an abnormal place.

Dermatologists often get little or no training on diseases and conditions of the mouth - particularly the tongue - because these problems tend to cross into specialties, such as maxillofacial surgery and ear, nose and throat.

But people with pigmentary, texture and other changes on the tongue often turn first to dermatologists for diagnoses and possible treatment, says Janellen Smith, M.D., dermatologist, associate clinical professor, University of California, San Francisco (UCSF) Medical Center, San Francisco.

Tongue anatomy 101 Knowing basic tongue anatomy is important. Dr. Smith says, the most notable elements of the tongue are:

The filiform papillae would change and the thought was that they could interpret those changes to better understand what was going on inside the body, according to Dr. Smith.

"It is true, to a certain degree, that you can do that," she tells Dermatology Times. "If someone is very ill the filiform papillae get thicker and become furred. This happens because each of the papillae has keratin. If someone is eating normally and is healthy, the food that person eats takes off the top keratin layer, constantly "dekeratinizing" the tongue. If someone is ill and they cannot eat, that does not happen."

Tongue conditions Dermatologists are among the first to see a host of tongue problems, many of which are not associated with illness but do cause cosmetic concern.

One of the most common is fissured tongue. Patients might be born with fissured tongue, also referred to as scrotal tongue, or develop it over time. The normal tongue has a smooth top at the back; a fissured tongue has deep fissures, one down the middle and then fissures branching off to the side, according to Dr. Smith.

"It is mostly a cosmetic issue but sometimes it can get painful from food getting caught in the deep fissures," she says. "If it is causing pain, patients probably need to cleanse their tongues better, and they can do so with a soft toothbrush or rinse it with 1 percent or 2 percent hydrogen peroxide or mouthwash."

While, tongue pigmentation is uncommon, most areas of pigmentation on the tongue are from ethnic variations; so, people who tend to be more pigmented on their skin tend to have more pigmentation in their mouths and sometimes on their tongues, according to Dr. Smith.

The pigmentation might be regular or irregular and is usually not something to worry about; however, dermatologists should biopsy any new area of pigmentation, according to Dr. Smith.

"Unfortunately, we do not have anything that we can do to de-pigment the tongue," she explains.

As people age, they might get caviar tongue, which occurs underneath the tongue or along its lateral edges. These patients present with dilated blood vessels on the tongue called varices.

"On the tongue, they often have rounded shapes that make them look like little dots of caviar," she says. "These lesions do not need to be treated and do not signal any underlying health issues."

Some conditions signal concern The tongue is often the site for choristomas, a condition where normal tissue is in an abnormal place.

"You can have on the back of your tongue little bits of brain or bony tissue or cartilage," Dr. Smith says.