Benign Migratory Glossitis: Etiology and Presentation

Description of the Condition

Benign migratory glossitis (BMG) is a common inflammatory condition affecting the dorsal surface of the tongue. It is characterized by areas of depapillation, resulting in smooth, red patches with raised, white or yellowish borders. These lesions typically migrate over time, giving the condition its descriptive name.

Predisposing Factors and Associations

The exact etiology of BMG remains unknown, but several factors have been implicated in its development. Genetic predisposition is suspected, with familial clustering observed in some cases. Certain systemic conditions have been linked, although causality is not established.

Potential Systemic Associations

• Psoriasis: A possible link exists between BMG and psoriasis, with some studies suggesting a higher prevalence of BMG in individuals with psoriasis.
• Atopy: Allergic conditions like asthma, eczema, and hay fever have been suggested as possible contributing factors.
• Diabetes: Although less consistently reported, some studies have noted a potential association with diabetes.
• Celiac disease: BMG can sometimes be seen in undiagnosed celiac disease.
• Down Syndrome: Higher rates of geographic tongue are observed in individuals with Down Syndrome.

Local Irritants and Other Influences

• Stress: Emotional stress is often reported as an exacerbating factor.
• Hormonal Factors: Fluctuations in hormone levels, particularly during menstruation and pregnancy, may influence lesion activity.
• Irritant Foods: Spicy or acidic foods can sometimes trigger or worsen symptoms.
• Tobacco Use: There is some evidence suggesting that tobacco use might contribute to the condition.
• Dental Irritants: Sharp teeth or poorly fitted dentures may cause localized irritation.

Histopathology and Microscopic Features

Microscopic examination of affected tissue reveals a loss of filiform papillae, accompanied by an inflammatory infiltrate primarily composed of neutrophils in the epithelium. Spongiosis and acanthosis are also typically observed. These features are not diagnostic but contribute to the overall understanding of the condition.

Clinical Presentation and Diagnosis

BMG is typically asymptomatic. However, some individuals may experience sensitivity to hot, spicy, or acidic foods. Diagnosis is primarily clinical, based on the characteristic appearance and migratory pattern of the lesions. Biopsy is rarely necessary unless the diagnosis is uncertain.