Photo Quiz

Burning on the Tip of the Tongue


Am Fam Physician. 2018 Jan 1;97(1):47-48.

A 29-year-old woman with a history of oral herpes simplex virus presented with sore throat, cough, headache, fatigue, and a reported fever of 102°F (38.9°C). She had experienced malaise over the previous three weeks. Mouth lesions and a burning sensation when she drank hot tea developed about two days before presentation.

On physical examination, the patient was not in acute distress, and she had normal vital signs. She had mildly tender anterior and posterior cervical lymphadenopathy. Vesicular lesions were visible on the bilateral labial commissures, and the dorsal tongue had well-demarcated bare patches with raised erythematous borders (Figure 1). The tongue lesions seemed to change and migrate daily. She had no genital lesions.

 Enlarge     Print



Laboratory findings included a negative rapid streptococcal test result and a nonreactive human immunodeficiency virus test, but a positive mononucleosis spot test result. A throat culture was positive for non–group A beta-hemolytic streptococcus.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Atrophic glossitis.

B. Behçet syndrome.

C. Burning tongue.

D. Geographic tongue.

E. Oral hairy leukoplakia.


The answer is D: geographic tongue, also known as benign migratory glossitis. The condition often resembles a map of the world, hence its name.1 It is thought to be an inflammatory disorder of unknown etiology.2 Focal regions of papillary atrophy on the dorsum of the tongue lead to ulcer-like patches surrounded by serpiginous, erythematous borders. The patches can rapidly resolve and migrate.3 Geographic tongue affects 1% to 14% of the U.S. population and has an inverse correlation with smoking, but there is no clearly established association with a disease process.3

Geographic tongue is usually self-limited and requires no treatment. Some patients with geographic tongue may report tongue sensitivities to hot or spicy foods.4 Topical steroid gels and antihistamine mouth rinses may reduce sensitivity.3

This patient tested positive for mononucleosis and n

Author disclosure: No relevant financial affiliations.

Address correspondence to Thomas M. Skinner, MD, FAAFP, at Reprints are not available from the authors.


show all references

1. Joseph BK, Savage NW. Tongue pathology. Clin Dermatol. 2000;18(5):613–618....

2. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. Am J Med. 2002;113(9):751–715.

3. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010;81(5):627–634.

4. Jainkittivong A, Langlais RP. Geographic tongue: clinical characteristics of 188 cases. J Contemp Dent Pract. 2005;6(1):123–135.

5. International Study Group for Behçet's Disease. Criteria for diagnosis of Behçet's disease. Lancet. 1990;335(8697):1078–1080.

6. Drage LA, Rogers RS III. Burning mouth syndrome. Dermatol Clin. 2003;21(1):135–145.

7. Triantos D, Porter SR, Scully C, Teo CG. Oral hairy leukoplakia: clinicopathologic features, pathogenesis, diagnosis, and clinical significance. Clin Infect Dis. 1997;25(6):1392–1396.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

A collection of Photo Quiz published in AFP is available at

Previously published Photo Quizzes are now featured in a mobile app. Get more information at

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. E-mail submissions to



Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

More in Pubmed


Jan 15, 2019

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article