Oral mucosal lesions presenting as erythematous patches usually pose difficulties for a clinical diagnosis. They elicit an array of differential diagnosis that mainly includes oral candidosis, contact mucosal reaction, oral lichenoid lesion, oral psoriasiform, autoimmune disease, and, not to forget, secondary syphilis. In this present case, all those above-mentioned possibilities were ruled out, while secondary syphilis stood as the main diagnosis. As this was also later excluded by a negative serological treponemal test, the final diagnosis rested on an ectopic manifestation of benign migratory glossitis (BMG), whose diagnosis was based on the clinical aspects of the lesions, along with their spontaneous disappearance in a short period of time (a hallmark of this condition) and the presence of fissured tongue, a manifestation that occurs very often in concomitance with BMG.
Geographic tongue, also called benign migratory glossitis, was found to be more frequent in adolescents when compared to previous reports in children [2, 5]. In our previous study on children under the age of 13 there seemed to be an association between geographic tongue and chronic diseases , while in the present sample there is a significant link with healthy adolescents. These finding seem to support the still unclear etiology of the pathology.
The changes in the COVID tongue shall be related to the geographic tongue or benign migratory glossitis. In the case of symptomatic geographic tongue, the term of migratory stomatitis is used. It is interesting to note that various studies on COVID-19 infection stated that geographic tongue is an oral presentation. The studies that documented tongue changes in the COVID-19 condition are listed in [Table 1].
Benign migratory glossitis also known as geographical tongue is a recurrent condition of unknown etiology characterized by loss of epithelium particularly of the filiform papillae on the dorsum of the tongue. Clinically the appearance is of multifocal, circinate, irregular erythematous patches bounded by slightly elevated, white colored keratotic bands. Several etiologic factors have been proposed. The condition may remain asymptomatic or patients may present with complains of pain and burning sensation. A review of the current opinion on benign migratory glossitis is presented.
Benign migratory glossitis or geographic tongue is common benign disorder of unknown etiology. The epithelium of the tongue is affected with loss of filiform papillae leading to smooth ulcer like lesions that rapidly change the color and size. The lesions commonly occur on the tip, lateral borders, dorsum of the tongue and sometimes extend to the ventral portion of the tongue.2 The prevalence rate is between 1.0% and 2.5%.3 According to Jainkttivong and Langlais4 the highest incidence of geographic tongue is in the 20-29 age group. Shulman and Carpenter5 on the other hand found no relation between benign migratory glossitis and age among US adults. A higher female preponderance is reported. Jainkittivong and Langlais observed higher rates in females (1.5:1) between ages 9 and 79 in a population in Thiland4. Similarly Marks and Simons reported a female to male ratio of 1.4:1 in the age group of 3 to 77 in an Australian population.6 Some authors on the other hand found that gender was not important to the incidence of geographic tongue.7
A tendency for familial occurrence of this condition has been suggested. Redman et al reported a higher prevalence of benign migratory glossitis among first degree relatives of affected University of Minnesota students than among those of control students as well as among population from which the students were drawn. They suggested a polygenic model of hereditary transmission, with a threshold for susceptibility to environmental factors.10 Eidelman et al also suggested that geographical tongue is an inherited condition with a polygenic mode of condition.27
It has been proposed that benign migratory glossitis is an isolated oral manifestation of psoriasis rather than a mere association.40 The relationship of human leukocyte antigens (HLA) with psoriasis has been extensively investigated. Associations of HLA- Cw6 presents a particularly strong association irrespective of the racial or ethnic group suggesting that Cw6 itself or closely linked gene in strong linkage disequilibrium, is the major HLA-linked susceptibility gene for psoriasis.41 Wysocki and Daley reported the HLA phenotypes of seven patients with benign migratory glossitis and juvenile diabetes and found that none of the cases had Cw6 antigen and five had DR3 or DR4 which are the classical diabetes association21. Marks and Tait in a study of ninety five patients with benign migratory glossitis found a marginal increase in the frequency of B15.42 Fenerly et al in a study of 50 Greek patients showed increased frequency of DR5 and DR6 and decreased frequency of B5135. Gonzaga et al in a study of 22 patients reported a highly significant association of Cw6 with both psoriasis and benign migratory glossitis, with this antigen being present in 59.1% of the patients of psoriasis, 43.8% of the patients with benign migratory glossitis and in only 12.6% of the controls41. These reports reinforce the concept of a pathogenitic relationship between migratory glossitis and psoriasis.
Patients with personal or family history of asthma, eczema and hay fever or elevated total serum immunoglobulin E levels may be more likely to have a geographic tongue. Psychosomatic factors, which probably contribute to both geographic tongue and atopy, may explain the high prevalence of this disorder in atopic patients. Goregen et al recently (2010) used patch test and prick tests to test different mechanisms associated with allergy. The skin prick test measures specific IgE anti bodies in the serum and is used to indicate sensitization. The patch test is helpful to determine delayed-type allergic reactions. The authors reported that performing both tests in combination improves the diagnostic efficacy of predisposition of allergy patients with benign migratory glossitis.45
Marks and Simons found a significantly increased frequency of atopy among patients with geographic tongue as compared to normal population. The prevalence of the HLA antigen B15 was found to be significantly elevated in cases with geographic tongue when compared to a normal population6. McLendon and Jaeger reported children with milk allergy and stated that benign migratory glossitis occurred in a significant proportion of these patients.46
Benign migratory glossitis or geographic tongue is common benign disorder of unknown etiology. The clinical presentation may vary from asymptomatic to a painful and burning ulceration. Management of geographic tongue depends upon the clinical presentation, the underlying etiology and should include reassuring the patients more so with cancer phobia about the benign nature of the disease.
Čanković, M., Bokor-Bratić, M., Marinoski, J. & Stilinović, N. (2018). The effect of zinc gluconate supplementation on the symptoms and tongue epithelium regeneration in non-psoriatic patients with migratory glossitis. Acta Dermatovenerologica Croatica, 26 (2), 125-125. Retrieved from
Čanković, Miloš, et al. \"The effect of zinc gluconate supplementation on the symptoms and tongue epithelium regeneration in non-psoriatic patients with migratory glossitis.\" Acta Dermatovenerologica Croatica, vol. 26, no. 2, 2018, pp. 125-125. Accessed 9 Feb. 2023.
Čanković, Miloš, Marija Bokor-Bratić, Jovan Marinoski and Nebojša Stilinović. \"The effect of zinc gluconate supplementation on the symptoms and tongue epithelium regeneration in non-psoriatic patients with migratory glossitis.\" Acta Dermatovenerologica Croatica 26, no. 2 (2018): 125-125.
Čanković, M., et al. (2018). 'The effect of zinc gluconate supplementation on the symptoms and tongue epithelium regeneration in non-psoriatic patients with migratory glossitis', Acta Dermatovenerologica Croatica, 26(2), pp. 125-125. Available at: (Accessed 09 February 2023)
Čanković M, Bokor-Bratić M, Marinoski J, Stilinović N. The effect of zinc gluconate supplementation on the symptoms and tongue epithelium regeneration in non-psoriatic patients with migratory glossitis. Acta Dermatovenerol Croat. [Internet]. 2018 [cited 2023 February 09];26(2):125-125. Available from:
M. Čanković, M. Bokor-Bratić, J. Marinoski and N. Stilinović, \"The effect of zinc gluconate supplementation on the symptoms and tongue epithelium regeneration in non-psoriatic patients with migratory glossitis\", Acta Dermatovenerologica Croatica, vol.26, no. 2, pp. 125-125, 2018. [Online]. Available: [Accessed: 09 February 2023]
The aim of this study was to evaluate zinc gluconate as a treatment option in patients with symptomatic migratory glossitis (MG). Using simple random sampling, 28 non-psoriatic patients with symptomatic MG were divided into a test and control group. The test group took 20 mg/day of chelated zinc gluconate for one month, and was put on a diet rich in zinc. The control group was only put on a diet rich in zinc. Changes in the size of red atrophied areas (width and length) and the intensity of symptoms were evaluated as primary and secondary outcomes, respectively, at baseline, after therapy, and one month later. In the test group, the mean value of the red atrophy area width and length displayed some significant reduction as a primary outcome. There were no significant changes in the size of red patches in the control group. Secondary outcome showed that the intensity of subjective symptoms in the test group significantly decreased (P=0.042) compared with controls. The filiform papillae had partially or completely regenerated in 85.7% of cases in the test group and in 23.1% of the controls (P=0.001). Red patches with raised keratotic rims may have healed spontaneously and reappeared in constantly changing patterns that are typical for MG. This