Common Signs on the Tongue
Dry TongueDehydration
Microglossia: small tonguePseudobulbar palsy
Macroglossia: large tongueDown syndrome, acromegaly, amyloidosis, sarcoidosis
Smooth tongue (atrophic glossitis): loss of the normal texture of the tongue.Use of dentures, iron / folate / B12 deficiency, low oestrogen
Fissured tongue - deep grooves, especially on the edges of the tongueAcromegaly, psoriasis, Sjogren's
Geographic tongue (benign migratory glossitis): painless discoloured patches with a punched-out appearance, that may resolve and reappear in a new configuration.Benign - 2% of the population
Tongue mass - note the size, shape, consistency and colourTraumatic fibroma, SCC, papilloma
Thrush - painless white plaques that are easily scraped offCandida infection
Leukoplakia: white patches that don't scrape off.Premalignant, or EBV infection in HIV patients
Black hairy tongueAspergillosis
Tongue Ulcers
Look For
- Ulcers on the tongue, noting their number, size, colour and distribution.
Causes of Tongue Ulcers
- Trauma - mechanical / chemical / radiation
- Aphthous stomatitis
- Dermatoses - pemphigus, lichen planus, erythema multiforme
- Infection - herpes simplex (cold sore), coxsackie (hand, foot and mouth), syphilis, bacterial, candidiasis
- Rheumatological - SLE, Reiter's syndrome
- GIT - Crohn's disease, coeliac disease
- Drugs - antineoplastics
- Malignancy
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