Geographic Tongue and Psoriasis — MFDS Part 1 MCQ

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HardOral MedicineGeographic Tongue and PsoriasisMFDS Part 1

A 38-year-old patient has recurrent, asymptomatic, depapillated erythematous patches on the dorsal tongue. Each patch has a serpiginous pale margin and changes position over several days. A biopsy obtained because the initial appearance was atypical shows parakeratosis, superficial epithelial neutrophils and elongation of the rete ridges. Which dermatological condition has the best-established epidemiological association with this oral disorder?

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Correct answer: A — Psoriasis

The migratory depapillated patches with serpiginous margins identify geographic tongue (benign migratory glossitis). Its best-established dermatological association is psoriasis: a systematic review and meta-analysis found substantially higher odds of geographic tongue in patients with psoriasis. The two disorders can also show overlapping psoriasiform microscopic features, including parakeratosis, epithelial neutrophils and elongated rete ridges. Geographic tongue is nevertheless not specific for psoriasis, and it should not automatically be diagnosed as oral psoriasis. Lichen planus more typically produces persistent reticular white striae or erosions, while pemphigus vulgaris causes fragile bullae and erosions with intraepithelial acantholysis. Atopic dermatitis and dermatitis herpetiformis do not have an equivalently established association with this characteristic migratory lingual lesion.

Reference: González-Álvarez L, García-Martín JM, García-Pola MJ. Association between geographic tongue and psoriasis: A systematic review and meta-analyses. Journal of Oral Pathology & Medicine. 2019;48(5):365–372. https://pubmed.ncbi.nlm.nih.gov/30739339/