Pathology · patient case with 2 questions
Grooved tongue and sensitivity to spicy food
Patient: Female, 36 years old
Chief Complaint: “My tongue burns whenever I eat anything spicy, and it looks cracked.”
Background: No systemic disease. Non-smoker. She has noticed the appearance for several years and it has not changed.
Current Findings: The dorsal tongue shows deep grooves radiating in several directions from a central furrow. No ulceration, no induration, no white plaque that can be wiped off. The lesion is symmetrical and non-tender to palpation.
Question 1
What is the diagnosis?
Show answer and explanation
Correct answer: A. Fissured tongue
- A. CORRECT. Fissured tongue (lingua fissurata, scrotal tongue) is a benign developmental variant showing multiple grooves and furrows on the dorsum, often with a deeper central fissure. Prevalence rises with age. It requires no treatment beyond gentle brushing of the dorsum, since debris collecting in the fissures causes irritation and halitosis.
- B. Median rhomboid glossitis is a single well-demarcated erythematous rhomboid area of papillary atrophy at the midline just anterior to the circumvallate papillae, associated with Candida.
- C. Hairy tongue is elongation of the filiform papillae producing a matted, hair-like, often brown or black surface — not deep grooves.
- D. Geographic tongue shows migrating erythematous patches with raised white serpiginous borders and characteristically CHANGES pattern over days to weeks. This lesion is stable and consists of grooves, not patches. Note that the two conditions frequently coexist.
Question 2
What is the appropriate management?
Show answer and explanation
Correct answer: D. Reassurance and gentle brushing of the tongue dorsum
- A. Antifungals are indicated if Candida superinfects the fissures, which can happen — but empiric systemic therapy for an uncomplicated fissured tongue is not appropriate.
- B. Biopsy is indicated for a persistent lesion with worrying features — induration, ulceration lasting over two weeks, a red or speckled patch. A symmetrical, stable, non-indurated fissured dorsum has none of these.
- C. Corticosteroids treat inflammatory and immune-mediated mucosal disease. There is no inflammatory infiltrate to suppress here.
- D. CORRECT. Fissured tongue is a benign anatomical variant with no malignant potential. The only intervention needed is brushing the dorsum to clear food debris and microorganisms from the fissures, which is what causes the intermittent soreness and any halitosis.
Note: The classic association to remember: fissured tongue is a feature of MELKERSSON-ROSENTHAL SYNDROME (fissured tongue + recurrent facial/lip swelling + recurrent facial nerve palsy) and is also seen at increased frequency in DOWN SYNDROME. It also coexists with geographic tongue very often.