Differential diagnoses - Conditions affecting the tongue

Dr Nigel Stollery explains the differences in characteristic features of diseases of the tongue.

Scarlet fever

Presentation

  • Strawberry tongue, initially pale with red spots, changing to bright red after a few days
  • Most commonly affects children aged three to 15 years
  • Caused by Group A streptococcus infection
  • Other symptoms include sore throat, headache, vomiting, generally unwell
  • A throat swab can confirm the diagnosis

Management

  • Treatment of choice is a 10-day course of penicillin
  • Although symptoms usually settle after a few days, patients are advised to complete the course to prevent spread and complications
  • Complications are rare and include meningitis, pneumonia and throat abscesses

Geographical tongue

Presentation

  • Common benign condition affecting 2-3% of the population
  • Characterised by areas of depapillation
  • Area migrates with time
  • Unknown cause
  • May cause a burning sensation
  • No association with oral malignancy

Management

  • Treatment not usually required
  • Condition tends to be chronic

Primary glossitis

Presentation

  • Soreness of the tongue, often with redness and loss of papillae
  • Swelling may also be present
  • In primary glossitis, the cause is unknown
  • In secondary cases, causes include iron deficiency anaemia, vitamin B deficiencies, infections, allergic reactions

Management

  • Aim is to reduce inflammation
  • Oral hygiene is very important
  • Fluid intake to maintain saliva
  • Investigations are required to exclude secondary causes

Fungal infection

Presentation

  • Presents with dark, sometimes black, coating on the tongue
  • More common in smokers
  • Tongue may swell and feel sore
  • Taste may also be affected in some cases
  • Differential diagnosis includes candida infections
  • If in doubt, a swab can be taken

Management

  • Topical antifungal drops are helpful
  • Reducing smoking and good oral hygiene are advisable
  • If recurrent, may be related to an immunocompromised state

Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Just published

Map: Which parts of England have the most patients per GP?

Map: Which parts of England have the most patients per GP?

Some CCG areas have almost twice as many patients per GP as others, analysis by GPonline...

10 ways to save general practice

10 ways to save general practice

Professor Rodger Charlton sets out ten changes that could make general practice a...

RCGP elects east London GP Professor Martin Marshall as new Chair

RCGP elects east London GP Professor Martin Marshall as new Chair

Professor Martin Marshall has been elected Chair of the RCGP and will take over from...

Rising patient numbers pile pressure on falling GP workforce

Rising patient numbers pile pressure on falling GP workforce

The number of patients registered with GP practices in England rose by more than...

Practice manager jailed after stealing £700,000 from GPs to fund gambling habit

Practice manager jailed after stealing £700,000 from GPs to fund gambling habit

A practice manager has been jailed for three years after stealing nearly £700,000...

GPs maintain high patient satisfaction despite rising demand

GPs maintain high patient satisfaction despite rising demand

The vast majority of patients are satisfied overall with their NHS GP service despite...