A 35-year-old woman presents complaining about the appearance of her tongue. She said she had never really been bothered by the appearance of her tongue until her 8-year-old daughter said, “Mommy, you have a funny tongue.”
The patient thinks her tongue has always looked this way. She does not complain of any specific symptoms associate with her tongue and has no other medical problems.
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Fissured tongue has multiple synonyms, including scrotal tongue, plicated tongue, ligua plicata and furrowed tongue.
Fissured tongue is considered to be a normal tongue variant and is relatively common, with an estimated prevalence between 2-30%. Men and women are equally affected. It may be an inherited trait, but there is no known specific associated gene.
In fissured tongue, there are furrows and grooves on the dorsum of the tongue. The grooves are approximately 2-3mm deep and are most prominent over the central dorsal tongue. Some have compared these furrows to the ruggae of the scrotum, hence the name “scrotal tongue.”
Fissured tongue is seen commonly in patients with Down syndrome. Other associations include Melkersson-Rosenthal syndrome, acromegaly, Cowden syndrome and pachyonychia congenital.
While geographic tongue is sometimes associated with fissured tongue, it is an entirely separate entity. Geographic tongue presents with red patches on the dorsum of the tongue and has a thin, white, scalloped border. The red patches are due to atrophy of the filliform papillae. The histologic appearance is similar to psoriasis.
Median rhomboid glossitis is a distinct form of mucosal candidiasis affecting the dorsal tongue. The condition is characterized by an oval or diamond shaped erythematous and atrophic patch on the midline posterior dorsal tongue, just anterior to the circumvallate papillae. It resolves with anticandidal therapy.
In black hairy tongue, black, brown or yellow patches occur on the dorsal anterior two-thirds of the tongue. The patches have a “hairy” appearance. The condition is due to hyperplasia of the papillae with increased retention of keratin. Although the condition is benign, patients may complain of a bad taste. Smoking is a common association.
The diagnosis is based on the characteristic appearance of furrows and grooves on the dorsum of the tongue. Fissured tongue requires no treatment.
Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.
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