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in a ratio of 1&#44;5&#58;1&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">4&#8211;6</span></a> Benign migratory glossitis is a condition to which many associations have been established&#44; leading to the formulation of different theories about its possible etiology&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Etiology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Although the cause of geographic tongue is still unknown&#44; most patients report family history of the condition&#44; suggesting then a possible genetic predisposition&#46; Prevalence of this condition among parents and siblings of these patients is significantly higher than general population&#46; A study of Redman et al<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">7</span></a> in students of the University of Minnesota who suffered from geographic tongue analyzed family history&#44; showing that prevalence of first-degree relatives with geographic tongue was significantly higher than in the control group &#40;14&#46;1&#37; vs 4&#37;&#41;&#46; In relation to the studies about this condition&#39;s heritage&#44; a polygenetic inheritance model has been proposed&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand&#44; different factors and related diseases have been described to be related to this condition&#44; such as allergies&#44; hormonal alterations&#44; pregnancy&#44; juvenile diabetes&#44; Reiter syndrome&#44; psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">9</span></a> Down syndrome&#44; nutritional deficiencies&#44; lichen planus&#44; and also some drugs such as oral contraceptives&#44; lithium an antihypertensives&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">1&#44;10&#44;11</span></a> An inverse relation has been observed with smoking&#46;&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">5&#44;11</span></a> Some of the main conditions that have been related with geographic tongue are named in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Psoriasis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory skin disease&#44; which can also compromise joints&#46; Its cause is multifactorial&#44; redounding in a pro-inflammatory environment that produces a defect in the normal cycle of epidermis&#44; with alterations in the proliferation and differentiation of keratinocytes&#44; associated with inflammatory changes&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Presence of oral lesions in psoriasis is uncommon and controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">12</span></a> Oral manifestations such as geographic tongue and fissured tongue are highly non-specific&#46; Some reports suggest that approximately 10&#37; of patients would have geographic tongue&#44; turning it the most common oral manifestation in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">13</span></a> This studies are based on the observation of elemental lesions&#44; the histological similarity of both conditions and the presence of a common genetic marker HLA-Cw6&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">13&#8211;16</span></a> Gonzaga et al showed a strong association between the presence of HLA-Cw6 in psoriasis with geographic tongue&#44; identifying this antigen in a 59&#46;1&#37; of patients with psoriasis and in a 43&#46;8&#37; of patients with benign migratory glossitis&#44; while only a 12&#46;6&#37; was observed in the control group&#46; As a consequence&#44; the presence of geographic tongue has been planted as an authentic oral manifestation of psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">16</span></a> However&#44; other investigations have suggested that the association cannot be established properly&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">17</span></a> given there is a non-negligible percentage of healthy patients with migratory glossitis&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">18</span></a> An study performed by Picciani et al&#46; has proposed that only some patients with suggestive tongue lesions would have true oral psoriasis&#44; while the rest corresponds only to a primary geographic tongue&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">19</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Geographic tongue has been described as an early manifestation of psoriasis&#44; with late evolution into the fissured variant&#44; which could be permanent and&#47;or concomitant with geographic tongue up to a 34&#46;5&#37; of affected patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">5&#44;20&#44;21</span></a> Given the strong family history among parents and twins&#44; both lesions could correspond to a polygenetic inheritance pattern&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">22</span></a> On the other hand&#44; the fissured form has been described in pustular psoriasis&#44;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">23&#44;24</span></a> establishing a probable relationship with the severity of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">21&#44;23&#44;24</span></a> Recent studies have shown that mutations in the gene IL36RN are associated with geographic tongue&#44; being the latter the main cause of generalized pustular psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Allergies</span><p id="par0040" class="elsevierStylePara elsevierViewall">Studies have linked the presence of allergies with geographic tongue&#46; It has been reported that patients with personal or family history of asthma&#44; eczema&#44; allergic rhinitis and higher levels of immunoglobulin E are more prone to have geographic tongue when compared to people without the mentioned diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">6&#44;26</span></a> Miloglu et al determined that 24&#46;1&#37; of patients with geographic tongue had concomitantly an atopic or allergic disease&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">5</span></a> Likewise&#44; the study of Marks et al<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">6</span></a> shows personal or family history of these diseases in 86&#37; of the studied patients&#44; while in the control group was only up to 37&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There is a relationship between geographic tongue and seborreic dermatitis&#44; with some subtypes of bronchitis in children&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">27</span></a> Furthermore&#44; a study in patients with cow&#39;s milk allergy by Mclendon and Jaeger<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">28</span></a> showed that a significant proportion of these patients present benign migratory glossitis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Atopic dermatitis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Atopic dermatitis is a relapsing chronic inflammatory skin disease associated with other atopic diseases such as allergic rhinitis and asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">29</span></a> In developed countries its prevalence has increased in the last 30 years&#44; affecting 15-30&#37; of children and 2-10&#37; of adults&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">30</span></a> It is characterized by periods of exacerbation and remission&#44; presenting erythematous&#44; highly pruritic&#44; scaly and scabby plaques&#44; evolving into lichenified plates secondary to scratching&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">31</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinical manifestations vary with age and its etiopathogenesis responds to multiple mechanisms&#44; hence 2 mainly hypothesis have been proposed&#58; On the one hand&#44; the primary defect would be an immunological alteration that causes an IgE-mediated sensitization&#44; with a dysfunction of the epithelial barrier secondary to local inflammation&#59; and on the other&#44; there would be an intrinsic defect in the epithelial cells that leads to a dysfunction of the skin barrier&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">32</span></a> However&#44; recent studies have proposed environmental allergens as a key triggering factor&#44; proposing a new concept of pathogenesis &#40;&#8220;from the outside in&#8221;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding its association with geographic tongue&#44; studies have reported that patients with a personal or family history of atopy are more likely to have benign migratory glossitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">6&#44;31</span></a> This association may respond to the existence of psychosomatic factors&#44; which contribute to both pathologies&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">33</span></a> Furthermore&#44; good response has been seen with the use of topical Tacrolimus in patients with symptomatic migratory glossitis&#44; which is widely used in the treatment of atopic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Vitamin D</span><p id="par0065" class="elsevierStylePara elsevierViewall">There is no consistent evidence to establish a direct relationship between vitamin D deficiency and migratory glossitis&#46; However&#44; in 2016 a meta-analysis was performed establishing a possible role of vitamin D in improving the symptoms of atopic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">35</span></a> Thus&#44; it is possible to assume that vitamin D supplementation could help diminish severe symptoms of atopic dermatitis and&#44; consequently&#44; symptomatic glossitis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Celiac disease</span><p id="par0070" class="elsevierStylePara elsevierViewall">Celiac disease is an autoimmune disease that produces chronic inflammation of the small intestine&#39;s mucosa due to gluten intolerance&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">36</span></a> There are genetic markers such as HLA DQ2 or HLA DQ8&#44;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">37</span></a> that are present in more than 95&#37; of patients with this disease&#44; compared to 40&#37; in the general population&#46; Clinically&#44; it presents with malabsorption and malnutrition&#44; diarrhea&#44; anorexia&#44; constipation&#44; vomiting and abdominal distension&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">38</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Celiac disease may compromise oral cavity&#46; The most frequent and best-documented oral manifestations are recurrent aphthous stomatitis and dental enamel defects&#44;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">39&#44;40</span></a> however&#44; geographic tongue may constitute a possible oral manifestation of celiac disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">41&#8211;43</span></a> Cigic et al conducted a study in patients with geographic tongue and no history of celiac disease&#46; This study showed a 15&#37; incidence of celiac disease in these patients&#44; with diagnosis confirmed by duodenal biopsy&#46; All patients had a genetic marker present &#40;HLA DQ2 or HLADQ8&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">38</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Although more studies are still required&#44; the clinical examination of the oral cavity could serve as a diagnostic tool in patients with celiac disease&#44; especially in atypical forms&#44; which would help prevent associated complications&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">38</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Nutritional deficiencies</span><p id="par0085" class="elsevierStylePara elsevierViewall">Since there is a relationship between iron and B complex vitamins deficiency with generalized glossitis with papillary atrophy&#44; a possible association between geographic tongue and nutritional deficiencies has been proposed&#46; This type of glossitis can be confused with geographic tongue&#44; especially when the apex and lateral borders are compromised&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">44&#44;45</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">A study was conducted by the University of Minnesota in 42 patients with geographic tongue&#44; in which no patient showed signs of nutritional deficiencies&#46; Moreover&#44; there was no trend towards improvement among the ten patients who received a high dose of multivitamins and minerals when compared with the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">45</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In a study performed in elderly patients suffering from lingual abnormalities&#44; including geographic tongue&#44; it was found that treatment with multivitamins for 6 months did not significantly influence these conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">46</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Infections</span><p id="par0100" class="elsevierStylePara elsevierViewall">Due to the inflammatory nature of the lesions&#44; some bacterial and fungal infections were thought to be related with geographic tongue&#46; However&#44; no associated microorganism was consistently found&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Syndromes and geographical language<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">33</span></a></span><p id="par0105" class="elsevierStylePara elsevierViewall">Some of the syndromes described are Reiter syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">47</span></a> Robinow syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">48</span></a> fetal hydantoin syndrome and Down syndrome&#46; Regarding the latter&#44; a study conducted on mucocutaneous alterations in these patients established a possible association with lingual alterations&#44; given that 28&#37; of these patients had fissured tongue and 4&#37; had a geographical tongue&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">49</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Diagnosis</span><p id="par0110" class="elsevierStylePara elsevierViewall">The diagnosis of benign migratory glossitis is essentially clinical&#46; Laboratory tests are usually normal and&#44; in general terms&#44; lesion biopsy is not required given the benign nature of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">1</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Clinically&#44; erythematous plaques can be observed in absence of filiform papillae&#44; with a well-defined whitish margin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and a mixture of neutrophils and keratin&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a> These lesions are found mainly in the dorsal and lateral regions of the tongue&#44; have a migratory pattern&#44; and can change size&#44; shape and location within minutes to hours &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; They present periods of exacerbation and remission&#44; without complications or sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">50</span></a> There may be compromise of other areas of the oral mucosa such as soft palate&#44; buccal mucosa&#44; floor of the mouth&#44; gums and uvula&#44; however these are rare to be present&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">33</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">In most cases it presents as an asymptomatic disease&#44; with few reports of stomatodynia and&#47;or foreign body sensation&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Differential diagnoses to be consider include&#58; oral candidiasis&#44; oral lichen planus&#44; lupus erythematous&#44; trauma and adverse drug reaction&#46; In children&#44; atrophic candidiasis&#44; local trauma and severe neutropenia should be ruled out&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Treatment</span><p id="par0130" class="elsevierStylePara elsevierViewall">Due to its benign nature and mainly asymptomatic course&#44; patients with geographic tongue do not usually receive treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">1</span></a> In cases of symptoms&#44; such as pain and&#47;or burning sensation&#44; the use of mouthwashes with local anesthetic&#44; topical corticosteroids and&#47;or sucralfate can be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a> There are case reports with symptomatic glossitis that have presented an optimal response to the use of topical tacrolimus&#44;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">34</span></a> even in pediatric patients&#44; and when given over a short period of time&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">51</span></a> However&#44; in severe and persistent cases&#44; the use of oral ciclosporin has been described as the main effective treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">52</span></a> It is recommended to avoid irritating agents that exacerbate injuries&#44; such as spiced and acid foods&#44; and maintaining a good oral hygiene&#44; with toothpastes free of dyes and preservatives&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">53</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A general approach to patients with geographic tongue is proposed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">The geographical tongue or &#8220;migratory glossitis&#8221; is a benign and chronic inflammatory condition of the tongue&#44; with no known cause&#46; The diagnosis is made essentially with clinical resources&#44; with characteristic findings on physical examination&#46; It usually does not require treatment&#44; given its benign condition and asymptomatic course&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Although there are no studies that aim at geographic tongue associations with certain pathologies and&#47;or clinical conditions&#44; it is possible to highlight some important aspects of these&#46; First place&#44; a considerable number of studies support the relationship between geographical tongue and psoriasis&#44; showing a histological similarity and a common genetic marker&#46; In this context&#44; it is important to perform a thorough physical examination of patients with psoriasis in search of oral lesions&#44; which if present&#44; can constitute a marker of severity&#46; In the same way&#44; in patients with migratory glossitis&#44; it is advisable to investigate in search of cutaneous lesions suggestive of psoriasis&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding the existing relationship between allergies or atopy and geographical tongue&#44; it could be useful to consider therapies that are beneficial in atopic patients for the treatment of symptomatic glossitis&#44; such as the use of topical tacrolimus&#46; Along these lines&#44; a possible association between atopic patients and hypovitaminosis D has been proposed&#44; so it has been suggested that supplementation with vitamin D could reduce its symptoms&#46; However&#44; there are no studies that demonstrate this relationship with migratory glossitis&#46; New lines of research are required to establish possible causality and relationship with severity of the lingual manifestations&#44; as well to offer other treatment alternatives to patients with symptomatic and persistent migratory glossitis&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of Interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Geographic tongue&#44; also known as benign migratory glossitis&#44; is a benign chronic inflammatory condition of the tongue&#46; It is characterized by erythematous lesions with filiform papillae atrophy&#44; surrounded by white limited areas in the dorsal and lateral aspects of the tongue&#44; producing a map-like aspect&#46; This lesions change in size and shape with time&#44; and are characterized by periods of exacerbation and remission without scaring&#46; The cause is unknown&#44; but multiple associations have been described&#44; which will be discussed below&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La lengua geogr&#225;fica&#44; tambi&#233;n conocida como glositis migratoria benigna&#44; es una condici&#243;n inflamatoria cr&#243;nica benigna de la lengua&#46; Se caracteriza por presentar lesiones eritematosas asociadas a una atrofia de papilas&#44; las que est&#225;n rodeadas por &#225;reas blanquecinas bien delimitadas y localizadas predominantemente en la cara lateral y dorsal de la lengua&#44; lo que da una imagen que recuerda un mapa geogr&#225;fico&#46; Estas lesiones pueden variar tanto de tama&#241;o como de forma durante su evoluci&#243;n&#59; adem&#225;s&#44; presentan periodos de exacerbaci&#243;n y remisi&#243;n sin dejar lesiones cicatriciales residuales&#46; La causa de esta entidad sigue siendo desconocida&#44; sin embargo&#44; m&#250;ltiples asociaciones se han descrito&#44; las que son comentadas a continuaci&#243;n&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ogueta IC&#44; Ram&#237;rez MP&#44; Jim&#233;nez CO&#44; Cifuentes MM&#46; Lengua geogr&#225;fica&#58; &#191;qu&#233; es lo que un dermat&#243;logo deber&#237;a saber&#63;&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;341&#8211;346&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">- Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">- Reiter syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Allergies&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">- Lichen planus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Atopic dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Drugs&#58; Oral contraceptives&#44; lithium&#44; antihypertensives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Nutritional deficiencies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Genetic syndromes&#58; Robinow syndrome&#44; Down syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Hormonal conditions&#58; pregnancy among others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">- Celiac disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Conditions that have been frequently associated with geographic tongue&#46;</p>"
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Review
Geographic Tongue: What a Dermatologist Should Know
Lengua geográfica: ¿qué es lo que un dermatólogo debería saber?
I.C. Oguetaa,
Autor para correspondencia
iaogueta@uc.cl

Corresponding author.
, M.P. Ramírezb, C.O. Jiménezb, M.M. Cifuentesa
a Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
b Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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in a ratio of 1&#44;5&#58;1&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">4&#8211;6</span></a> Benign migratory glossitis is a condition to which many associations have been established&#44; leading to the formulation of different theories about its possible etiology&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Etiology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Although the cause of geographic tongue is still unknown&#44; most patients report family history of the condition&#44; suggesting then a possible genetic predisposition&#46; Prevalence of this condition among parents and siblings of these patients is significantly higher than general population&#46; A study of Redman et al<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">7</span></a> in students of the University of Minnesota who suffered from geographic tongue analyzed family history&#44; showing that prevalence of first-degree relatives with geographic tongue was significantly higher than in the control group &#40;14&#46;1&#37; vs 4&#37;&#41;&#46; In relation to the studies about this condition&#39;s heritage&#44; a polygenetic inheritance model has been proposed&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand&#44; different factors and related diseases have been described to be related to this condition&#44; such as allergies&#44; hormonal alterations&#44; pregnancy&#44; juvenile diabetes&#44; Reiter syndrome&#44; psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">9</span></a> Down syndrome&#44; nutritional deficiencies&#44; lichen planus&#44; and also some drugs such as oral contraceptives&#44; lithium an antihypertensives&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">1&#44;10&#44;11</span></a> An inverse relation has been observed with smoking&#46;&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">5&#44;11</span></a> Some of the main conditions that have been related with geographic tongue are named in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Psoriasis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory skin disease&#44; which can also compromise joints&#46; Its cause is multifactorial&#44; redounding in a pro-inflammatory environment that produces a defect in the normal cycle of epidermis&#44; with alterations in the proliferation and differentiation of keratinocytes&#44; associated with inflammatory changes&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Presence of oral lesions in psoriasis is uncommon and controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">12</span></a> Oral manifestations such as geographic tongue and fissured tongue are highly non-specific&#46; Some reports suggest that approximately 10&#37; of patients would have geographic tongue&#44; turning it the most common oral manifestation in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">13</span></a> This studies are based on the observation of elemental lesions&#44; the histological similarity of both conditions and the presence of a common genetic marker HLA-Cw6&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">13&#8211;16</span></a> Gonzaga et al showed a strong association between the presence of HLA-Cw6 in psoriasis with geographic tongue&#44; identifying this antigen in a 59&#46;1&#37; of patients with psoriasis and in a 43&#46;8&#37; of patients with benign migratory glossitis&#44; while only a 12&#46;6&#37; was observed in the control group&#46; As a consequence&#44; the presence of geographic tongue has been planted as an authentic oral manifestation of psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">16</span></a> However&#44; other investigations have suggested that the association cannot be established properly&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">17</span></a> given there is a non-negligible percentage of healthy patients with migratory glossitis&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">18</span></a> An study performed by Picciani et al&#46; 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being the latter the main cause of generalized pustular psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Allergies</span><p id="par0040" class="elsevierStylePara elsevierViewall">Studies have linked the presence of allergies with geographic tongue&#46; It has been reported that patients with personal or family history of asthma&#44; eczema&#44; allergic rhinitis and higher levels of immunoglobulin E are more prone to have geographic tongue when compared to people without the mentioned diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">6&#44;26</span></a> Miloglu et al determined that 24&#46;1&#37; of patients with geographic tongue had concomitantly an atopic or allergic disease&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">5</span></a> Likewise&#44; the study of Marks et al<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">6</span></a> shows personal or family history of these diseases in 86&#37; of the studied patients&#44; while in the control group was only up to 37&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There is a relationship between geographic tongue and seborreic dermatitis&#44; with some subtypes of bronchitis in children&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">27</span></a> Furthermore&#44; a study in patients with cow&#39;s milk allergy by Mclendon and Jaeger<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">28</span></a> showed that a significant proportion of these patients present benign migratory glossitis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Atopic dermatitis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Atopic dermatitis is a relapsing chronic inflammatory skin disease associated with other atopic diseases such as allergic rhinitis and asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">29</span></a> In developed countries its prevalence has increased in the last 30 years&#44; affecting 15-30&#37; of children and 2-10&#37; of adults&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">30</span></a> It is characterized by periods of exacerbation and remission&#44; presenting erythematous&#44; highly pruritic&#44; scaly and scabby plaques&#44; evolving into lichenified plates secondary to scratching&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">31</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinical manifestations vary with age and its etiopathogenesis responds to multiple mechanisms&#44; hence 2 mainly hypothesis have been proposed&#58; On the one hand&#44; the primary defect would be an immunological alteration that causes an IgE-mediated sensitization&#44; with a dysfunction of the epithelial barrier secondary to local inflammation&#59; and on the other&#44; there would be an intrinsic defect in the epithelial cells that leads to a dysfunction of the skin barrier&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">32</span></a> However&#44; recent studies have proposed environmental allergens as a key triggering factor&#44; proposing a new concept of pathogenesis &#40;&#8220;from the outside in&#8221;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding its association with geographic tongue&#44; studies have reported that patients with a personal or family history of atopy are more likely to have benign migratory glossitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">6&#44;31</span></a> This association may respond to the existence of psychosomatic factors&#44; which contribute to both pathologies&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">33</span></a> Furthermore&#44; good response has been seen with the use of topical Tacrolimus in patients with symptomatic migratory glossitis&#44; which is widely used in the treatment of atopic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Vitamin D</span><p id="par0065" class="elsevierStylePara elsevierViewall">There is no consistent evidence to establish a direct relationship between vitamin D deficiency and migratory glossitis&#46; However&#44; in 2016 a meta-analysis was performed establishing a possible role of vitamin D in improving the symptoms of atopic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">35</span></a> Thus&#44; it is possible to assume that vitamin D supplementation could help diminish severe symptoms of atopic dermatitis and&#44; consequently&#44; symptomatic glossitis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Celiac disease</span><p id="par0070" class="elsevierStylePara elsevierViewall">Celiac disease is an autoimmune disease that produces chronic inflammation of the small intestine&#39;s mucosa due to gluten intolerance&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">36</span></a> There are genetic markers such as HLA DQ2 or HLA DQ8&#44;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">37</span></a> that are present in more than 95&#37; of patients with this disease&#44; compared to 40&#37; in the general population&#46; Clinically&#44; it presents with malabsorption and malnutrition&#44; diarrhea&#44; anorexia&#44; constipation&#44; vomiting and abdominal distension&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">38</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Celiac disease may compromise oral cavity&#46; The most frequent and best-documented oral manifestations are recurrent aphthous stomatitis and dental enamel defects&#44;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">39&#44;40</span></a> however&#44; geographic tongue may constitute a possible oral manifestation of celiac disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">41&#8211;43</span></a> Cigic et al conducted a study in patients with geographic tongue and no history of celiac disease&#46; This study showed a 15&#37; incidence of celiac disease in these patients&#44; with diagnosis confirmed by duodenal biopsy&#46; All patients had a genetic marker present &#40;HLA DQ2 or HLADQ8&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">38</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Although more studies are still required&#44; the clinical examination of the oral cavity could serve as a diagnostic tool in patients with celiac disease&#44; especially in atypical forms&#44; which would help prevent associated complications&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">38</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Nutritional deficiencies</span><p id="par0085" class="elsevierStylePara elsevierViewall">Since there is a relationship between iron and B complex vitamins deficiency with generalized glossitis with papillary atrophy&#44; a possible association between geographic tongue and nutritional deficiencies has been proposed&#46; This type of glossitis can be confused with geographic tongue&#44; especially when the apex and lateral borders are compromised&#46;<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">44&#44;45</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">A study was conducted by the University of Minnesota in 42 patients with geographic tongue&#44; in which no patient showed signs of nutritional deficiencies&#46; Moreover&#44; there was no trend towards improvement among the ten patients who received a high dose of multivitamins and minerals when compared with the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">45</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In a study performed in elderly patients suffering from lingual abnormalities&#44; including geographic tongue&#44; it was found that treatment with multivitamins for 6 months did not significantly influence these conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">46</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Infections</span><p id="par0100" class="elsevierStylePara elsevierViewall">Due to the inflammatory nature of the lesions&#44; some bacterial and fungal infections were thought to be related with geographic tongue&#46; However&#44; no associated microorganism was consistently found&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Syndromes and geographical language<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">33</span></a></span><p id="par0105" class="elsevierStylePara elsevierViewall">Some of the syndromes described are Reiter syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">47</span></a> Robinow syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">48</span></a> fetal hydantoin syndrome and Down syndrome&#46; Regarding the latter&#44; a study conducted on mucocutaneous alterations in these patients established a possible association with lingual alterations&#44; given that 28&#37; of these patients had fissured tongue and 4&#37; had a geographical tongue&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">49</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Diagnosis</span><p id="par0110" class="elsevierStylePara elsevierViewall">The diagnosis of benign migratory glossitis is essentially clinical&#46; Laboratory tests are usually normal and&#44; in general terms&#44; lesion biopsy is not required given the benign nature of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">1</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Clinically&#44; erythematous plaques can be observed in absence of filiform papillae&#44; with a well-defined whitish margin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and a mixture of neutrophils and keratin&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a> These lesions are found mainly in the dorsal and lateral regions of the tongue&#44; have a migratory pattern&#44; and can change size&#44; shape and location within minutes to hours &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; They present periods of exacerbation and remission&#44; without complications or sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">50</span></a> There may be compromise of other areas of the oral mucosa such as soft palate&#44; buccal mucosa&#44; floor of the mouth&#44; gums and uvula&#44; however these are rare to be present&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">33</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">In most cases it presents as an asymptomatic disease&#44; with few reports of stomatodynia and&#47;or foreign body sensation&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Differential diagnoses to be consider include&#58; oral candidiasis&#44; oral lichen planus&#44; lupus erythematous&#44; trauma and adverse drug reaction&#46; In children&#44; atrophic candidiasis&#44; local trauma and severe neutropenia should be ruled out&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Treatment</span><p id="par0130" class="elsevierStylePara elsevierViewall">Due to its benign nature and mainly asymptomatic course&#44; patients with geographic tongue do not usually receive treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">1</span></a> In cases of symptoms&#44; such as pain and&#47;or burning sensation&#44; the use of mouthwashes with local anesthetic&#44; topical corticosteroids and&#47;or sucralfate can be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a> There are case reports with symptomatic glossitis that have presented an optimal response to the use of topical tacrolimus&#44;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">34</span></a> even in pediatric patients&#44; and when given over a short period of time&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">51</span></a> However&#44; in severe and persistent cases&#44; the use of oral ciclosporin has been described as the main effective treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">52</span></a> It is recommended to avoid irritating agents that exacerbate injuries&#44; such as spiced and acid foods&#44; and maintaining a good oral hygiene&#44; with toothpastes free of dyes and preservatives&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">53</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A general approach to patients with geographic tongue is proposed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">The geographical tongue or &#8220;migratory glossitis&#8221; is a benign and chronic inflammatory condition of the tongue&#44; with no known cause&#46; The diagnosis is made essentially with clinical resources&#44; with characteristic findings on physical examination&#46; It usually does not require treatment&#44; given its benign condition and asymptomatic course&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Although there are no studies that aim at geographic tongue associations with certain pathologies and&#47;or clinical conditions&#44; it is possible to highlight some important aspects of these&#46; First place&#44; a considerable number of studies support the relationship between geographical tongue and psoriasis&#44; showing a histological similarity and a common genetic marker&#46; In this context&#44; it is important to perform a thorough physical examination of patients with psoriasis in search of oral lesions&#44; which if present&#44; can constitute a marker of severity&#46; In the same way&#44; in patients with migratory glossitis&#44; it is advisable to investigate in search of cutaneous lesions suggestive of psoriasis&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding the existing relationship between allergies or atopy and geographical tongue&#44; it could be useful to consider therapies that are beneficial in atopic patients for the treatment of symptomatic glossitis&#44; such as the use of topical tacrolimus&#46; Along these lines&#44; a possible association between atopic patients and hypovitaminosis D has been proposed&#44; so it has been suggested that supplementation with vitamin D could reduce its symptoms&#46; However&#44; there are no studies that demonstrate this relationship with migratory glossitis&#46; New lines of research are required to establish possible causality and relationship with severity of the lingual manifestations&#44; as well to offer other treatment alternatives to patients with symptomatic and persistent migratory glossitis&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of Interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Geographic tongue&#44; also known as benign migratory glossitis&#44; is a benign chronic inflammatory condition of the tongue&#46; It is characterized by erythematous lesions with filiform papillae atrophy&#44; surrounded by white limited areas in the dorsal and lateral aspects of the tongue&#44; producing a map-like aspect&#46; This lesions change in size and shape with time&#44; and are characterized by periods of exacerbation and remission without scaring&#46; The cause is unknown&#44; but multiple associations have been described&#44; which will be discussed below&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La lengua geogr&#225;fica&#44; tambi&#233;n conocida como glositis migratoria benigna&#44; es una condici&#243;n inflamatoria cr&#243;nica benigna de la lengua&#46; Se caracteriza por presentar lesiones eritematosas asociadas a una atrofia de papilas&#44; las que est&#225;n rodeadas por &#225;reas blanquecinas bien delimitadas y localizadas predominantemente en la cara lateral y dorsal de la lengua&#44; lo que da una imagen que recuerda un mapa geogr&#225;fico&#46; Estas lesiones pueden variar tanto de tama&#241;o como de forma durante su evoluci&#243;n&#59; adem&#225;s&#44; presentan periodos de exacerbaci&#243;n y remisi&#243;n sin dejar lesiones cicatriciales residuales&#46; La causa de esta entidad sigue siendo desconocida&#44; sin embargo&#44; m&#250;ltiples asociaciones se han descrito&#44; las que son comentadas a continuaci&#243;n&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ogueta IC&#44; Ram&#237;rez MP&#44; Jim&#233;nez CO&#44; Cifuentes MM&#46; Lengua geogr&#225;fica&#58; &#191;qu&#233; es lo que un dermat&#243;logo deber&#237;a saber&#63;&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;341&#8211;346&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">- Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">- Reiter syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Allergies&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">- Lichen planus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">- Atopic dermatitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">- Drugs&#58; Oral contraceptives&#44; lithium&#44; antihypertensives&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Nutritional deficiencies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Genetic syndromes&#58; Robinow syndrome&#44; Down syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Hormonal conditions&#58; pregnancy among others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Celiac disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Conditions that have been frequently associated with geographic tongue&#46;</p>"
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