- Email: [email protected]
Migratory stomatitis
Migratory
stomatitis
M. M. Littner, D.M.D., D. Dayan, D.M.D., D. Moskona, D.M.D., and M. Harel-Raviv, SECTION SCHOOL
OF ORAL OF DENTAL
PATHOLOGY MEDICfNE,
AND TEL
ORAL AVIV
M.S., M. Gorsky, D.M.D., D.M.D., Tel Aviv, Israel
MEDICINE, UNIVERSITY
THE
MAURICE
AND
GABRIELA
GOLDSCHLEGER
Migratory stomatitis is a unique oral condition with several descriptive names. The diagnosis is based on the clinical appearance and the history of the lesions. The etiology of this entity is still open to debate. A review of the literature and a clinical description of a study group consisting of seven additional cases, in which long-term follow-up was done, are presented. Migrafory sfomatitis is suggested as the most suitable term (ORAL
to describe SURC.
ORAL
accurately
the nature
MED.
PATHOL.
ORAL
and the behavior 1987;63:555-9)
of this condition.
I
n 1955, Cooke’ described a unique oral condition of slightly raised, round, erythematous lesions that were circumscribed by well-defined whitish borders and that appeared on the oral mucosa. He named this condition erythema migrans. Other terms describing this condition, such as areata linguae et mucosae oris and ectopic geographic tongue, have been given.2-5 The last name was given to the condition because of its similarity in nature and behavior to the glossal condition known as geographic tongue. A literature review revealed only a few case reports that described this condition. In some cases, there was a relationship to other conditions such as fissured tongue or geographic tongue. The purpose of this article is to analyze the signs, the symptoms, and the behavior of this condition in a long-term study of a group of seven patients, and to discuss the differential diagnosis and a suitable term to describe this entity. The term migratory stomatitis is suggested. CLINICAL
DESCRIPTION
OF THE STUDY
GROUP
The study group consisted of seven patients: five women and two men, aged 22 to 58, with a mean age of 36 (Table I). All patients underwent routine dental treatment at the Oral Diagnosis Clinic, Tel Aviv University School of Dental Medicine. During the examinations, erythematous ovoid lesions ranging between 0.3 and 0.8 mm in diameter with horseshoe-shaped whitish borders were noticed on the buccal mucosa (Fig. l), on the labial mucosa, on the soft palate, and on the ventral surface of the tongue. In all of the patients, the conditions were diagnosed clinically as migratory stomatitis., In five patients, similar lesions were observed on the dorsum
Fig. 1. Migratory stomatitis appearing as ovoid, shoeshaped lesion (0.8 mm) on left buccal mucosaof 22-
year-old white woman.
of the tongue and were diagnosed as geographic tongue. In three patients, fissured tongue was associated with migratory stomatitis. One patient exhibited both geographic tongue and fissured tongue. Most patients were asymptomatic, except for two who complained of occasional itching at the sites of the lesions. Follow-up showed that the lesions appeared at intervals of days up to weeks at different locations on the mucous membranes such as the labial mucosa, the soft palate (Fig. 2), and the ventral surface of the tongue (Fig. 3). The medical histories of patients in the study group were not contributory except for that of one patient who suffered from diabetes, which was controlled by a low-sugar diet. This patient was the only one who used tobacco (cigarettes). All of the patients were free of allergies. 555
556
Littner et al.
Oral Surg. May, 1987
Fig. 2. Migratory stomatitis appearing as erythematous lesions on soft palate in patient depicted in Fig. 1.
fable
I. Study Group A-general Gender
Age at admission
description of patients with migratory Symptoms
M
22
F
39
F
31 58
Asymptomatic Asymptomatic
34 37 31
Asymptomatic Asymptomatic Asymptomatic
M
F F
F
Fig. 3. Migratory stomatitis on ventral surface of tongue in patient depicted in Fig. 1.
Occasional itching Occasional itching
stomatitis
Sites of lesions
__I_ Tongue
Right and left buccal mucosa
GT*
Buccal mucosa, ventral surface of tongue, lower labial mucosa Right and left buccal mucosa Ventral surface of tongue, buccal mucosa Lower labial mucosa Right and left buccal mucosa Labial mucosa, soft palate, ventral surface of tongue
GT,
conditions
FT’*
GT GT FT FT GT
*geographic tongue **fissured tongue.
No aggravating factors were detected. Three patients became afraid they had cancer and were reassured of the benign nature of the oral condition. Biopsy specimens taken from the sites of the lesions showed similar microscopic pictures. Histologic sections showed the epithelium to be thick with thickened swollen rete ridges pushing down into the showed lamina propria. The surface epithelium acanthosis and spongiosis. Areas demonstrating a mild increase of keratin could be noted at the region of the white border of the lesion. The reddish central portion of the lesion resulted from desquamation. The lamina propria was infiltrated with lymphocytes, plasma cells, histiocytes, and polymorphonuclear leukocytes. A marked transmigration of polymorphonuclear leukocytes and lymphocytes through the surface epithelium was also evident (Fig. 4). Focal zones in the epithelium showed degeneration with marked intercellular and intracellular edema
and were in association with increased inflammatory cell infiltration, suggesting intraepithelial microabscesses(Fig. 5). The picture of elongated rete ridges, acanthosis, spongiosis, and transmigration of polymorphonuclear leukocytes and lymphocytes supported the clinical diagnosis of migratory stomatitis. A 4-year follow-up conducted with all of the patients revealed only the migratory behavior of these asymptomatic lesions. No scars were left at the sites of the previous lesions. DISCUSSION
Migratory stomatitis is described as a horseshoeshaped, erythematous area with whitish, raised margins. The lesions are commonly located on the buccal mucosa, the lips, the palate, the floor of the mouth, the ventral surface of the tongue, and the gingiva.1~2~4-*In the majority of cases reported in the literature, we found that migratory stomatitis
Volume 63 Number 5
Migratory
stomatitis
Fig. 4. Elongated rete ridges of epithehum in lamina propria showing marked transmigration inflammatory cells through surface. (Hematoxylin and eosin stain. Original magnification, x40.)
557
of
5. Intraepithelial microabscesses in surface epithelium of migratory stomatitis. (Hematoxylin and eosinstain. Original magnification, X250.)
Fig.
appeared with another oral lesion such as geographic tongue or fissured tongue. However, oral mucosal lesions may also appear in patients in whom the dorsum of the tongue is normal.“ Most patients were unaware of this condition, which is usually detected in a routine dental examination.4~6~9~‘0 In a few patients, the symptoms of migratory stomatitis, which vary from a little discomfort to a persistent burning sensation aggravated by different condimentat foods,*, ‘I,‘* are the main reason for seeking medical help.’ Table I (our study group, hereafter referred to as Group A) demonstrates that only two (28.5%) out of seven patients complained of an itching sensation,
while the other five patients were asymptomatic. The cases found in the literature (Table II, Group B), added to the present study group, revealed that only four (17%) out of twenty-three patients were symptomatic. No article dealt with the prevalence of appearance and of symptoms of migratory stomatitis. According to Hoexter,4 there is a male predominance associated with the condition, with a maleto-female ratio of 5:4. We found the same tendency when Groups A and B were combined; 61% of the patients were male and 39% were female. The cause of migratory stomatitis is unknown. However, the clinical similarity between migratory stomatitis and
558
Littner
et al.
Ordl
!kg.
May,
II. Literature
Table
Author’s name Cooke1
Sapiro
and ShklaP
Weathers
et al’*
HoexteP Kogon
Rails
Dupre
and Staki’
et al8
et al’”
case reports (Group B)-general
description of patients with migratory
stomatitis
Sites of lesions
Age
Gender
Floor of mouth, soft palate, mucosa of lower lip Vestibule of mandible, buccal mucosa Mandibular vestibule, labial alveolar mucosa Alveolar mucosa, buccal mucosa Buccal mucosa Buccal mucosa Right buccal mucosa Left buccal mucosa Alveolar mucosa (upper and lower) Buccal mucosa Buccal mucosa, labial mucosa Buccal mucosa, maxillary alveolar mucosa Labial mucosa (upper and lower lip), buccal
30
M
FT* and GT**
Occasional sore tongue and itching
40
M
FT
None
37
M
FT and GT
None
44
M
27 23 24 16 9
F F F M M
27 21
M M
73
M
27
M
GT
None
62
M
FT
None
82 16
F M
GT FT
None None
Buccal mucosa, tongue, gingiva, soft palate, labial mucosa of lips Lower lip Upper and lower lip
19x7
Tongue conditions
None GT GT
GT
None None Slight burning None None None _-. None
*fissured tongue. **geographic tongue.
geographic tongue in nature, behavior, and histologic appearance may be suggestive of its etiology. In geographic tongue, the following factors are considered causes: l Allergy.13”7 l Familial tendency and/or congenital anoma13. 14, 16 ly. l Acute inflammatory reaction.“j l Psychosomatic factors.3 Weathers and coworkers’* claim that migratory stomatitis might be a form of psoriasis. In their opinion, there is an abundance of cases of migratory stomatitis in association with cutaneous psoriasis. In order to diagnose oral or psoriatic lesions, it is best to find oral lesions together with parallel skin lesions. Therefore, oral lesions that are not accompanied by any skin lesions are known as psoriasiform lesions. This statement is contradictory of the results of a study of 100 psoriatic patients conducted by Buchner and Begleiter,19 which revealed that in psoriatic patients, no oral lesions could be found. Thus, the occurrence of psoriatic lesions on oral mucosa membranes is a subject of controversy.20v2’
Additional large-scale studies are needed in order to clarify the etiology of migratory stomatitis. In patients with symptomatic migratory stomatitis, reassurance of the benign nature of the lesion, together with advice to avoid irritants, especially spicy foods and smoking, alleviates most of the discomfort. Topical anesthetics, topical steroids, or a combination of the two, control the more persistent symptomatic lesions. Tranquilizers should be considered for patients in whom emotional stress develops because of an extreme fear of cancer. A number of descriptive terms are used for migratory stomatitis: erythema migrans,’ stomatitis areata migrans,6 exfoliation areata lingual in the oral mucosa,2 and annulus migrans.20The term ectopic geographic tongue was used to emphasize the fact
that lesions that usually appear on the tongue appear with this entity in other locations as well as on the tongue. The term geographic or migratory glossitis was used to describe the clinical changes in the appearance of the lesions on the dorsum of the tongue since they resemble a picture of a geographic map. Ectopic
Volume Number
Migratory
63 5
migratory glossitis does not seem to be an accurate term since lesions that are located on other mucous membranes are not lesions of the tongue. We suggest that migratory stomatitis is an accurate term to describe the nature and the behavior of these lesions that may appear on the tongue and at other sites in the oral cavity. We wish assistance.
to
thank
Mrs.
R.
Lazar
for
her
editorial
REFERENCES 1. Cooke
Erythema migrans affecting the oral mucosa. MED ORAL PATHOL 1955;8:164-7. Kuffer R, Brocheriou C, Cernea P. Exfoliatio areata linguae et mucosae oris. Rev Stomatol Chir Maxillofac 1971;72:10919. Correll RW, Wescott WB, Jensen JL. Non-painful, erythematous, circinate lesions of a protean nature on a fissured tongue. J Am Dent Assoc 1984;109:90-1. Hoexter DL. Erythema circinata migrans--ectopic geographic tongue. NY State Dent J 1980;46:350-1. Leuker J, Scully C. Erythema migrans affecting the palate. Br Dent J 1983;155:385. Sapiro SM, Shklar G. Stomatitis areata migrans. ORAL SURG ORAL MED ORAL PATHOL 1973;36:28-33. Hume WJ. Geographic stomatitis: a critical review. J Dent 1975;3:25-43. Rails AS, Warnock GR, Lakes G. Stomatitis areata migrans affecting the gingiva. ORAL SURG ORAL MED ORAL PATHOL 1985;650:197. Kogon SL, Stakiw JE. Stomatitis areata migrans. Dent J 1978;44:26-7. Dupre A, Christol B, Lassere J. Geographic lip: a variant of geographic tongue. Cutis 1976;17:263-5.
ORAL
2.
3.
4. 5. 6. 7. 8.
9. IO.
BED.
SURG
ORAL
stomatitis
559
11. Cooke BED. Median rhomboid glossitis and benign glossitis migrans (geographical tongue). Br Dent J 1962;112:389-93. 12. Rood JP. An unusual presentation of erythema migrans. J Dent 1974;2:207-8. 13. Robin M, Brian T. HLA antigens in geographic tongue. Tissue Antigens 1980;15:60-2. 14. Robin M, Malcolm JS. Geographic tongue-a manifestation of atopy. Br J Dermatol 1979;101:152-62. 15. Marks MB. Recognizing the allergic individual. Postgrad Med 1975;58:55-61. 16. Barton DH, Spier SK, Crovello TJ. Benign migratory glossitis and allergy. Pediatr Dent 1982;4:249-50. 17. Robin M, Czarny D. Geographic tongue: sensitivity to the environment. ORAL SURG ORAL MED ORAL PATHOL 1984;58:156-9. 18. Weathers DR. Baker G, Archard HO, Bucks EJ Jr. Psoriasiform: lesions of the oral mucosa (with emphasis on “ectopic geographic tongue”). ORAL SURC ORAL MED ORAL PArtJoL 1974;37:872-88. 19. Buchner A, Begleiter A. Oral lesions in psoriatic patients. ORAL SURG ORAL MED ORAL PATHOL 1976;41:327-32. 20. O’Keefe E, Braverman IM, Cohen I: Annulus migrans. Identical lesions in pustular psoriasis, Reiter’s syndrome, and geographic tongue. Arch Dermatol 1973;107:240-4. 21. Kanerva L, Hietanen J. Electron microscopy of composite and intranuclear keratohyalin granules in geographic tongue of psoriasis. J Cutan Pathol 1984;l 1:149-53. Reprint requests to: Dr. Mark M. Littner Section of Oral Pathology and Oral Medicine The Maurice and Gabriela Goldschleger School of Dental Medicine Tel Aviv University Tel Aviv. Israel
stomatitis
M. M. Littner, D.M.D., D. Dayan, D.M.D., D. Moskona, D.M.D., and M. Harel-Raviv, SECTION SCHOOL
OF ORAL OF DENTAL
PATHOLOGY MEDICfNE,
AND TEL
ORAL AVIV
M.S., M. Gorsky, D.M.D., D.M.D., Tel Aviv, Israel
MEDICINE, UNIVERSITY
THE
MAURICE
AND
GABRIELA
GOLDSCHLEGER
Migratory stomatitis is a unique oral condition with several descriptive names. The diagnosis is based on the clinical appearance and the history of the lesions. The etiology of this entity is still open to debate. A review of the literature and a clinical description of a study group consisting of seven additional cases, in which long-term follow-up was done, are presented. Migrafory sfomatitis is suggested as the most suitable term (ORAL
to describe SURC.
ORAL
accurately
the nature
MED.
PATHOL.
ORAL
and the behavior 1987;63:555-9)
of this condition.
I
n 1955, Cooke’ described a unique oral condition of slightly raised, round, erythematous lesions that were circumscribed by well-defined whitish borders and that appeared on the oral mucosa. He named this condition erythema migrans. Other terms describing this condition, such as areata linguae et mucosae oris and ectopic geographic tongue, have been given.2-5 The last name was given to the condition because of its similarity in nature and behavior to the glossal condition known as geographic tongue. A literature review revealed only a few case reports that described this condition. In some cases, there was a relationship to other conditions such as fissured tongue or geographic tongue. The purpose of this article is to analyze the signs, the symptoms, and the behavior of this condition in a long-term study of a group of seven patients, and to discuss the differential diagnosis and a suitable term to describe this entity. The term migratory stomatitis is suggested. CLINICAL
DESCRIPTION
OF THE STUDY
GROUP
The study group consisted of seven patients: five women and two men, aged 22 to 58, with a mean age of 36 (Table I). All patients underwent routine dental treatment at the Oral Diagnosis Clinic, Tel Aviv University School of Dental Medicine. During the examinations, erythematous ovoid lesions ranging between 0.3 and 0.8 mm in diameter with horseshoe-shaped whitish borders were noticed on the buccal mucosa (Fig. l), on the labial mucosa, on the soft palate, and on the ventral surface of the tongue. In all of the patients, the conditions were diagnosed clinically as migratory stomatitis., In five patients, similar lesions were observed on the dorsum
Fig. 1. Migratory stomatitis appearing as ovoid, shoeshaped lesion (0.8 mm) on left buccal mucosaof 22-
year-old white woman.
of the tongue and were diagnosed as geographic tongue. In three patients, fissured tongue was associated with migratory stomatitis. One patient exhibited both geographic tongue and fissured tongue. Most patients were asymptomatic, except for two who complained of occasional itching at the sites of the lesions. Follow-up showed that the lesions appeared at intervals of days up to weeks at different locations on the mucous membranes such as the labial mucosa, the soft palate (Fig. 2), and the ventral surface of the tongue (Fig. 3). The medical histories of patients in the study group were not contributory except for that of one patient who suffered from diabetes, which was controlled by a low-sugar diet. This patient was the only one who used tobacco (cigarettes). All of the patients were free of allergies. 555
556
Littner et al.
Oral Surg. May, 1987
Fig. 2. Migratory stomatitis appearing as erythematous lesions on soft palate in patient depicted in Fig. 1.
fable
I. Study Group A-general Gender
Age at admission
description of patients with migratory Symptoms
M
22
F
39
F
31 58
Asymptomatic Asymptomatic
34 37 31
Asymptomatic Asymptomatic Asymptomatic
M
F F
F
Fig. 3. Migratory stomatitis on ventral surface of tongue in patient depicted in Fig. 1.
Occasional itching Occasional itching
stomatitis
Sites of lesions
__I_ Tongue
Right and left buccal mucosa
GT*
Buccal mucosa, ventral surface of tongue, lower labial mucosa Right and left buccal mucosa Ventral surface of tongue, buccal mucosa Lower labial mucosa Right and left buccal mucosa Labial mucosa, soft palate, ventral surface of tongue
GT,
conditions
FT’*
GT GT FT FT GT
*geographic tongue **fissured tongue.
No aggravating factors were detected. Three patients became afraid they had cancer and were reassured of the benign nature of the oral condition. Biopsy specimens taken from the sites of the lesions showed similar microscopic pictures. Histologic sections showed the epithelium to be thick with thickened swollen rete ridges pushing down into the showed lamina propria. The surface epithelium acanthosis and spongiosis. Areas demonstrating a mild increase of keratin could be noted at the region of the white border of the lesion. The reddish central portion of the lesion resulted from desquamation. The lamina propria was infiltrated with lymphocytes, plasma cells, histiocytes, and polymorphonuclear leukocytes. A marked transmigration of polymorphonuclear leukocytes and lymphocytes through the surface epithelium was also evident (Fig. 4). Focal zones in the epithelium showed degeneration with marked intercellular and intracellular edema
and were in association with increased inflammatory cell infiltration, suggesting intraepithelial microabscesses(Fig. 5). The picture of elongated rete ridges, acanthosis, spongiosis, and transmigration of polymorphonuclear leukocytes and lymphocytes supported the clinical diagnosis of migratory stomatitis. A 4-year follow-up conducted with all of the patients revealed only the migratory behavior of these asymptomatic lesions. No scars were left at the sites of the previous lesions. DISCUSSION
Migratory stomatitis is described as a horseshoeshaped, erythematous area with whitish, raised margins. The lesions are commonly located on the buccal mucosa, the lips, the palate, the floor of the mouth, the ventral surface of the tongue, and the gingiva.1~2~4-*In the majority of cases reported in the literature, we found that migratory stomatitis
Volume 63 Number 5
Migratory
stomatitis
Fig. 4. Elongated rete ridges of epithehum in lamina propria showing marked transmigration inflammatory cells through surface. (Hematoxylin and eosin stain. Original magnification, x40.)
557
of
5. Intraepithelial microabscesses in surface epithelium of migratory stomatitis. (Hematoxylin and eosinstain. Original magnification, X250.)
Fig.
appeared with another oral lesion such as geographic tongue or fissured tongue. However, oral mucosal lesions may also appear in patients in whom the dorsum of the tongue is normal.“ Most patients were unaware of this condition, which is usually detected in a routine dental examination.4~6~9~‘0 In a few patients, the symptoms of migratory stomatitis, which vary from a little discomfort to a persistent burning sensation aggravated by different condimentat foods,*, ‘I,‘* are the main reason for seeking medical help.’ Table I (our study group, hereafter referred to as Group A) demonstrates that only two (28.5%) out of seven patients complained of an itching sensation,
while the other five patients were asymptomatic. The cases found in the literature (Table II, Group B), added to the present study group, revealed that only four (17%) out of twenty-three patients were symptomatic. No article dealt with the prevalence of appearance and of symptoms of migratory stomatitis. According to Hoexter,4 there is a male predominance associated with the condition, with a maleto-female ratio of 5:4. We found the same tendency when Groups A and B were combined; 61% of the patients were male and 39% were female. The cause of migratory stomatitis is unknown. However, the clinical similarity between migratory stomatitis and
558
Littner
et al.
Ordl
!kg.
May,
II. Literature
Table
Author’s name Cooke1
Sapiro
and ShklaP
Weathers
et al’*
HoexteP Kogon
Rails
Dupre
and Staki’
et al8
et al’”
case reports (Group B)-general
description of patients with migratory
stomatitis
Sites of lesions
Age
Gender
Floor of mouth, soft palate, mucosa of lower lip Vestibule of mandible, buccal mucosa Mandibular vestibule, labial alveolar mucosa Alveolar mucosa, buccal mucosa Buccal mucosa Buccal mucosa Right buccal mucosa Left buccal mucosa Alveolar mucosa (upper and lower) Buccal mucosa Buccal mucosa, labial mucosa Buccal mucosa, maxillary alveolar mucosa Labial mucosa (upper and lower lip), buccal
30
M
FT* and GT**
Occasional sore tongue and itching
40
M
FT
None
37
M
FT and GT
None
44
M
27 23 24 16 9
F F F M M
27 21
M M
73
M
27
M
GT
None
62
M
FT
None
82 16
F M
GT FT
None None
Buccal mucosa, tongue, gingiva, soft palate, labial mucosa of lips Lower lip Upper and lower lip
19x7
Tongue conditions
None GT GT
GT
None None Slight burning None None None _-. None
*fissured tongue. **geographic tongue.
geographic tongue in nature, behavior, and histologic appearance may be suggestive of its etiology. In geographic tongue, the following factors are considered causes: l Allergy.13”7 l Familial tendency and/or congenital anoma13. 14, 16 ly. l Acute inflammatory reaction.“j l Psychosomatic factors.3 Weathers and coworkers’* claim that migratory stomatitis might be a form of psoriasis. In their opinion, there is an abundance of cases of migratory stomatitis in association with cutaneous psoriasis. In order to diagnose oral or psoriatic lesions, it is best to find oral lesions together with parallel skin lesions. Therefore, oral lesions that are not accompanied by any skin lesions are known as psoriasiform lesions. This statement is contradictory of the results of a study of 100 psoriatic patients conducted by Buchner and Begleiter,19 which revealed that in psoriatic patients, no oral lesions could be found. Thus, the occurrence of psoriatic lesions on oral mucosa membranes is a subject of controversy.20v2’
Additional large-scale studies are needed in order to clarify the etiology of migratory stomatitis. In patients with symptomatic migratory stomatitis, reassurance of the benign nature of the lesion, together with advice to avoid irritants, especially spicy foods and smoking, alleviates most of the discomfort. Topical anesthetics, topical steroids, or a combination of the two, control the more persistent symptomatic lesions. Tranquilizers should be considered for patients in whom emotional stress develops because of an extreme fear of cancer. A number of descriptive terms are used for migratory stomatitis: erythema migrans,’ stomatitis areata migrans,6 exfoliation areata lingual in the oral mucosa,2 and annulus migrans.20The term ectopic geographic tongue was used to emphasize the fact
that lesions that usually appear on the tongue appear with this entity in other locations as well as on the tongue. The term geographic or migratory glossitis was used to describe the clinical changes in the appearance of the lesions on the dorsum of the tongue since they resemble a picture of a geographic map. Ectopic
Volume Number
Migratory
63 5
migratory glossitis does not seem to be an accurate term since lesions that are located on other mucous membranes are not lesions of the tongue. We suggest that migratory stomatitis is an accurate term to describe the nature and the behavior of these lesions that may appear on the tongue and at other sites in the oral cavity. We wish assistance.
to
thank
Mrs.
R.
Lazar
for
her
editorial
REFERENCES 1. Cooke
Erythema migrans affecting the oral mucosa. MED ORAL PATHOL 1955;8:164-7. Kuffer R, Brocheriou C, Cernea P. Exfoliatio areata linguae et mucosae oris. Rev Stomatol Chir Maxillofac 1971;72:10919. Correll RW, Wescott WB, Jensen JL. Non-painful, erythematous, circinate lesions of a protean nature on a fissured tongue. J Am Dent Assoc 1984;109:90-1. Hoexter DL. Erythema circinata migrans--ectopic geographic tongue. NY State Dent J 1980;46:350-1. Leuker J, Scully C. Erythema migrans affecting the palate. Br Dent J 1983;155:385. Sapiro SM, Shklar G. Stomatitis areata migrans. ORAL SURG ORAL MED ORAL PATHOL 1973;36:28-33. Hume WJ. Geographic stomatitis: a critical review. J Dent 1975;3:25-43. Rails AS, Warnock GR, Lakes G. Stomatitis areata migrans affecting the gingiva. ORAL SURG ORAL MED ORAL PATHOL 1985;650:197. Kogon SL, Stakiw JE. Stomatitis areata migrans. Dent J 1978;44:26-7. Dupre A, Christol B, Lassere J. Geographic lip: a variant of geographic tongue. Cutis 1976;17:263-5.
ORAL
2.
3.
4. 5. 6. 7. 8.
9. IO.
BED.
SURG
ORAL
stomatitis
559
11. Cooke BED. Median rhomboid glossitis and benign glossitis migrans (geographical tongue). Br Dent J 1962;112:389-93. 12. Rood JP. An unusual presentation of erythema migrans. J Dent 1974;2:207-8. 13. Robin M, Brian T. HLA antigens in geographic tongue. Tissue Antigens 1980;15:60-2. 14. Robin M, Malcolm JS. Geographic tongue-a manifestation of atopy. Br J Dermatol 1979;101:152-62. 15. Marks MB. Recognizing the allergic individual. Postgrad Med 1975;58:55-61. 16. Barton DH, Spier SK, Crovello TJ. Benign migratory glossitis and allergy. Pediatr Dent 1982;4:249-50. 17. Robin M, Czarny D. Geographic tongue: sensitivity to the environment. ORAL SURG ORAL MED ORAL PATHOL 1984;58:156-9. 18. Weathers DR. Baker G, Archard HO, Bucks EJ Jr. Psoriasiform: lesions of the oral mucosa (with emphasis on “ectopic geographic tongue”). ORAL SURC ORAL MED ORAL PArtJoL 1974;37:872-88. 19. Buchner A, Begleiter A. Oral lesions in psoriatic patients. ORAL SURG ORAL MED ORAL PATHOL 1976;41:327-32. 20. O’Keefe E, Braverman IM, Cohen I: Annulus migrans. Identical lesions in pustular psoriasis, Reiter’s syndrome, and geographic tongue. Arch Dermatol 1973;107:240-4. 21. Kanerva L, Hietanen J. Electron microscopy of composite and intranuclear keratohyalin granules in geographic tongue of psoriasis. J Cutan Pathol 1984;l 1:149-53. Reprint requests to: Dr. Mark M. Littner Section of Oral Pathology and Oral Medicine The Maurice and Gabriela Goldschleger School of Dental Medicine Tel Aviv University Tel Aviv. Israel