MRG is a common condition and it has been estimated that up 1% of the population show some degree of central papillary atrophy [1]. Men are affected about three times as often as women.

MRG appears as a well-demarcated, roughly rhomboid, erythematous and thus bright red lesion directly anterior to the vallate papillae [2]. Commonly, it seems patchy as the rhomboid area still includes papilla-carrying spots that bear an off-white color. Its surface is smooth or lobulated, and rarely bears erosions [1]. It may be slightly elevated above the surrounding tongue surface. While an MRG lesion is most commonly located in the midline of the dorsum of the tongue, paramedian occurrences have also been described [3]. Usually, patients don't claim any other symptoms. In few cases only, they describe pruritus or pain in the affected area.

There may be a similar lesion in the opposing area of the palate. Such an anomaly is sometimes referred to as "kissing lesion". It may imply an infectious pathogenesis of MRG in an immunodeficient patient. Accordingly, diagnostic measures should be taken to assess their immune system. Diabetes mellitus should be considered in this context, but this variant of MRG is more commonly associated with an HIV infection and an acquired immunodeficiency syndrome [4].

• Anemia

  Geographic tongue is seen in Reiter syndrome and is associated with atopic dermatitis, diabetes mellitus, anemia, hormonal disturbances, Down syndrome, and lithium therapy. [dermaamin.com]

  (vitamin B12 deficiency), deficiency of riboflavin, niacin or pyridoxine; sprue, iron deficiency anemia; also associated with jagged teeth, ill fitting dentures, rarely syphilis, burns and ingestion of corrosive chemicals Susceptible to recurring or [pathologyoutlines.com]

  Red and beefy tongue in pernicious anemia Glossitis Glossodynia Glossopyrosis leads to bald tongue 20. treatment  Administration of vit B12  Folic acid  Delayed treatment causes anemia, neurological complications 21. [slideshare.net]

  For instance, when glossitis results from pernicious anemia the tongue may turn pale or when it is related to vitamin B deficiency the tongue may turn fiery red and become smooth. [healthpedian.org]

  Glossitis may be the primary disease, or may be a symptom of one of several hereditary and acquired conditions (such as certain forms of anemia, pellegra, syphilis, or nutritional deficiencies). [britannica.com]

• Turkish

  Avcu and Kanli ( 2003 ) also observed that the prevalence of MRG was not associated with tobacco use, use of black tea, and oral hygiene index in a Turkish population. [pocketdentistry.com]

  Keywords Median rhomboid glossitis MRG Central papillary atrophy Candida Antifungal therapy References Avcu N, Kanli A (2003) The prevalence of tongue lesions in 5150 Turkish dental outpatients. [link.springer.com]

  The prevalence of tongue lesions in 5,150 Turkish dental outpatients. Oral Dis. 2003;9:188–195. Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis. 2006;12:381‒386. [dimensionsofdentalhygiene.com]

  Allen 28 Estimated H-index: Prevalence of tongue lesions among Turkish schoolchildren. [amichixi.online]

• Chronic Infection

  Median rhomboid glossitis median rhomboid glossitis A usually midline rugosity on the tongue, which is more common in men age 30 to 50 and caused by chronic infection, especially by Candida albicans, but also by actinomycosis. [medical-dictionary.thefreedictionary.com]

  Clinical features of oral candida infection Candida may arise suddenly as an acute infection or persist for long periods as a chronic infection. Classification of oral candida infection Acute pseudomembranous candidiasis. [dermnetnz.org]

  Sometimes Candida lesions disappear spontaneously or with minimal therapy. 1,3, 6,10 The clinical presentation of oral candidiasis includes both acute and chronic infections. [dentistrytoday.com]

• Sore Throat

   Symptoms of tongue cancer  A red or white patch on the tongue, that will not go away  sore throat  A sore spot (ulcer) or lump  Pain when swallowing  Numbness in the mouth  Unexplained bleeding from the tongue (that is not caused by biting your [slideshare.net]

  By doing over-consumption, you may face the problems like diabetes, slow digestion, weight loss, sore throats, high blood pressure, sinuses problems, leg cramps and pain etc. [homeremedies9.com]

• Cough

  […] satisfied customers I have a very annoying chronic condition of a thick, almost I have a very annoying chronic condition of a thick, almost pasty phlegm in the back of my throat that I have to constantly try to remove with a sort of scraping and forced cough [justanswer.com]

• Dysphagia

  She reported no tongue pain, dysphagia, dysarthria, or bleeding. There was no evidence of candidiasis on the tongue or adjacent structures. [nejm.org]

  Referral Admit to hospital if there are systemic symptoms, the patient is unwell or if there are oesophageal symptoms (dysphagia or retrosternal pain) - particularly if there is immunocompromise. [patient.info]

  Disorders Other associated disorders such as pernicious anaemia, erythema multiform, pemphigus vulgaris, oral lichen planus, aphthous ulcers, Plummer-Vinson syndrome, dysphagia, psoriasis may also lead to glossitis. [primehealthchannel.com]

• Vomiting

   Toxic shock syndrome:This is characterized by fever, drop in blood pressure, vomiting, rashes, red mouth and throat. It is caused by toxins released by certain bacteria.This can quickly assume life threatening proportions. 16. [slideshare.net]

  Clinical features are fever (unresponsive to broad-spectrum antibiotics), abdominal pain, tender hepatosplenomegaly, vomiting, dysphagia and jaundice. It may be a form of inflammatory immune reconstitution syndrome. [patient.info]

• Lesion of the Tongue

  Median rhomboid glossitis is an inflammatory lesion of the tongue, now believed to be secondary to candidiasis. We document a case of median rhomboid glossitis with heavy colonisation by Actinomyces in a 60-year-old male. [ncbi.nlm.nih.gov]

  Three months after Brocq and Pautrier's original contribution, Jourdanet (3) reported a single case and emphasized the importance of distinguishing this lesion from other lesions of the tongue. [pubs.rsna.org]

  The main sign of median rhomboid glossitis is a lesion on your tongue. This lesion is erythematous (red) and is located either in the middle of your tongue or at the back of your tongue. [aupairargentina.com]

  J Postgrad Med 1991 Oct;37(4):238-40 Abstract quote Median rhomboid glossitis is an inflammatory lesion of the tongue, now believed to be secondary to candidiasis. [thedoctorsdoctor.com]

• Fissured Tongue

  ( 5275506 ) Baughman R. 1971 38 Prevalence of geographic tongue, fissured tongue, median rhomboid glossitis, and hairy tongue among 3,611 Minnesota schoolchildren. ( 5270895 ) Redman R.S. 1970 39 Median rhomboid glossitis. [malacards.org]

  BACKGROUND: Fissured tongue (FT), geographic tongue (GT) and median rhomboid glossitis (MRG) are frequently misdiagnosed and overtreated. [ncbi.nlm.nih.gov]

  Redman RS: Prevalence of geographic tongue, fissured tongue, median rhomboid glossitis, and hairy tongue among 3,611 Minnesota schoolchildren. Oral Surg Oral Med Oral Pathol 1970;30:390–395. [karger.com]

  TONGUE With fissured tongue ( Figure 2 ), deep grooves can develop due to physiologic deepening of normal tongue fissures. [aafp.org]

  Fissured tongue/ scrotal tongue/ lingua plicata  Characterized by grooves that vary in depth  Seen on dorsal and lateral aspects of tongue  Seen in melkersson rosenthal syndrome and downs syndrome  Debris can be trapped in the fissure  Depth of fissure [slideshare.net]

• Coated Tongue

  At the same time at serious infectious diseases (sypny, belly typhus, etc.) in connection with fever, the lowered salivation language becomes covered by a plaque — a so-called coated tongue. [bigmed.info]

  HAIRY TONGUE Hairy tongue, also referred to as black hairy tongue or coated tongue, affects just 0.5% of the adult population. 5 Amato Lusitano, a Portuguese physician, first described this condition in 1557. 11 In a 2003 study conducted on 5,150 Turkish [dimensionsofdentalhygiene.com]

• Pruritus

  In few cases only, they describe pruritus or pain in the affected area. There may be a similar lesion in the opposing area of the palate. Such an anomaly is sometimes referred to as "kissing lesion". [symptoma.com]

  Most of these lesions are asymptomatic, although some patients may complain of persistent pain, irritation, or pruritus. Despite the relative frequency of MRG, little is known about its etiology. [link.springer.com]

  Generalised cutaneous candidiasis (rare): a widespread rash, worse in skin folds and extremities, with pruritus. Skin lesions in patients with invasive candidiasis - see 'Invasive candidal infections', below. [patient.info]

• Fussiness

  The infant may be overly fussy and irritable. The mother’s breast may become infected and the pain can range from mild to severe with sensitive, red and itchy nipples. [naturalremedies.org]

• Irritability

  Patients complain of pain, irritation or burning, hypogeusia, or dysgeusia. Treatment consists of correcting any underlying etiology, recommendation of a soft, bland diet, and analgesics. [dermaamin.com]

  […] on the median portion of the dorsum of the tongue just anterior to the circumvalate papillae; thought to represent a persistent tuberculum impar. median rhomboid glossitis a red, depressed, diamond-shaped area on the dorsum of the tongue, frequently irritated [medical-dictionary.thefreedictionary.com]

  […] teeth use a toothpaste that doesn't contain sodium lauryl sulphate brush your tongue or use a scraper to help improve a white tongue use a straw to drink cool drinks take painkillers do not eat hard, spicy, salty, acidic or hot food and drink that may irritate [nhs.uk]

  Consumption of hot and spicy foods can act as irritants for the tongue. Alcohol and tobacco can also give rise to tongue irritation. Glossitis Symptoms The symptoms of Glossitis may arise rapidly or gradually over a period of time. [hxbenefit.com]

  Causes of Glossitis Glossitis may result from numerous factors, including infections, allergies, hormonal changes, reactions to irritants, mineral and vitamin deficiencies, compromised immune system, family history and certain medical conditions such [healthpedian.org]

MRG is usually diagnosed clinically. However, it may not always be feasible to distinguish an uncomplicated MRG from aphthous stomatitis, granuloma, precancerous erythroplakia or neoplasms like hemangioma, squamous cell carcinoma or granular cell tumor [3]. In order to do so, a biopsy and subsequent analysis of the tissue sample is required. During a microscopic examination, the absence of papillae can be confirmed. Also, epithelial anomalies ranging from atrophic to hyperplastic changes are most commonly revealed [5]. Atypical nuclei and numerous mitotic figures are not characteristic of MRG and may indicate a neoplasm, though. In underlying layers of tissue, infiltrating inflammatory cells may be visible. Immunohistochemical stains may be applied to further evaluate the cells' characteristics if deemed necessary.

Additionally, characteristic spores and yeast buds forming pseudohyphae can be recognized microscopically and reveal the presence of Candida spp. If doubts remain as to the presence of yeasts, samples can be subjected to fungal stains. Fungal cultures are rarely required, but may provide interesting epidemiological data. In general, MRG has been associated with chronic Candida infections: A recent microbiological study found Candida albicans to account for the majority of cases, while Candida kefyr, tropicalis, krusei and glabrata have also been isolated [2]. However, one out of ten MRG patients tested negative for Candida spp. Non-Candida pathogens have occasionally been implicated in the development of MRG and may serve as an explanation in this regards [6].

As has been implied in the previous paragraph, if a kissing lesion is present or additional symptoms hint at a dysfunction of the immune system, this suspicion should be followed up.

Treatment: Mycological tests are required, followed by antifungal treatment – median rhomboid glossitis being assimilated with chronic candidiasis. Most of the times the lesion is reversable with proper treatment. [citydent.ro]

Dentures and other mouth appliances are also treated with the antifungal treatments to stop the candida from spreading. Although these treatments can help clear the candida, they are not always effective at clearing the lesions. [wisegeekhealth.com]

Other management strategies and second-line treatments: Voriconazole (may be an alternative or a step-down treatment). [patient.info]

Q: What is the treatment for median rhomboid glossitis? A: In general, no treatment is necessary for median rhomboid glossitis. [aaom.com]

In most cases, the prognosis for recovery is very good. Defining Oral Candidiasis Oral candidiasis is a fungus and was first isolated in the sputum of a tuberculous patient in 1844. [naturalremedies.org]

[…] ulceration -X-ray = opacification of sinus Rhinocerebral zygomycosis Histopathology -necrosis -branching non-septated hyphae -blood vessel invasion Rhinocerebral zygomycosis treatment -surgical debrdigement -Amphotericin B -control underlying disease -poor prognosis [quizlet.com]

Glossitis Prognosis This condition generally shows a positive response to treatment if the cause of inflammation is addressed and cured. [hxbenefit.com]

Prognosis Erythroplasia has areas of dysplasia, carcinoma in situ, or invasive carcinoma in most cases. [nature.com]

The findings in 18 patients with median rhomboid glossitis only support partly the hypothesis of Candida albicans being an important etiologic factor. [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Maria Angela Naval Machado) Despite the relative frequency of MRG, little is known about its etiology. MRG once was thought to be developmental in origin, although it is seen almost exclusively in adults (Baughman 1971 ; Cooke 1975 ). [pocketdentistry.com]

These findings demonstrated that the etiology of the M. R. G. is a localized chronic Candida infection, not only a developmental anomaly. [ci.nii.ac.jp]

The anomalies are organized by anatomical system and presented in a consistent manner, including details of the clinical presentation, epidemiology, embryology, treatment and prevention for each anomaly. [books.google.com]

Fungal cultures are rarely required, but may provide interesting epidemiological data. [symptoma.com]

Usually the mucosal changes resolve with antifungal therapy, but sometimes the lesion is resistant to complete resolution.[2][4] Epidemiology[edit] It is an uncommon condition, occurring with equal prevalence in males and females and at any age.[2] History [en.wikipedia.org]

[…] general Inflammation or beefy red tongue associated with deficiency states Due to atrophy of tongue papillae, thinning of mucosa and exposure of underlying vasculature Terminology Also called central papillary atrophy, posterior lingual papillary atrophy Epidemiology [pathologyoutlines.com]

Pathophysiology Symptoms Signs Differential Diagnosis Management References Extra: Related Bing Images Extra: Related Studies Extra: UMLS Ontology Extra: Navigation Tree II. Pathophysiology Erythematous Candidiasis (see Thrush) III. [fpnotebook.com]

Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol. 2010;28:100‒108. From Dimensions of Dental Hygiene. August 2013; 11(8): 21–25. [dimensionsofdentalhygiene.com]

The anomalies are organized by anatomical system and presented in a consistent manner, including details of the clinical presentation, epidemiology, embryology, treatment and prevention for each anomaly. [books.google.com]

You will be directed to: You are leaving the Oral Cancer Toolkit You will be directed to the Oral cancer: Early detection and prevention educational quiz on Doctors.net.uk. [cruk.m3medical.com]

It can also be prevented by drinking lots of water so as to produce sufficient amounts of saliva which shall prevent the growth of bacteria in the mouth. [primehealthchannel.com]

Treatment and Prevention of Glossitis In the vast majority of cases, glossitis is not a dangerous condition to a person’s health and usually does not require any special treatment. [healthpedian.org]

Candida tends to create an environment that generally results in poor oral health as it prevents harmful bacteria from being washed away. Another possible cause might be excess force exerted from the tongue during speaking or swallowing. [wisegeekhealth.com]

1. Joseph BK, Savage NW. Tongue pathology. Clin Dermatol. 2000; 18(5):613-618.
2. Goregen M, Miloglu O, Buyukkurt MC, Caglayan F, Aktas AE. Median rhomboid glossitis: a clinical and microbiological study. Eur J Dent. 2011; 5(4):367-372.
3. Lago-Mendez L, Blanco-Carrion A, Diniz-Freitas M, Gandara-Vila P, Garcia-Garcia A, Gandara-Rey JM. Rhomboid glossitis in atypical location: case report and differential diagnosis. Med Oral Patol Oral Cir Bucal. 2005; 10(2):123-127.
4. Fine DH, Tofsky N, Nelson EM, Schoen D, Barasch A. Clinical implications of the oral manifestations of HIV infection in children. Dent Clin North Am. 2003; 47(1):159-174, xi-xii.
5. Fowler JC, White P. A classic case of median rhomboid glossitis. Jaapa. 2009; 22(6):70.
6. Deshpande RB, Bharucha MA. Median rhomboid glossitis: secondary to colonisation of the tongue by Actinomyces (a case report). J Postgrad Med. 1991; 37(4):238-240.