Why is My Tongue Red and Sore?

Recently I have developed what appears to be a strange abrasion on the top of my tongue. It follows almost directly down the mid-line of my tongue from the back to the tip. It looks like a burn. It is also sore and is very sensitive to heat -- i.e., coffee, hot food, etc. I don't recall burning it originally. Also, tongue burns heal faster than this. I have had this for about nine days now. Please advise?


A: The description of your tongue sores is most reminiscent of a condition known as erythematous candidiasis. "Erythematous" means red (ya gotta love medical jargon) and "candidiasis" refers to infection with the yeast, Candida albicans. You may be more familiar with another oral infection caused by Candida: thrush. Thrush is also known as pseudomembranous candidiasis, another two-cent bit of jargon that sounds far more impressive than "thrush." Thrush has a much different appearance: Typically, the tongue and oral mucosal surfaces are covered with scattered white plaques that are often compared to cottage cheese. The plaques can be scraped away, revealing red mucosa that may bleed.

Back to erythematous candidiasis. In this condition, there are no white plaques. The most impressive finding is that of a smooth, red patch in the center of the tongue's top surface. You've described it perfectly; this smooth patch looks and feels like a burn. Like thrush, erythematous candidiasis frequently follows treatment with antibiotics, but can also occur in malnourished, debilitated or immunocompromised individuals. Both conditions are treated with oral antifungal medication.

There is also a very similar condition, known as median rhomboid glossitis: "median" for its location in the middle of the tongue's top surface, "rhomboid" for its typically diamond shape, and "glossitis" to indicate that it is an inflammatory condition of the tongue. Median rhomboid glossitis, however, usually causes no other symptoms. Since this condition also responds to antifungal medications, it is most likely due to infection with Candida.

A few other conditions are associated with patchy, smooth areas on the tongue. Erythema migrans ("migrating redness"), also known as benign migratory glossitis or geographic tongue, is a fairly common condition in which irregularly shaped smooth patches are found on the top surface of the tongue. This is often asymptomatic, but may be associated with sensitivity to spicy or hot foods. Lichen planus also causes smooth patches, but these patches typically have a very white border, which you have not mentioned.

You have described the spots on your tongue well enough that I think erythematous candidiasis is the best possibility. Since you will need a prescription medication to cure this disorder, you should see your primary care physician as soon as possible. Your doctor can confirm the diagnosis and prescribe treatment. You may want to bring a copy of this column with you when you see your doctor.

by Douglas Hoffman