What is transient lingual papillitis?
Transient lingual papillitis is a common painful inflammatory condition affecting one or several fungiform papillae on the tongue. It is also known as ‘lie bumps’ and may be related to or the same as eruptive (familial) lingual papillitis and fungiform papillary glossitis. A nonpainful papulokeratotic variant has been reported.
Transient lingual papillitis
What are fungiform papillae?
Fungiform papillae are one of the special types of bumps found on the surface of the tongue. Fungiform papillae contain taste buds (especially for bitter taste), temperature receptors and have a good blood supply.
They are scattered over the top and sides of the tongue, mainly towards the tip. Usually they are not obvious, being flat and pink.
The number and size of fungiform papillae varies:
- Females have more fungiform papillae than males
- They become even more numerous after the menopause
- Nerve injury may result in a reduced number of fungiform papillae and reduced taste sensation.
Fungiform papillae can become obvious in a number of conditions, the most well recognised of which is the ‘strawberry tongue’ of scarlet fever, and most recently as the most common oral manifestation of COVID-19.
Who gets transient lingual papillitis and why?
The classic form of transient lingual papillitis affects over 50% of the population. It appears to be most common in young women, but all age groups can be affected. The most likely cause of transient lingual papillitis is local irritation or trauma to a fungiform papilla. However many other possible triggers have been suggested including stress, hormone fluctuations, gastrointestinal upset and specific foods.
Eruptive (familial) lingual papillitis affects young children, and their families. It appears to be most common in Spring, although it can occur all year round. Children in contact with many other children, such as school, kindergarten or daycare, appear to be most likely to develop this condition. A viral cause has been suggested because of the common development of the condition in family members. One theory is that, similar to herpes simplex virus / cold sores, the virus is caught in childhood and may then cause recurrent episodes throughout life, in this case presenting in adulthood as the classic form of transient lingual papillitis.
Transient lingual papillitis is also reported in patients with COVID-19.
Fungiform papillary glossitis has been described in patients with a history of eczema, asthma, or hayfever. It may be another name for transient lingual papillitis. These authors suggested the condition is due to increased environmental sensitivity of the tongue, similar to the increased sensitivity of the skin, lungs or nose resulting in eczema, asthma or hayfever respectively.
Clinical features of transient lingual papillitis
The classic form of transient lingual papillitis presents as a single painful raised red or white bump on the tongue, usually towards the tip. It lasts 1-2 days then disappears, often recurring weeks, months, or years later. There is no associated illness or lymph gland enlargement. Less commonly the lesions are more numerous, may disappear within hours or last several days, or may be associated with a burning or tingling sensation. Uncommonly the lesion(s) may not cause any symptoms. Some reports suggest an association with geographic tongue or scalloped markings on the side of the tongue.
The papulokeratotic variant presents as recurrent multiple white bumps over the tongue that do not cause any symptoms. They may be persistent.
Eruptive lingual papillitis
Eruptive lingual papillitis is a systemic illness often associated with fever and lymph gland enlargement. The onset is sudden. An affected child may be reluctant to eat and produces excessive saliva. The tongue shows enlarged inflamed fungiform papillae on the tip and the sides of the tip but not the top. These may look like pustules. Angular cheilitis may be seen.
The illness lasts on average 1 week (range 2-15 days). Recurrences have been reported 1-2 months later with the same clinical features. Family members, parents and siblings, may develop symptoms on average one week later (range 1-15 days). In adults, the illness presents as a sudden intense burning of the tongue made worse by food. The clinical appearance is the same as in the child.
Transient U-shaped lingual papillitis
Transient U-shaped lingual papillitis often associated with swelling of the tongue is reported to be the most common oral mucosal change observed in patients with COVID-19. This may be due to SARS-CoV-2 infection of the mucosa or secondary such as poor oral hygiene or oxygen therapy.
Eruptive lingual papillitis
How is transient lingual papillitis diagnosed?
Transient lingual papillitis and eruptive lingual papillitis are usually diagnosed clinically based on typical presentation.
Mucosal biopsy shows inflammation and swelling of a fungiform papilla, but is not usually necessary. Special stains fail to detect viral, fungal or bacterial infection. In the papulokeratotic variant, biopsy shows severe hyperparakeratosis and mild chronic inflammation.
Treatment of transient lingual papillitis
Usually no treatment is required for the classic form of transient lingual papillitis as the condition resolves within hours or days.
Treatments reported by some patients to give relief have included:
- Salt water mouth rinses
- Cold fluids
- Soothing foods such as yoghurt
- Antiseptic or local anaesthetic mouthwashes
- Topical steroids.
However, the majority of sufferers have found nothing to relieve the symptoms or prevent recurrence.
In eruptive lingual papillitis, paracetamol, ibuprofen and topical antiseptics have not been found to alter the duration or severity of the symptoms in children.