Scrotal Tongue - Causes, Symptoms, Diagnosis and Treatment

Introduction:

A variation from the usual, flat, and smooth appearing tongue is a condition called - scrotal tongue, which shows a fissured or grooved appearance with a prominent groove separating the tongue in its midline. Though abnormal, it is neither serious nor a spreading condition. Fissured tongue is common and does not require management until it shows symptoms which are usually minimal and rare.

What Is a Scrotal Tongue?

It is a non-dangerous condition characterized by single or multiple fissures on the upper surface and the sides of the tongue, giving it a wrinkled appearance. These fissures are sometimes interconnected and divide the tongue into lobes. The depth of the fissures is inconsistent and might be shallow or deep. It is seen that the depth of fissures increases with age and is seen prominently in older adults.

What Are the Other Names of Scrotal Tongue?

The scrotal tongue is also called a fissured tongue, plicated tongue or lingua plicata, furrowed tongue, grooved tongue, etc.

How Is Scrotal Tongue Classified?

The scrotal tongue or fissured tongue is classified based on certain factors such as fissure pattern, the number of fissures, and associated symptoms.

• Based on the fissure pattern;

  • Central longitudinal pattern.
  • Central transverse pattern.
  • Lateral longitudinal.
  • Branching pattern.
  • Diffuse pattern.

• Based on the number of fissures;

  • Mild - when there are one to three fissures.
  • Moderate - when there are more than three fissures.
  • Severe - when the number of fissures is more than ten.

• Based on the associated symptoms;

  • With a burning sensation.
  • Without burning sensation.

What Are the Causes of a Scrotal Tongue?

There is no specific cause for the development of the scrotal tongue; It can even occur in healthy individuals. Still, certain underlying factors influence the appearance of the fissured tongue, which includes;

• Genetics - Research has shown scrotal tongue running in families.

• The scrotal tongue is usually present from birth, but the prominence increases with age. Hence, the symptoms are more evident in older adults.

• It is more prevalent in males than females.

• Underlying medical conditions or congenital abnormalities.

• Research shows that malnutrition can cause scrotal tongue but is less frequent.

• Patients with long-term dryness in the mouth due to underlying conditions or medications develop fissured tongues.

• Vitamin deficiencies such as vitamin B-12, folic acid, and zinc deficiencies could be the reason.

• Constant and recurrent trauma is said to play a role in developing fissured tongue.

What Are the Conditions Associated With Scrotal Tongue?

Some medical conditions show fissured tongue as a significant feature or symptom, which includes;

• Kids affected with Down syndrome (a genetic disorder that shows developmental and intellectual delay) show fissured tongue as one of the characteristic features.

• Melkersson-Rosenthal syndrome is a rare neurological disorder with the fissured tongue as a characteristic feature.

• Geographic tongue is a non-severe tongue anomaly that shows reddish tongue patches that resemble islands due to the loss of tiny hair-like projections usually present in the tongue. Geographic tongue and fissured tongue go hand in hand with certain people.

• Sjogren's syndrome is an autoimmune condition that involves dry eyes and dry mouth. Due to constant dryness, the tongue gets fissured.

• Studies have shown a link between pustular psoriasis (a common skin condition) and fissured tongue.

• Chronic granulomatous disease is a genetic disorder that shows fissured tongue as an oral manifestation.

• The scrotal tongue is a prevalent sign in patients suffering from pemphigus vegetans.

What Are the Symptoms of Scrotal Tongue?

• The scrotal tongue shows single or multiple fissures on its surface.

• The appearance of cracks is more in the middle portion of the tongue.

• The scrotal tongue is completely asymptomatic, but when the oral hygiene is poor, food debris and bacteria get lodged in the fissures resulting in foul smell, burning sensation, and rarely pain.

• Burning sensation could be due to other factors such as allergy to toothpaste or mouthwashes, vitamin deficiencies, allergy to dentures or dental materials, consuming acidic and spicy foods, etc.

• Burning sensation and discomfort interfere with normal eating, and hence, the availability of nutrients to the body parts gets compromised.

How Is Scrotal Tongue Diagnosed?

• Though clinical examination is the best way to diagnose scrotal tongue, taking an elaborate history and certain laboratory tests rule out any underlying medical reasons.

• Blood tests such as hemoglobin levels, blood sugar, and peripheral blood smear are done to rule out underlying medical conditions.

How Is Scrotal Tongue Treated?

• The scrotal tongue is not a disease as such but a common condition that does not require a pharmacological or medical approach.

• Persons with a scrotal tongue should follow proper oral hygiene measures such as

  • Brushing followed by tongue cleaning.
  • Avoid using harsh tongue cleaners.
  • Mouth rinsing after every meal to prevent food lodgement in the fissures.

• Patients with burning sensations are advised to consume a bland diet, including lots of green leafy vegetables, for a few weeks. Supplements such as Folic acid and Vitamin B- complex are prescribed. Vitamin B complex is prescribed for 15 to 30 days and shows rapid effects on such symptoms.

• Candidal infections caused due to poor oral hygiene can be treated by using antifungal drugs such as Clotrimazole, Amphotericin-B, etc.

Conclusion:

Scrotal tongue or fissured tongue is a common alteration in the tongue that could occur in any individual. The tongue plays an important role in various functions such as tasting, speech, swallowing, etc. If proper hygiene is not followed, the scrotal tongue can become symptomatic and interfere with these normal functions. In short, if you have a fissured tongue, this is a reminder to spend an extra minute taking care of your tongue and mouth.