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. A 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 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 could be more consistent and shallow or deep. The depth of fissures increases with age and is prominently seen in older adults. The scrotal tongue is also called a fissured tongue, plicated tongue or lingua plicata, furrowed tongue, grooved tongue, and more.

How Is Scrotal Tongue Classified?

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

1. Based on the fissure pattern;

• Central longitudinal pattern.

• Central transverse pattern.

• Lateral longitudinal.

• Branching pattern.

• Diffuse pattern.

2. 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.

3. Based on the associated symptoms;

• With a burning sensation.

• Without a 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 that scrotal tongues run in families.

• The scrotal tongue is usually present from birth, but its 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 a fissured tongue.

Who Is Susceptible to a Fissured Tongue?

A fissured tongue can develop in anyone, especially later in life. While its cause is unknown, it is important to note that it's not contagious, and individuals cannot transmit it to others.

What Are the Conditions Associated With Scrotal Tongue?

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

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

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

3. 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 tongues and fissured tongues go hand in hand with certain people.

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

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

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

7. 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.

• Cracks appear more in the middle portion of the tongue.

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

• Burning sensations could be caused by other factors, such as allergies to toothpaste or mouthwashes, vitamin deficiencies, dentures or dental materials, and consumption of acidic and spicy foods.

• Burning sensations and discomfort interfere with normal eating; hence, the availability of nutrients to the body parts is 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 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 rapidly affects such symptoms.

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

What Complications Can Arise From a Fissured Tongue?

The primary complications include orofacial granulomatosis (facial swelling) or Melkersson-Rosenthal syndrome, characterized by a fissured tongue, orofacial swelling, and facial palsy. A fissured tongue can serve as an initial indication.

Conclusion:

A scrotal 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, and more. If proper hygiene is not followed, the scrotal tongue can become symptomatic and interfere with these normal functions. In short, if someone has a fissured tongue, this is a reminder to spend an extra minute caring for the tongue and mouth.