![]() ![]() The various mucocutaneous manifestations of scarlet fever have characteristic eponymous descriptions, as outlined in. The rash resolves with desquamation along with palmoplantar peeling in approximately 2 weeks. The exanthem confers a typical rough and abrasive texture to the skin and is accentuated at the flexures. The pharyngeal symptoms are followed in a couple of days by a papular exanthem that spreads cephalocaudally. The initial manifestations include an exudative tonsillitis accompanied by a white strawberry tongue which loses its coating in the next 1–2 days giving rise to the red strawberry tongue. Scarlet fever is an acute febrile exanthematous illness associated with group A streptococcal pharyngitis mediated by an erythrogenic toxin that produces cutaneous vasodilatation. Scarlet fever and Group A streptococcal pharyngitis īacterial Toxin/superantigen Mediated Disorders However, certain other conditions are also associated with this unique morphological alteration. Consequently, most of these are multisystem disorders. The bacterial toxins act as superantigens and provoke a nonspecific polyclonal immune cell activation and massive release of inflammatory mediators. Most disorders exhibiting strawberry tongue are bacterial toxin-mediated disorders. Where All Do We See the Strawberry Tongue? The term “strawberry tongue” used further in this article implies a red strawberry tongue.įigure 1: White strawberry tongue (see text) This coating desquamates in a few days giving rise to the typical “red strawberry” tongue. In certain conditions such as scarlet fever, the prominent papillae are initially covered by a white coating giving a “white strawberry” appearance to the tongue. This gives a red denuded appearance to the surface that is interspersed with persistent, inflamed and hypertrophic fungiform papillae (seeds of strawberry). The topographic alteration leading to strawberry appearance of the tongue is possibly the desquamation of the keratinized epithelium of the filiform papillae. Table 1: Disorders demonstrating a strawberry tongue While it is a diagnostic feature of disorders such as Kawasaki disease and scarlet fever (see below), it can also be seen in various other conditions when it serves as a useful diagnostic indicator. ![]() Strawberry tongue (or raspberry tongue) is a distinctive enanthem of the dorsum of the tongue characterized by the prominence of inflamed and hypertrophic fungiform papillae together with hyperemia. The walls of these papillae have taste buds. The foliate papillae are seen as parallel ridges alternating with deep groves situated on the lateral surface of the tongue. Taste buds are present on the walls of these grooves. Eight to twelve large circumvallate papillae are situated anterior to the sulcus terminalis, each surrounded by a groove into which the ducts of minor salivary glands open. Interspersed between the filiform papillae are the red, mushroom-shaped fungiform papillae covered by nonkeratinizing epithelium and possessing taste buds on their surface. ![]() The anterior part of the dorsal surface of the tongue is covered by the filiform papillae which have a keratinizing epithelium that confer an abrasive texture. The dorsal surface of the tongue is divided into anterior two-third and posterior one-third by the sulcus terminalis (a V-shaped groove). Strawberry tongue refers to the characteristic appearance of the tongue seen in certain disorders where it resembles the skin of a strawberry. Geographic tongue refers to a “map-like” appearance of the tongue seen in a host of disorders such as psoriasis and Reiter's disease. These include alteration in color such as pallor and redness and surface alterations, giving rise to “balding,” “geographic tongue,” and the “strawberry tongue.” Iron deficiency anemia and vitamin B12/folic acid deficiency are the causes of balding/pallor and hyperemia (beefy red glossitis), respectively. Morphological alteration of the dorsum of the tongue is seen in many disorders. ![]()
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