What are the Underlying Causes of Strawberry Tongue?

Key Takeaways

• Strawberry tongue is a type of tongue inflammation. It causes a swollen, red, bumpy appearance, similar to a strawberry.
• Various conditions can cause strawberry tongue, some of which have severe potential complications.
• Some causes of strawberry tongue include bacterial and viral infections, allergies, and vitamin deficiencies.
• See your doctor if you notice any unusual changes to your tongue, especially if they’re accompanied by a fever.

What is Strawberry Tongue?

Strawberry tongue is a term for a tongue that is red, swollen, and covered in small bumps. A tongue in this condition can strongly resemble a strawberry, hence the name. It’s a form of glossitis, or tongue inflammation.

The bumps that look like strawberry seeds are papillae, the natural bumps on your tongue, that have become swollen and inflamed.

You may also notice other symptoms, such as tongue pain or difficulty swallowing. It may be hard to eat due to the swelling.

What Causes Strawberry Tongue?

Strawberry tongue isn’t an illness but rather a symptom of an underlying condition. Some conditions that cause strawberry tongue can have severe complications. We’ll discuss them in detail below.

Scarlet Fever

Scarlet fever is caused by the same Streptococcus bacteria that cause strep throat. It’s most common in children and adolescents.

Early on, scarlet fever may cause white strawberry tongue, where a white coating covers the swollen papillae. After a few days, the coating begins to fade, and the tongue becomes red.

In addition to strawberry tongue and fever, other symptoms include:

• Sore throat
• Swollen lymph nodes
• Skin rash

Prompt treatment with antibiotics is needed to prevent scarlet fever from having long-term effects on the heart, kidneys, brain, and joints.

Toxic Shock Syndrome

Toxic shock syndrome (TSS) can be caused by several bacteria, usually Streptococcus or Staphylococcus (staph). It’s associated with using super-absorbent tampons or having open cuts or wounds.

Strawberry tongue is a less common symptom of TSS, but other symptoms may include:

• High fever
• Malaise and fatigue
• Low blood pressure
• A sunburn-like rash

TSS can lead to multiple organ failure, the need for amputation, or death within 2 days. However, proper treatment can lead to a full recovery over a period of weeks. Seek emergency care if you suddenly notice the above symptoms.

Kawasaki Disease

Kawasaki disease mainly affects children under 5. It doesn’t have a clear cause. It involves blood vessel inflammation, causing strawberry tongue as well as:

• High fever (generally lasts more than 5 days and is resistant to typical medications)
• Rashes
• Swollen lymph nodes in the neck
• Red eyes

It’s thought that Kawasaki disease may result from a heightened immune response to an unknown infection. This may be due to some children having a genetic predisposition.

Kawasaki disease can be difficult to diagnose, but early treatment is vital. While the immediate symptoms are likely to subside on their own, there can be long-term complications due to heart damage. Treatment aims to prevent and relieve symptoms.

Allergies

Strawberry tongue can occur as part of an allergic reaction. It may show up with other symptoms such as congestion, a runny nose, itching, or hives.

Sometimes an allergic reaction can be severe and affect the whole body (anaphylaxis). If you have an allergic reaction that causes chest pain or difficulty breathing, seek medical attention immediately.

Nutrient Deficiencies

If you’re deficient in vitamin B12, vitamin B9 (folate), or iron, you may have a red, swollen tongue as a symptom. Other symptoms include fatigue, tingling sensations, numbness, and altered taste.

If you notice these symptoms and don’t have a fever or nausea, it’s likely they’re caused by an iron or vitamin deficiency.

Diets low in meat and dairy are more likely to cause vitamin B12 deficiency. Some medications, such as metformin, can also lead to lower levels of B12.

Other Infections

Other infections can also have strawberry tongue as a symptom. These include:

• Other strep and staph infections — these typically also cause a fever. You may also experience low blood pressure or a flaky rash on your hands or other parts of your body.
• Yellow fever — this is a viral infection that usually causes fever, nausea, headache, and muscle aches that subside within 5 days. However, severe cases can cause liver issues and jaundice (yellow skin and eyes). Vaccination can prevent yellow fever.
• Yersinia pseudotuberculosis — this is a bacterial infection from the same genus as the plague. It typically causes fever, abdominal cramping, diarrhea, and vomiting. Strawberry tongue is a less common symptom.

When to See a Doctor for Strawberry Tongue

See a doctor if you notice any unusual changes to your tongue, especially if a fever or other symptoms accompany them. If your symptoms include chest pain or difficulty breathing, seek emergency care.

Some conditions that cause strawberry tongue can have lifelong or fatal complications if left untreated. Prompt medical treatment is crucial for ensuring a full recovery.

How is Strawberry Tongue Diagnosed?

To diagnose the underlying cause of your strawberry tongue, your healthcare provider will check for additional symptoms. They’ll physically examine you and will likely ask you questions about what you’ve been experiencing.

Depending on the cause your doctor suspects, they may also take a blood or fluid sample for testing. This will help identify a bacterial or viral infection. You may also be given an allergy test.

Kawasaki disease doesn’t have a definite cause or specific diagnostic test, so pediatricians have to pay close attention to physical symptoms. An accurate history of symptoms is important for making a Kawasaki disease diagnosis.

How to Treat Strawberry Tongue

Because strawberry tongue is a symptom of an underlying condition, treatment will depend on the specific cause:

• Scarlet fever, TSS, and other bacterial infections — antibiotics will be used to fight the infection. You may also be given blood pressure medication for TSS.
• Yellow fever — as a viral infection, yellow fever won’t respond to antibiotics, but pain-relieving and fever-reducing medications can treat symptoms. 
• Kawasaki disease — aspirin is likely to be prescribed to bring down the fever and reduce inflammation. A protein injection may be needed to prevent lasting damage to the heart.
• Allergies — epinephrine and steroid injections can treat anaphylaxis. For milder reactions, you may be given antihistamines. Avoiding the allergen (if possible) will help prevent future reactions.
• Nutrient deficiencies — a dietary supplement or injection of the deficient nutrient should reverse the symptoms.

Healing Timeline and Outlook

Recovery time will depend on the cause and how early you begin treatment. Infections like scarlet fever can last a few days to a few weeks, but this may be shortened with early treatment.

Kawasaki disease can last anywhere from 1 to 4 weeks. It is generally shorter when treated early. The fever should break within about 2 days of beginning treatment with aspirin and immune system protein injections.

Allergy and nutrient deficiency symptoms typically subside quickly once you’re given the necessary medication or supplement.