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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.
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 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:
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 (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:
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 mainly affects children under 5. It doesn’t have a clear cause. It involves blood vessel inflammation, causing strawberry tongue as well as:
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.
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.
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 can also have strawberry tongue as a symptom. These include:
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.
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.
Because strawberry tongue is a symptom of an underlying condition, treatment will depend on the specific cause:
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.
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