Geographic tongue severity index: A new and clinical scoring system Bruna Lavinas Sayed Picciani, DDS, PhD, a L  ılian Rocha Santos, DDS, MSc, a Thays Teixeira-Souza, DDS, MSc, a Thaylla N u~ nez Amin Dick, DDS, MSc, a Sueli Carneiro, MD, PhD, b Jane Marcy Neffa Pinto, MD, PhD, c Joao Carlos Regazzi Avelleira, MD, PhD, d David Rubem Azulay, MD, MSc, d Ronir Raggio Luiz, SD, PhD, e and Heron Fernando de Sousa Gonzaga, MD, PhD f Objective. This study was designed to develop a severity index for geographic tongue (GT) based on the Psoriasis Area and Sever- ity Index. Study Design. This cross-sectional observational study, with a retrospective sample of 100 participants, included 5 photographs of each case (dorsum, right border, left border, apex, and lingual belly), totaling 500 images of GT, which were evaluated by 3 experi- enced researchers in the area of GT and psoriasis. At the end of the analysis, GT was classified as mild, moderate, or severe. Results. Of the 100 patients, white women were most prevalent, accounting for 53% of cases. Of these participants, 34% had pso- riasis and 24% reported a burning sensation. The values of the proposed new index obtained at time 1 (0.855) and time 2 (0.819) presented low variability, and intra- and interrater correlations produced satisfactory values ranging from 0.950 to 0.898 and 0.898 to 0.850, respectively. Conclusion. The new index, Geographic Tongue Area and Severity Index, provides a better characterization of GT by assessing the severity of lesions in an easy and reliable manner, and it is indicated as a first step for interpreting the condition in clinical rou- tines and clinical trials. (Oral Surg Oral Med Oral Pathol Oral Radiol 2019;000:1À9) Geographic tongue (GT) is a chronic and immune- mediated condition characterized by a lymphocyte response that generates epithelial atrophy, particularly of the filiform papillae. 1,2 It occurs in 0.78% to 5% of the population, and women are most affected, by a ratio of 2:1. 3,4 Although it was described several years ago, its etiopathogenesis remains unknown. 4 This lesion has been associated with systemic diseases, especially psori- asis, and it is considered an oral manifestation and a severity marker of this dermatosis. 3,5,6 Patients with GT, especially male patients, can have a differential diagno- sis that includes Reiter syndrome. This syndrome involves the classic triad of conjunctivitis, urethritis, and arthritis, and it may manifest with cutaneous and oral lesions, such as GT. Thus a correct diagnosis of GT is essential to rule out this condition. 3,7 Clinically, erythematous areas are often found cir- cumscribed by a white halo, which regresses spontane- ously, recurring and coalescing in varying proportions. 2,8 The diagnosis is often clinical, requiring biopsy in atypical cases. 9 These lesions are usually asymptomatic, but in some cases the patient reports great suffering as a result of a burning sensation, pain, or bad appearance, which may bring about emotional and social losses. 1,10 There is no protocol for clinical evaluation and treatment, and it is essential to have clinical parameters to start appropriate therapy. In addi- tion, recent studies have found that GT is a marker of psoriasis severity and should be included in the criteria for the therapeutic definition of psoriasis, making in- depth assessment of GT essential. 11,12 Thus we believe the severity of GT can be evaluated from changes to an existing index that is already con- sidered in the evaluation of psoriasis, the Psoriasis Area and Severity Index (PASI) based on the clinical aspects of lesions. The present study was designed to develop a severity index for geographic tongue (Geo- graphic Tongue Area and Severity Index [GTASI]) in a consistent and accurate way to make it valuable for Statement of Clinical Relevance The proposed index for characterization of geo- graphic tongue by assessing the severity of lesions and area of involvement in a reliable manner may facilitate description and communication of the pre- sentation of geographic tongue over time in clinical and research settings. This study has no funding, and the authors declare no conflicts of interest. a Graduate Program in Pathology, School of Medicine, Fluminense Federal University, Niter oi, RJ, Brazil. b Sector of Dermatology, Medical Clinic Department, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil. c Department of Dermatology, Fluminense Federal University, Niter oi, RJ, Brazil. d Institute of Dermatology, Santa Casa da Miseric ordia, Rio de Janeiro, RJ, Brazil. e Institute of Public Health Studies, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil. f Department of Dermatology, Medical School, Mar  ılia University, Mar  ılia, SP, Brazil. Received for publication Aug 17, 2019; returned for revision Nov 3, 2019; accepted for publication Dec 18, 2019. Ó 2019 Elsevier Inc. All rights reserved. 2212-4403/$-see front matter https://doi.org/10.1016/j.oooo.2019.12.007 1 ARTICLE IN PRESS Vol. 00 No. 00 && 2019