The appearance of small lesions or red dots on the tongue is a rather common phenomenon, both because the tongue is subjected to numerous factors that cause irritation, skin lesions, burns and scalds, and because it represents an organ in which they manifest themselves in many cases symptoms of a bacterial or viral infection .
Symptoms that may accompany the appearance of red lesions on the tongue are pain and burning in the throat, itching, swelling, fever, chills and general malaise, swollen lymph nodes, changes in taste and skin manifestations spread all over the body.
In pediatric age the appearance of these signs very often and in relation to a viral or bacterial infection that falls within the so-called exanthematous diseases: very widespread diseases whose consequences can have serious repercussions on the state of health, especially in adulthood and for which there are specific vaccinations.
In most cases there is no reason to be alarmed, however if fever and skin manifestations appear it is necessary to refer the case to the pediatrician (if the episode affects a child), or to your GP if it concerns an adult person, to the in order to identify the cause of infection and to administer adequate therapies, if necessary.
Given the main symptomsaccompanying the appearance of red dots on the tongue and the subjects most affected by the phenomenon, we can proceed to illustrate the pathologies most involved in the manifestation of this disorder.

Red dots on the tongue: what are the possible causes

Bites and burns
The tongue is an organ subjected to numerous stresses due to the chewing function, therefore to hot foods or drinks that can cause burns that are accompanied by a temporary decrease in the sense of taste and appearance a red skin lesion.
Sometimes during chewing an uncoordinated movement can be made in clenching the jaws, biting the tongue and causing a wound on the mucous membrane of the tongue.
An event that can also happen if you suffer from bruxism .

fever Like many of the diseases that we will see below, it is an exanthematous disease typical of childhood, but unlike the others, caused by a virus, scarlet fever and caused by a bacterium, beta-haemolytic Streptococcus pyogenes .
It is a disease characterized by a widespread rash that typically spares the soles of the feet and hands and the area around the mouth. One of the characteristic signs is the so-called “strawberry tongue”, in which the tongue takes on a white color which later flakes and leaves room for red spots and dots. The marks fade within a few days without scarring.

Measles Exanthematous
disease typical of childhood that was very common before the trivalent vaccine valid for measles, mumps and rubella (MMR). It is a potentially dangerous infection for the nervous system that is transmitted by air and spreads through the body through the lymphatic system and then passes to the bloodstream, where it infects lymphocytes, monocytes and macrophages.
The infection then reaches various parts of the body such as the respiratory tract, urinary tract, conjunctiva, central nervous system and blood vessels. There is a period of between when the virus enters the body and when skin lesions appearvariable incubation , between 7 and 15-18 days, in which in the last 3-5 days of incubation the subject is infectious, therefore it can transmit the virus through the airways.
Symptoms of measles include cough without sputum (without expulsion of phlegm), conjunctivitis, high fever , appearance of white lesions in the mouth, tongue and mucous membranes surrounded by a red halo called Koplik’s spots . After about 12-24 hours from the appearance of Koplik’s spots, the classic manifestation of diffuse macules on the body then appears, which then disappear within a few days.

It is an airborne infectious disease, so it occurs through respiratory secretions. The rubella virus typically replicates in the upper airways (therefore in the mucous membrane of the nose), reaches the lymphatic system, therefore the lymph nodes, and from there spreads throughout the body via the bloodstream.
In pediatric age, symptoms often include fever and a widespread red rash on the skin that occurs after an incubation period of about 20 days after the virus enters the body, and then resolves within a few days. The symptoms and possible consequences are of greater importance if the infection affects an adult individual, in fact the risk of encountering infections of the central nervous system are very concrete.
Another issue to be taken into serious consideration is the teratogenic effect in case of pregnancy , in fact if the rubella virus is contracted by the mother during pregnancy, it constitutes a real danger of spontaneous abortion or malformations . It is therefore recommended to follow medical indications regarding the need to undergo vaccination.

The appearance of red dots on the tongue is less in chickenpox than in the other exanthematous diseases mentioned, but however, small bubbles may also appear on the tongue and oral mucosa. It is a typical exanthematic disease of children, but it can also affect adults who did not contract it in pediatric age.
Transmission occurs by air, so the virus is conveyed by sneezing or by secretions expelled by the infected person, and once it enters the body it spreads into the lymphatic system. From the moment the virus enters the body to its skin manifestations, there is an incubation period of about 15-20 days, in which fever, cough and malaise appear, that is the typical symptoms of a viral infection. It is important to say that during the incubation period the subject is infected and therefore can in turn transmit the virus through the respiratory tract.
At the end of the incubation then the typical skin manifestations appear that follow a precise trend, that is, they originate as macules which then evolve into vesicles and pustules, and then finally result in itchy crusts that can leave scarring if scratched. The manifestations on the skin cover the entire surface of the body, also affecting the scalp and the surface of the tongue with more or less bright red dots . The lesions heal within a few days.
When the infection is contracted in adulthood, the outcomes can be much more severe, leading in some cases to sepsis and pneumonia.

Allergic reaction
The appearance of red dots on the tongueit can be the consequence of an allergic manifestation to a food. In this case, it is necessary to pay close attention to the associated symptoms, in fact if the tongue swells and breathing difficulties are felt, it is necessary to immediately contact 118 or go to the nearest emergency room.

Vitamin deficiencies
In some cases the tongue can show the appearance of red dots on its surface in relation to an unbalanced diet in which vitamin deficiencies develop. An example of this is a lack of vitamin B12 (cobalamin), vitamin B3 (niacin) or B2 (riboflavin).

Diagnosis and Therapies: what to do in case of red spots on the tongue
It is always useful to reiterate the importance of not relying on useless comparisons based on the observation of images found on the internet, this is because the diagnosis based on skin signs requires very in-depth knowledge (therefore those of a doctor), but above all because in doing so you lose valuable time with the risk of worsening your condition. As seen, an exanthematous disease in adulthood can have serious repercussions.
The appearance of only one sign of lesion on the tongueit can be an indication of a bite (perhaps while chewing a meal, or unknowingly in the case of bruxism), or a burn related to taking a drink that is too hot. In this case, if the lesion is limited and does not bleed, there is no need to be alarmed, but if healing is delayed and bleeding is observed, it is strongly recommended to consult a doctor.
In case of red spots on the tongue that are associated with fever and widespread manifestations such as rashes and swollen lymph nodes, you are probably facing an infection and you need to consult a pediatrician (if in pediatric age) or your doctor basic if in adulthood, and submit the disorder for its evaluation.
In the case of exanthematous diseases, the diagnosis is largely based on observing the rashes and mucous membranes, so the doctor evaluates their appearance, their location and associated symptoms such as fever, pain and itching. Generally observation alone allows to identify the disease, but a blood sample can be very useful, through which to analyze the immunoglobulins in the serum and identify with certainty the bacterial or viral strain responsible. Based on the identification of the infectious agent, the most appropriate therapy is prescribed, which may only be symptomatic, thus treating fever and inflammation or through targeted treatments with the use of antibiotics or antivirals. Vaccines
are also of great importanceavailable today, despite the strong disinformation campaigns on vaccines implemented in recent years, exanthematous diseases, although very widespread, can cause serious repercussions, especially in adulthood, therefore the use of vaccination is a safe and strongly indicated strategy.
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