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Explained: ‘COVID tongue’, and other unusual symptoms of Covid-19

COVID tongue is an inflammatory disorder that usually appears on the top and sides of the tongue, according to the American Academy of Oral Medicina (AAOM).

COVID tongue is an inflammatory disorder that usually appears on the top and sides of the tongue. (Representational Image)

‘COVID tongue’ may be a new condition associated with COVID-19, and it was identified with the help of the ZOE COVID-19 Symptoms Study app. A number of participants submit reports of their symptoms to this app on a daily basis which helped in identifying this unusual symptom of the disease.

Tim Spector, who is a professor of genetic epidemiology at King’s College London and a principal investigator of the PREDICT studies and the ZOE app, wrote on Twitter in January, “One in five people with Covid still present with less common symptoms that don’t get on the official PHE list – such as skin rashes. Seeing increasing numbers of Covid tongues and strange mouth ulcers . If you have a strange symptom or even just headache and fatigue stay at home!”.

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What is ‘COVID tongue’?

According to the American Academy of Oral Medicina (AAOM), COVID tongue is an inflammatory disorder that usually appears on the top and sides of the tongue. Affected tongues typically have a bald, red area of varying sizes that is surrounded by an irregular white border. Because the affected areas on the tongue can change in shape and size, like the continental drift, the disease is commonly referred to as “geographic tongue” (GT).

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AAOM says that the cause of GT is unknown and the condition can occur any time in life, including in childhood and it is estimated to affect 1-2.5 percent of the population. Some factors that may be responsible for the condition include emotional stress, psychological factors, habits, allergies, diabetes and hormonal disturbances.

So, how is COVID tongue associated with COVID-19?

A letter written to the British Dental Journal and published in January said that while some elements of the media have called for COVID tongue to be included as a symptom, the diagnostic value of the condition is not known yet. “However, as dental professionals, we must also be receptive to these developments. If a GT is of recent onset, could it signify COVID-19? Possibly,” the letter says.

Significantly, the letter points out that GT might be associated with elevated levels of an inflammatory cytokine, a protein which is associated with cytokine storms that some COVID-19 patients suffering from severe disease may face. The tongue is also rich in the expression of the ACE2 receptor, that the spike protein of the SARS-CoV-2 virus binds with to infect cells.


What are the common symptoms of COVID-19?

The US Centers for Disease Control and Prevention (CDC) lists out a range of the most common symptoms of the disease, which include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body ache, headaches, new loss of taste and smell and sore throat among others. The emergency warning signs include trouble breathing, persistent pain or pressure in the chest, new confusion, trouble waking up or staying awake and pale, gray, or blue-colored skin, lips, or nail beds, depending on the person’s skin tone.

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Less common symptoms and conditions associated with COVID-19

‘COVID toe’

COVID toe is one of the conditions whose cases were reported initially from Spain and the US. The skin condition causes purple, blue or red discolouration of the toes (and sometimes fingers).

A study in the International Journal of Dermatology (IJD) described the condition as chilblain-like lesions. In the United States, images of the condition popped up all over the country, dermatologist Dr Amy Paller said in a statement released last year by Northwestern University. These images are being collected as part of a US national paediatric dermatology registry. The BJD study looked at “unexplained” skin manifestations in 375 patients, including confirmed and suspected COVID-19 cases. They described five patterns of skin conditions; among these, COVID toe was observed in 19% (71 of 375). And among these 71 cases, 29 (41%) had confirmed infection with SARS-CoV2.


According to the American Academy of Dermatology Association (AADA), while COVID toes can appear at any age, young adults are most likely to develop this condition. The signs of this condition can appear on both the toes and the fingers, but most people develop it only on their toes. Further, while it is less likely for the virus to affect the skin, for some infected individuals, COVID toe might be the only symptom.

‘Long Covid’

For some infected with COVID-19, symptoms may last for weeks or even months after recovery of the virus. As per the CDC, the most commonly reported long term symptoms of the disease are fatigue, shortness of breath, cough, joint pain and chest pain. Some other reported long-term symptoms include difficulty with thinking and concentration, depression, muscle pain, headache, intermittent fever and fast-beating or pounding heart, which is also known as heart palpitations.

CDC says that some other long-term complications can also occur, although they appear to be less common. These include inflammation of the heart muscle, lung function abnormalities, acute kidney injury, rashes or hair loss, smell and taste problems, sleep issues, difficulty with concentration and memory problems, depression, anxiety and changes in mood.

Cytokine storms

In some patients of COVID-19, severe disease can be caused as a result of a cytokine storm, which is when the body’s immune system goes into an overdrive. When the immune system response is not regulated, it can cause damage that can lead to sepsis and death in some cases.

Essentially, a cytokine storm can be referred to as a severe immune reaction, leading to the secretion of too many cytokines (proteins that signal the production of immune cells) in the bloodstream, can be harmful since an excess of immune cells can attack healthy tissue as well.


Kawasaki disease

In June 2020, children in the UK were falling ill with symptoms of high fever and swollen arteries, and doctors believed at the time that it could be coronavirus-related. These children were showing abdominal and gastrointestinal symptoms as well as cardiac inflammation. According to Paediatric Intensive Care Society (PICS), there were also overlapping symptoms of toxic shock syndrome and atypical Kawasaki disease, an acute inflammatory disease of the blood vessels and usually occurs in children below the age of five. The inflammation caused by the disease affects many parts of the body but has a more serious effect on the heart since it causes inflammation in the coronary arteries that are responsible for supplying blood to the heart.

Guillain Barre Syndrome (GBS)

This is a rare autoimmune disorder in which the immune system accidentally starts attacking the peripheral nervous system. Some patients infected with COVID-19 were diagnosed with this disorder and India such cases have been reported since August 2020. According to the fact sheet published by the National Institute of Neurological Disorders and Stroke, “GBS can range from a very mild case with brief weakness to nearly devastating paralysis, leaving the person unable to breathe independently. Fortunately, most people eventually recover from even the most severe cases of GBS. After recovery, some people will continue to have some degree of weakness.”

First published on: 08-03-2021 at 18:57 IST
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