COVID Tongue: How a Swollen Tongue Could Indicate COVID-19

After the start of the COVID-19 pandemic, reports trickled in about unusual symptoms of COVID-19. There were COVID toes, unusual skin rashes, and loss of taste and smell. Later, the Centers for Disease Control and Prevention [CDC] included loss of taste and smell in the list of COVID-19 symptoms. Adding to the not-so-common symptoms is COVID tongue.

According to a research letter published in the British Journal of Dermatology in September 2020, a significant number of COVID-19 patients experience bumps on their tongues, along with inflammation and swelling. The letter analyzed data from 666 patients at a temporary field hospital in Spain and found that more than 45% had some form of mucocutaneous symptoms. (Mucocutaneous symptoms appear on areas where mucous membranes and skin meet, like your mouth, eyes, and parts of genitalia.)

More than 25% had symptoms in their mouth, including inflammation of the bumps on the tongue surface and overall redness and swelling of the tongue. It was common for patients also to say they felt a burning sensation in their mouth and a loss of taste.

The letter even includes photos so that you can see close-ups of (a) a swollen COVID tongue and (b) a patchy, bumpy COVID tongue. These symptoms raise many questions, including whether you should keep close tabs on your tongue. So we asked doctors to weigh in.

How Common Is COVID Tongue?

While the CDC and other health organizations do not list COVID tongue among COVID-19 symptoms, some doctors reported instances of it. "I've seen a few," Rajeev Fernando, MD, an infectious disease physician working in field hospitals nationwide, told Health.

Others, like Richard Watkins, MD, an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University, haven't seen this in COVID-19 patients, but there could be a reason. Patients "are usually wearing a mask, and I don't ask them to take their mask off," Dr. Watkins told Health.

It's because of this that COVID tongue is likely underreported, Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York, told Health. "Many physicians focus on the heart, lungs, and abdomen and, in the age of COVID-19, they pass on examining the mouth even more because it can increase their risk of getting infected," said Dr. Russo. "This has probably been missed in a lot of individuals."

What Causes COVID Tongue—And Could a Swollen Tongue Be a Sign of Something Else?

It's important to point out that what's been dubbed "COVID tongue" isn't necessarily unique to COVID-19. "A number of viruses can cause mucocutaneous manifestations," said Dr. Russo. Dr. Fernando agreed: "These symptoms aren't a slam dunk for a COVID-19 diagnosis."

And while this phenomenon hasn't been studied heavily, Dr. Russo said it's "biologically plausible" COVID-19 can make your tongue swell. After all, the mouth is one of the main entryways into the body for the SARS-CoV-2 virus—the virus that causes COVID-19—according to an April 2021 Journal of Clinical and Pharmaceutical Research review.

Dr. Fernando explained it this way: Your cells contain enzymes called ACE receptors, which SARS-CoV-2 latches onto. From there, the virus gets into your cells, replicates, and makes you sick. "There are a lot of ACE receptors in the tongue, so the virus concentrates very heavily in this region," said Dr. Fernando. "In the tongue, there can be a lot of COVID." And that can lead to symptoms like tongue bumps and tongue swelling.

Furthermore, beyond other viruses, there are other causes of tongue swelling (known as glossitis, per MedlinePlus). The condition can present the same way as COVID tongue: A person might have a sore or swollen tongue, or their tongue could appear pale. Glossitis could also appear due to conditions such as allergic reactions (e.g., to oral care products or food), mouth-related skin conditions, mouth injuries, hormones, or some vitamin deficiencies. Thus, you'll want to pay attention to if you have any COVID-19 symptoms to determine if COVID-19 is the true culprit of your tongue inflammation.

Treatments

As of September 2022, there have not been any treatments identified that may alleviate COVID tongue specifically. However, because COVID tongue symptoms include swelling and inflammation, it's possible that any remedies that help with tongue swelling can help with an instance of COVID tongue. Per MedlinePlus, those remedies include:

• Maintaining good oral hygiene (e.g., brushing at least twice per day and flossing at least once per day)
• Avoiding foods or other substances (e.g., tobacco) that could cause tongue irritation
• Taking antibiotics or other medications for infections
• Making any diet changes or utilizing supplements for nutritional issues

Of note, if your tongue is very swollen, that could indicate a severe allergic reaction, which would require an immediate visit to the hospital per MedlinePlus.

Additionally, tongue swelling and inflammation related to having COVID-19 would also likely go away with treatment of COVID-19 itself. Therefore, following the CDC's guidelines for what to do when you get sick from COVID-19—such as getting rest, staying hydrated, and taking over-the-counter (OTC) medications—may be helpful.

What Should You Do if You Think You Have COVID Tongue?

Dr. Fernando said it's unlikely that you would just develop COVID tongue. Instead, Dr. Fernando noted it's more likely that you'd notice tongue oddities alongside other, more recognizable symptoms like a cough, shortness of breath, or loss of taste and smell. "It will be part of a constellation of symptoms," said Dr. Fernando.

If your tongue feels or looks unusual, it could be a sign that you have another type of virus—or that you just ate something that irritated you, according to Dr. Russo. "All of these oral and mucocutaneous manifestations tend to be nonspecific," said Dr. Russo. While Dr. Russo noted that tongue symptoms "could increase your suspicion for coronavirus infection, it's likely that other symptoms would trigger that diagnostic pathway."

Besides the symptoms listed above, other COVID-19 symptoms—per the CDC—you may want to look out for that might accompany a swollen tongue include:

• Fever or chills
• Fatigue
• Muscle or body aches, including headaches
• Sore throat
• Nasal congestion or runny nose
• Nausea or vomiting
• Diarrhea

The bottom line is that you don't want to ignore bumps or inflammation of your tongue—but don't panic if you develop one of these symptoms, either.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.