Case report

Oxford, UK
International
IJD
Blackwell
1365-4632
45 Publishing,
Publishing
Journal Ltd,
of
Ltd.
Dermatology
2004

Lingual traumatic ulceration (Riga–Fede disease)

Lingualettraumatic
Baroni
Cameo al. ulceration

Adone Baroni, MD, Carlo Capristo, MD, Luigi Rossiello, MD, Franco Faccenda, MD, and
Rocco Alfredo Satriano, MD

From the Departments of Dermatology and An 11-month-old male infant was referred to our clinic because of a painful ulcer of
Pediatrics, 2nd University of Naples, Naples, approximately 5 months’ duration on the ventral surface of the tongue (Fig. 1). On physical
Italy
examination, the lesion was circular (3 cm × 2 cm) with erythematous, raised, and indurated
borders.
Correspondence
Rocco Alfredo Satriano, MD No pathologic findings emerged from the laboratory data, neurologic examination, or
2nd University of Naples clinical history. The family history was also negative for developmental disorders and congenital
via Sergio Pansini 5 syndromes. No biopsy was performed in view of the age of the infant, the particular site of the
80131 Napoli lesion, and the clinical evidence of diagnosis. The treatment included odontologic cream
Italy
(methylvinylether/maleic acid) as a protective shield, a collutorium (chlorhexidine 0.2%), and
E-mail: vincruoc@tin.it
the use of a teething ring. Complete healing of the lesion (Fig. 2) occurred within 3 weeks.

A broad variety of terms have been used to describe RFD,

Discussion
Riga–Fede disease (RFD) is extremely rare and is character-
ized by an ulceration of the tongue, often caused by repetitive
traumatic injuries from back and forward movement of the
tongue over the mandibular anterior incisors. The lesion was
first identified by Antonio Riga, an Italian physician, in 1881.
Further cases of the disease were described by Fede, who also
performed histologic studies of the lesion.1–3 Microscopic
findings mainly show an inflammatory infiltrate composed of
numerous eosinophils with lymphocytes, macrophages, plasma
cells, and mast cells.4,5
such as eosinophilic ulcer of the oral mucosa, sublingual
fibrogranuloma, sublingual growth in infants, lingual traumatic
ulceration, traumatic atrophic glossitis, traumatic granuloma
of the tongue, and traumatic ulcerative granuloma with stro-
mal eosinophilia.1–3 RFD may be considered as a benign con-
dition in healthy infants, but it may be associated with other
serious neurologic disorders.2,6 Early detection of RFD is
recommended to treat these severe diseases, but also for other-
wise healthy infants. Indeed, a failure to diagnose or treat
these lesions properly may induce deformity or mutilation of
the tongue and dehydration or inadequate nutrient intake for

1096 Figure 1 Ulcer on the tongue

International Journal of Dermatology 2006, 45, 1096–1097 © 2004 The International Society of Dermatology
Baroni et al.
Figure 2 Healing of the ulcer after treatment
the infant.1,2,6 Nevertheless, traumatic ulceration related to
teething is highly unusual in infants, so that the lack of experi-
ence may result in a failure to diagnose.
Ulceration of the tongue may also be due to other causes,
including bacterial or mycotic infections, allergy and immuno-
logic diseases, tumors, or genetic disorders.2,3,6 The clinical
presentation, laboratory data, and positive results obtained
after treatment rule out these diagnostic hypotheses in this
case, so that a biopsy was not performed. With regard to the
treatment of RFD, several management options have been
reported that may be used alone or in combination: (i) cellu-
lose film or other protective dental appliance; (ii) oral dis-
infectant; (iii) corticosteroids; (iv) teething ring; and (v) filing of
the teeth to smooth sharp cutting edges.1,3,6 The extraction of
the lower incisors may also be indicated, but must be regarded
as a last resort.2,6 In the present case, we used conservative
treatment, consisting of a protective composite over the sharp
edges, oral disinfectant, and a teething ring.
© 2004 The International Society of Dermatology
Lingual traumatic ulceration Case report 1097
References
1 Ahmet T, Ferruh B, Gurcan A. Lingual traumatic ulceration
(Riga–Fede disease). Br J Oral Maxillofac Surg 2003;
41: 201.
2 Baghdadi ZD. Riga–Fede disease: association with
microcephaly. Int J Paediatr Dent 2002; 12: 442– 445.
3 Elzay RP. Traumatic ulcerative granuloma with stromal
eosinophilia (Riga–Fede disease) and traumatic eosinophilic
granuloma. Oral Surg 1983; 55: 497 –506.
4 Zaenglein AL, Chang MW, Meehan SA, et al. Extensive
Riga–Fede disease of the lip and tongue. J Am Acad
Dermatol 2002; 47: 445– 447.
5 Terzioglu A, Bingul F, Aslan G. Lingual traumatic ulceration
(Riga–Fede disease). J Oral Maxillofac Surg 2002;
60: 478.
6 Slayton RL. Treatment alternatives for sublingual traumatic
ulceration (Riga–Fede disease). Pediatr Dent 2000; 22:
413 –414.
International Journal of Dermatology 2006, 45, 1096–1097