Strawberry Tongue

What is strawberry tongue?

A strawberry tongue is an uncommon symptom that changes your tongue’s appearance. Healthy tongues are typically pink with tiny bumps. But a strawberry tongue is bright red with enlarged bumps that resemble seeds on strawberry skin. Some people think the bumps and the color look more like raspberries. This is why some people call strawberry tongue “raspberry tongue” instead.

Most of us think of strawberries (and raspberries) as delicious, warm-weather treats, but having a strawberry tongue isn’t so good. The most common conditions that cause strawberry tongue are treatable — but can be serious without it.

You’ll need to see a healthcare provider to determine whether the redness and bumps are a sign of something serious.

What are the most common causes of strawberry tongue?

Scarlet fever, toxic shock syndrome (TSS) and Kawasaki disease are the most common causes of strawberry tongue.

In extremely rare instances, strawberry tongue may be a sign of:

• Rare infectious diseases (including Yersinia pseudotuberculosis and yellow fever).
• Food or drug allergies.
• Vitamin B12 deficiency.

Scarlet fever

Scarlet fever is a bacterial infection caused by group A Streptococcus — the same bacteria that cause strep throat. Anyone can get this infection, but it’s most common in children ages 5 to 15.

Unlike strep throat alone, with scarlet fever, the bacteria release a poison responsible for the uniquely red (scarlet) symptoms — like a strawberry tongue. If you have an infection, your tongue may start out white. This is called “white strawberry tongue.” But within a few days, it turns bright red.

Your provider may suspect scarlet fever if they notice symptoms in addition to a strawberry tongue, like:

• A red, sandpaper-like skin rash.
• Red lines in the creases of your skin (like your elbows and underarms).
• Red spots on the roof of your mouth (petechiae).
• Swollen tonsils.
• Fever.

Toxic shock syndrome (TSS)

A strawberry tongue is one potential sign of toxic shock syndrome (TSS). TSS is a rare condition most often caused by infections from Staphylococcus and group A Streptococcus bacteria. Most people think of TSS as an infection you can get from leaving a tampon in for too long. But anyone can get it if the bacteria grow out of control and start to produce toxins (poisons).

Signs and symptoms of TSS usually develop fast, within 48 hours. Symptoms other than a strawberry tongue include:

• Rash that may look like a bad sunburn.
• Redness in your throat and eyes (a sign of pink eye).
• Nausea or vomiting.
• Diarrhea.
• Fever.

Kawasaki disease

A strawberry tongue may be a sign your child has a rare condition called Kawasaki disease. This condition causes inflammation that can damage your child’s blood vessels if it’s left untreated. It’s unclear what causes it, but it’s most common in children 6 months to 5 years old.

Your healthcare provider will act fast to determine whether your child’s strawberry tongue is a sign of Kawasaki disease, so they can treat it immediately.

Symptoms of this condition besides a strawberry tongue include:

• Red or pink eyes.
• Rash that’s mostly on their chest, belly or back.
• Swelling and/or redness on your child’s palms and the soles of their feet.
• Peeling skin (usually starts around their nails).
• Fever.

How is strawberry tongue treated?

Your strawberry tongue will go away once you get treatment for the condition that caused it. Treatments may include:

• Antibiotics: People with scarlet fever usually take a 10-day course of either penicillin or amoxicillin to kill the bacteria. You’ll need antibiotics to clear infections associated with TSS, too.
• Immune globulin (IVIG): Your child will need to receive IVIG by IV (in a vein) in a hospital if they have Kawasaki disease. This helps calm the inflammation that’s causing symptoms, like strawberry tongue.
• Antihistamines: Antihistamines can help ease the swelling and redness if an allergy caused your strawberry tongue.
• Eating certain foods or taking vitamin B12 supplements. You may need to eat more foods containing vitamin B12 or take a supplement if a vitamin deficiency is causing your strawberry tongue. This is much less common, though, since a strawberry tongue is an extremely rare sign of a vitamin B12 deficiency.

What are the risks of not treating strawberry tongue?

Most causes of strawberry tongue don’t lead to complications. Healthcare providers usually treat the underlying condition before there’s an issue.

But skipping treatment altogether can pose serious health risks.

For example, untreated Kawasaki disease can damage the arteries that supply blood to your child’s heart (coronary arteries). This can cause serious heart problems. Without treatment, the bacterial infections that cause scarlet fever and TSS can spread, causing organ damage.

There’s no need to panic about these worst-case scenarios if you or your child has a strawberry tongue. Still, take these tongue changes seriously enough to have your healthcare provider take a look.

When should strawberry tongue be treated by a doctor or healthcare provider?

Always contact a healthcare provider if you suspect you or your child has strawberry tongue. Most conditions that cause this symptom won’t just go away on their own, and they can get worse without treatment. It’s important to get checked.

What can be mistaken for strawberry tongue?

It’s easy to mistake glossitis for a strawberry tongue. Glossitis is tongue inflammation that causes redness and swelling. Like strawberry tongue, you can develop glossitis from causes like infections, allergies and nutritional deficiencies.

But with glossitis, your tongue usually looks smooth and even glossy, not bumpy. Glossitis has more potential causes than strawberry tongue. With strawberry tongue, providers usually think of scarlet fever first, or (less commonly) toxic shock syndrome or Kawasaki disease.

A note from Cleveland Clinic

A tongue that looks like a ripened strawberry or raspberry isn’t something to worry about. Still, it’s something your provider needs to check. Often, the issue is a bacterial infection that a course of antibiotics can take care of. Schedule an appointment to have a provider check your or your child’s tongue if it’s strawberry red.