Strawberry tongue is the name given to a swollen, bumpy tongue. Most often, the enlarged tongue is very red, like a strawberry or raspberry. Occasionally, the tongue will be white for a few days before turning red.

Strawberry tongue isn’t itself a condition. A red, bumpy tongue with enlarged taste buds are symptoms of an underlying condition or disorder. Diagnosing and treating the condition or disorder will revert your tongue to its usual appearance.

Several conditions can lead to a strawberry tongue. Understanding each possible cause and its unique symptoms will help you understand why you may be experiencing the enlarged, rough tongue. Conditions that can cause strawberry tongue include:

Kawasaki disease

Kawasaki disease is rare. It’s not clear why some people develop it and others don’t. It’s most common in children, but it can occur at any age. The primary sign of Kawasaki disease is inflamed arteries.

More visible symptoms include:

  • high fever
  • rash
  • red, irritated eyes that can have a thick discharge
  • peeling skin
  • chapped lips
  • swelling in hands and feet

Allergies

Food and drug allergies can cause a variety of symptoms, including a strawberry tongue. Medication and food allergies can also cause other symptoms like:

  • itchy, water eyes
  • rash
  • scratchy mouth
  • difficulty breathing

In severe cases, an allergy can be life-threatening.

First aid you should know: How to treat allergic reaction »

Scarlet fever

Strep throat that isn’t treated properly can turn into a bacterial illness called scarlet fever. Most people with scarlet fever have a white strawberry tongue at first. In a few days, their tongue may turn red.

Other symptoms of scarlet fever include:

  • a red rash over large portions of your body
  • a flushed face
  • high fever
  • sore throat
  • headache
  • red lines in the folds of your skin, such as those around your groin

This illness is most common in children ages 5 to 15.

Toxic shock syndrome (TSS)

Toxic shock syndrome is a life-threatening disease. As well as strawberry tongue, it causes symptoms such as:

  • a sudden high fever
  • nausea
  • vomiting
  • diarrhea
  • headache
  • an achy feeling all over

If it’s not treated quickly, TSS can be life-threatening. TSS is commonly connected to the use of tampons, but it can also occur in people who stuff gauze or tissue in their nose to stop a nosebleed. You should seek emergency medical attention if you have the symptoms of TSS.

Vitamin deficiency

Low levels of vitamin B-12 and folate can cause a strawberry tongue, but this deficiency will likely be diagnosed if you experience its more common symptoms. These symptoms include:

  • weakness
  • fatigue
  • memory difficulties
  • balance problems

Glossitis, a swollen tongue that is smooth, is very similar to strawberry tongue. It can also be a symptom of this deficiency.

Learn more about folate deficiency »

A strawberry tongue is a symptom of a condition, and some of these conditions can be serious. A vitamin B-12 deficiency isn’t a life-threatening condition, but TSS can become so very quickly if it’s not diagnosed and treated.

A red, swollen, and bumpy tongue can also be a sign of scarlet fever. The high fever that scarlet fever can cause may be dangerous, especially to young children.

A food or medication allergy can be serious if you begin having a hard time breathing. Anaphylaxis can cause:

  • swelling in the face
  • increased heart rate
  • chest pain
  • difficulty breathing

If it’s not treated, an anaphylactic response can be deadly.

If you develop a strawberry tongue, it’s a good idea to make an appointment with your doctor. Diagnosing the underlying cause is the only way to treat the swollen tongue. Seek emergency medical attention if other symptoms you’re experiencing indicate a serious problem.

A strawberry tongue can be painful and irritating. You may bite your tongue because it’s larger than normal. You may also have a harder time chewing and swallowing food and drink until the swelling ends.

The conditions that can cause a strawberry tongue can result in serious complications, however. Kawasaki disease, which causes inflammation of arteries in your body, can lead to long-term artery inflammation.

Scarlet fever may lead to rheumatic fever. This disease can cause inflammation in your heart, brain, joints, and skin. In some cases, it can also lead to kidney disease and severe ear infections.

If not treated quickly, TSS can result in organ damage, shock, and possibly death.

One of the easiest ways to figure out what’s causing strawberry tongue is to see what other symptoms you’re experiencing. The first thing your doctor might do is ask for a recent medical history. Explain when you developed changes to your tongue. Tell your doctor about any other symptoms you’re experiencing and when they started.

This list of symptoms may be all that’s necessary for a diagnosis, but some tests may help your doctor confirm a diagnosis. For example, if they suspect a vitamin deficiency, your doctor my request a blood test to check vitamin levels in your blood.

Treating strawberry tongue requires treatment for the underlying cause of the symptom. These include:

Kawasaki disease

The first phase of treatment aims to reduce the fever and inflammation, as well as prevent heart damage. Medicines like aspirin (Bufferin) can reduce inflammation. An injection of immune system proteins may be necessary to prevent heart damage.

Allergies

An antihistamine can treat less serious symptoms of an allergic reaction. For a severe reaction, including anaphylaxis, an injection of epinephrine and intravenous steroids may be necessary.

Scarlet fever

A full course of antibiotics can treat scarlet fever.

Read more: Side effects of antibiotics »

Toxic shock syndrome

TSS requires multiple steps for treatment. An antibiotic fights the infection. Another medicine may be necessary to stabilize blood pressure. If TSS makes you nauseated and you become dehydrated from vomiting, you may need fluids.

Vitamin deficiencies

A change in diet may be enough to correct a vitamin deficiency. Eating more foods rich in vitamin B can boost your blood levels of these important nutrients. For severe vitamin B-12 deficiencies, you may need a B-12 injection to raise your levels of this vitamin.