Geographic Tongue, Aquagenic Skin Wrinkling, and Other Oddities in CF

There are lots of little weird things in cystic fibrosis that you eventually stumble upon, such as salivary gland obstruction. Here's three more to add to your collection:

1) Geographic Tongue. Some CF persons develop strange raised circles on their tongue, almost looking like crop circles. No, the aliens haven't invaded your tongue; this is called "geographic tongue," and can be a marker of a nutrient deficiency or of excess inflammation, both of which CF persons may have. In our family's experience, our first child with CF developed geographic tongue as a baby. Though we have no idea if this can be generalized, when we added to his regimen a health food drink designed to provide mineral micro-nutrients, the geographic tongue disappeared and has not recurred. Levels of zinc, magnesium, and other minerals may be depressed in CF persons, and developing a slight mineral deficiency is common.

2) Aquagenic Skin Wrinkling: If you have kids with CF, you know that if you put them in the bath or the pool, they come out with intense skin wrinkling on the palms and inner fingers (and soles of the feet). The wrinkling may be so intense that a layer of skin may in fact slough off as a result. Scientists have now determined that this is in fact due to CFTR mutation, though they still do not completely understand the mechanisms at work. While we can just laugh at the wrinkling, the skin sloughing is another matter. You may wish to moisturize the palms and soles if your child will be soaking in water for a long time, or you may wish to limit the time they do soak.

3) Finger Clubbing: Over time, the fingertips of CF persons become more bulbous. Interestingly, after a lung transplant, this finger clubbing goes away. Scientists still do not understand the exact mechanism of finger clubbing, but some have speculated that in severe lung disease, the body releases a circulating vasodilator of unknown identity that is causing the clubbing.