'Black Hairy Tongue' (Condition / Syndrome)


I knew the job was dangerous when I took it ...
Jul 19, 2004
Out of Bounds
I don't recall hearing of this condition before ... Its name says it all ...

What Made This Woman's Tongue Turn Black and 'Hairy'?
A 55-year-old woman's tongue took on a black, "hairy" appearance after the woman was treated with antibiotics for an infection following a car accident.

The accident crushed both of her legs and led her to develop a polymicrobial wound infection — an infection caused by more than one microbe ...

To treat the infection, doctors started her on two separate antibiotics: meropenem and minocycline. After a week, the woman reported feeling nauseous and having a bad taste in her mouth, according to the report. She also had another, more striking symptom: Her tongue had turned black and hairy. ...

This condition, perhaps unsurprisingly called "black hairy tongue," isn't harmful, the report said, and is caused by the enlargement and growth of little bumps on the tongue's surface. These bumps, called filiform papillae, unlike other kinds of papillae on the tongue, do not contain taste buds, according to the Encyclopedia of Neuroscience. Instead, they help to grip food ...

Black hairy tongue could be caused by a number of factors including certain medications, tobacco use, irritating mouthwashes or poor oral hygiene. In the woman's case, the doctors suspect that the antibiotic minocycline was to blame, according to the report.

Indeed, when the doctors switched the minocycline to another antibiotic and advised her to practice good oral hygiene, her tongue returned to its normal appearance within a month.

FULL STORY (With Photos): https://www.livescience.com/63522-black-tongue-antibiotics.html
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Here's a recent case study involving black hairy tongue (BHT). According to this study, BHT isn't all that rare or (usually) serious.
Thick, black 'hairs' coated a man's tongue. Here's why.

A man went to a dermatology clinic after the top of his tongue became coated in a dense carpet of hairlike fibers. His doctors quickly diagnosed him with a surprisingly common medical condition: "black hairy tongue," known medically as lingua villosa nigra.

Three months prior to his examination, the man, who is in his 50s, had a stroke that caused paralysis on the left side of his body, and his left side still remained weak at the time of his dermatology appointment ... After the stroke, the man was put on a diet of pureed food and liquids, and about two and a half months later, his caretakers noticed "black pigmentation" covering the surface of his tongue.

The thick, black coating was tinged with "yellowish" streaks near the midline and back of the tongue, according to the case report. (The outer edges, tip and dead center of the tongue were free of the gunk, the authors noted.) A closer examination revealed that the black coating was made up of long, thin fibers, with bright, yellow deposits — likely trapped food particles — scattered throughout. The man's doctors also scraped mucus samples from his tongue to check for abnormal bacterial or fungal growth, but they found no such growth when they cultured the scrapings in lab dishes. ...

Black hairy tongue occurs when tiny, cone-shaped bumps on the surface of the tongue, called filiform papillae, don't shed as they normally do, according to the Cleveland Clinic. These papillae typically grow about 0.04 inch (1 millimeter) long before detaching from the tongue in a process called desquamation. But if the top of the tongue does not undergo regular abrasion — for instance, from a toothbrush, tongue scraper, or solid, textured foods — these papillae can grow to be unusually long — up to about 0.7 inch (18 mm) in length.

For these reasons, poor oral hygiene and a diet of soft foods can raise the risk of developing black hairy tongue. Excessive consumption of coffee, tea, alcohol or tobacco products; certain medications, like antibiotics; radiation treatment of the head and neck; and certain mouthwashes can also disrupt the process of desquamation and drive the condition's onset, according to theCleveland Clinic. Dry mouth is another risk factor ...
FULL STORY: https://www.livescience.com/black-hairy-tongue-case-report
Here are the bibliographic details and abstract for the published case study.

Jayasree P, Kaliyadan F, Ashique KT.
Black Hairy Tongue
JAMA Dermatol. Published online March 09, 2022.

A man in his 50s presented to the dermatology department with a painless thick black coating on his tongue. Three months prior he had experienced a cerebrovascular incident with dense hemiplegia, and his caregivers first noticed the black pigmentation over the dorsum of the tongue 15 days before presentation. He was being fed a diet of pureed food and liquids and was taking oral antiplatelets and antihypertensives.

On examination, he did not have a fever and was conscious and oriented, with left-sided motor weakness. The dorsal aspect of his tongue showed a thick black coating that was yellowish toward the medial and proximal parts. The lateral borders, tip, and central part of median sulcus were spared (Figure, A). Dermoscopy results (Figure, B) showed thin, elongated, black fibers that gave the appearance of a hairy surface. Amorphous yellowish deposits were visible peripherally. Mucosal scrapings from the lingual surface grew normal bacterial flora on culture. No fungal growth was isolated. With these findings, a diagnosis of black hairy tongue (BHT) was made. The patient and caregivers were given advice regarding proper cleansing measures, and the discoloration resolved after 20 days.

SOURCE: https://jamanetwork.com/journals/jamadermatology/article-abstract/2789440