An Atlas of Lingual Lesions, Part 1

Hairy Tongue

Hairy tongue, also known as lingua villosa or furred tongue, results from the accumulation of excess keratin on the filiform papillae of the dorsal tongue, leading to elongation and hypertrophy of filiform papillae that resemble hair (Figure).¹ The prevalence is estimated to be 3% to 4% of the adult population and increases with age.² Rarely, the condition has been reported in children.^3,4 The male to female ratio is approximately 3 to 1.^5,6

Clinically, a hairy tongue is characterized by hair-like projections on the dorsal surface of the tongue with typical carpet-like appearance that can be scraped off.^5,6 Typically, the condition does not occur on the sides of the tongue, tip of the tongue, or posterior to the circumvallate papillae/sulcus terminalis.⁵ The color of the tongue varies from yellow, tan, brown, green, blue, or, more commonly black (lingua villosa nigra).^1,2,5,6 The discoloration results from chromogenic bacteria or yeast trapped between the hyperkeratotic papillae.² Most patients are asymptomatic, although some patients may have a stale/metallic taste, nausea, gagging, tickling of the tongue, or halitosis.^1-3 The condition may cause cosmetic concerns to the patient.⁵

A hairy tongue occurs most commonly in older adults, smokers, mouth-breathers, and those with poor oral hygiene.^1,2,6 Other predisposing factors include excessive coffee or black tea consumption, alcoholism, xerostomia, medications (eg, penicillin, erythromycin, tetracycline, linezolid, bismuth, ranitidine, lansoprazole, methyldopa, olanzapine, lorazepam, lithium), prolonged use of oxidizing mouthwashes, and, less commonly, substance abuse, HIV infection, graft-versus-host disease, trigeminal neuralgia, and internal malignancies.^3,5,6

The condition is benign. Treatment of hairy tongue is mainly symptomatic and consists of maintaining regular appropriate oral hygiene and gentle debridement with a soft-bristled toothbrush or tongue scraper.² Predisposing factors should be avoided if possible.

REFERENCES:

1. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010;81(5):627-634.
2. Rogers RS III, Bruce AJ. The tongue in clinical diagnosis. J Eur Acad Dermatol Venereol. 2004;18(3):254-259.
3. Akcaboy M, Sahin S, Zorlu P, Şenel S. Ranitidine-induced black tongue: a case report. Pediatr Dermatol. 2017;34(6):e334-e336.
4. Popik E, Barroso F, Pombeiro J, Carvalho C, Almeida A. Hairy tongue in a 1-month-old infant. Arch Dis Child. 2019;104(2):158.
5. Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastroenterol. 2014;20(31):10845-10850.
6. Mangold AR, Torgerson RR, Rogers RS III. Diseases of the tongue. Clin Dermatol. 2016;34(4):458-469.