A Man Presented to Doctors in India With Black, Hairy Tongue: Report

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A man in his fifties presented to doctors in India with a black, hairy tongue.
Black hairy tongue can occur in about 13% of the population, per the American Academy of Oral Medicine.
It’s usually harmless and self-resolves with regular cleansing.

A man in his fifties presented to doctors in India with a black, hairy tongue after suffering a stroke, according to a report by JAMA Dermatology.

The man had left-sided weakness from a stroke three months prior and was put on a pureed diet, doctors said in a report published Wednesday. A thick, black coating covered most of his tongue, sparing the sides and middle part, which he’d had for about two weeks, they said.

The doctors diagnosed the condition as black hairy tongue, or lingua villosa nigra — a harmless condition that occurs in about 13% of the population, according to the American Academy of Oral Medicine.

The Indian dermatologists said that black hairy tongue was more likely to occur in people on a pureed diet, and it forms due to a lack of abrasion or stimulation to the top of the tongue, leading to a build up of a protein called keratin.

As a result, conical shaped projections covering the tongue, called filiform papillae, get long, and form a hair-like appearance on the top of the tongue.

Other predisposing factors include: poor oral hygiene, smoking, oxidizing mouthwashes, oral

antibiotics

, excessive coffee or tea drinking and conditions that suppress the immune system, such as HIV or cancer.

It can occur at any age, but happens more frequently in older people, according to the National Institutes of Health.

Black hairy tongue can appear brown, yellow, or green, as well as black, according to the NIH, depending on the bacteria and fungi that can overgrow on the altered surface, as well as other anaerobic bacteria that ferment food particles trapped in the papillae. It’s those anaerobic bacteria that give the tongue the black appearance.

Usually black hairy tongue gets better by brushing the tongue with a toothbrush or using a tongue scrape.

For this patient, the condition resolved after 20 days after “proper cleansing”, the doctors said.