Black Hairy Tongue

A 15-year-old boy noticed that his tongue had become dark shortly after he recovered from an upper respiratory tract infection. The dusky, matted layer seen on its dorsal surface represents hypertrophied filiform papillae and lack of normal desquamation. The papillae mimic long hairs and may be stained black, brown, yellow, or whited from foods, medications, tobacco, or chromogenic bacterial overgrowth. Hence the term: black hairy tongue.

This asymptomatic condition is a common aftermath of radiation therapy of the head and neck or, as in this case, treatment with broad-spectrum antibiotics. Drs Charles E. Crutchfield III and Eric J. Lewis of Minneapolis advised this patient to brush his tongue with a toothbrush. The resulting desquamation usually resolves the problem, but recovery can be hastened with topical retinoids and antifungal therapy.