BLACK HAIRY TONGUE
By Gary M. White, MD
Black hairy tongue is a benign discoloration of the dorsal surface of the tongue. Excessively long filiform papillae are black in color due to accumulation of keratin and chromogenic microorganisms.
- The condition usually occurs in older individuals but infants as young as 2 months of age may be affected [CMAJ].
- Some oral antibiotics can precipitate a black, hairy tongue by altering the microflora of the oral mucosa.
- Taking bismuth subsalicylate (Pepto-Bismol) can induce it as well.
The dorsal surface of the tongue is blackened. The filiform papillae are long and dark in color.
If an oral antibiotic precipitated the condition, the condition may remit once the antibiotic is stopped. Increasing the frequency of brushing may help. Brushing the tongue after application of benzoyl peroxide 1-2%, papain (meat tenderizer) or tretinoin gel has been recommended.
For infants, no treatment is recommended as it usually remits spontaneously within a month or two.
Very rarely, black hairy tongue may occur in infants. Unfortunately, this cute baby would only show (for the camera) the edge which was white.
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