Black Hairy Tongue (Lingua Villosa Nigra)

This is an answer to the Case – Black Discoloration of the Tongue

An 85-year-old male cigar smoker with no notable medical history presented with black discoloration and hairy appearance of the tongue, which had lasted for several years. He said he did not use bismuth-containing compounds.

Black hairy tongue, also known as lingua villosa nigra, is a painless, benign disorder caused by defective desquamation and reactive hypertrophy of the filiform papillae of the tongue. It is characterized clinically by an abnormal brownish-black coating of the dorsal surface of the tongue.

Etiology of Black Hairy Tongue

The exact pathogenesis is unclear. A number of relevant etiologic factors have been assumed, including:

  • topical or systemic antibiotics
  • psychotropic agents
  • dehydration
  • hyposalivation
  • trigeminal neuralgia
  • poor oral hygiene
  • smoking
  • ingestion of alcohol
  • infections

Symptoms of Black Hairy Tongue

Symptoms may include:

  • nausea
  • halitosis (bad breath)
  • dysgeusia
  • unattractive appearance of the tongue.

Therapy for Black Hairy Tongue

Therapeutic options of modest benefit include:

  • increasing hydration and salivation
  • discontinuing smoking
  • brushing the tongue with a soft toothbrush enhanced by previous application of 40 percent urea
  • applying topical retinoids or salicylic acid
  • undergoing surgical excision