Dental News - Rare case of black hairy tongue reported

Dental Tribune International

Thu. 13. September 2018

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ST. LOUIS, U.S.: Black hairy tongue (BHT) refers to a condition of black or brown discoloration of the tongue due to elongated filiform papillae, giving the tongue a black and hairy appearance. Being so unusual, when a case does arise, it tweaks the interest of many health professionals. Recently, a 55-year-old woman was diagnosed with BHT, reportedly caused by antibiotics.

One of the interested practitioners in the case was Dr Yasir Hamad. Speaking to Dental Tribune International, Hamad said, “I am an infectious disease physician at Barnes-Jewish Hospital in St. Louis, Missouri. I happened to be covering the service on a Saturday in November 2018 when I got a call from the team taking care of the patient that her tongue has turned completely black. I reviewed her chart, and I suspected that minocycline was the culprit. I went to see her, and it was a dramatic finding.”

Known predisposing factors for BHT include poor oral hygiene, smoking, excessive coffee or black tea consumption, trigeminal neuralgia, general debilitation, xerostomia and medication use. According to a paper written by Hamad about the case, the patient had been in a severe car accident that had crushed both of her legs. When her wounds became infected, doctors put her on an intravenous drip containing minocycline. After a week on the medication, her tongue began to turn black.

Usually reversable, BHT has no long-term sequelae. In the case of the patient in question, the minocycline was discontinued, and an alternate antimicrobial regimen was started. The patient was then advised to practice good oral hygiene, and within four weeks, her tongue had returned to its normal color. For Hamad, it was his first such case. “Milder cases have been reported where the tongue becomes yellow or green in color, but I have never seen a black tongue like that before,” he explained.

The paper, titled “Black hairy tongue,” was published online on Sept. 6, 2018, in the New England Journal of Medicine.

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