Hairy tongue

Abstract

A 55-year-old man developed a new, hair-like coating on his tongue after a month in the intensive care unit (ICU) with Guillain-Barré syndrome. He had been intubated for 11 days and had had a tracheostomy. Aside from distress about the appearance of his tongue, he was concerned about a decreased sense of taste. The patient had no other oral complaints. He had a 30 pack-year history of smoking. During his stay in the ICU, he received piperacillin-tazobactam, trimethoprim-sulfamethoxazole, ciprofloxacin and quetiapine. The patient's management team initially diagnosed oral candidiasis and treated him with several courses of oral nystatin and systemic fluconazole. Nonresponse to antifungal medications, combined with a typical clinical appearance and history, led us to diagnose hairy tongue (Figure 1).Hairy tongue is a benign condition resulting from elongation of the filiform papillae because of keratin build up. This can result from inadequate exfoliation (e.g., from decreased oral intake, poor oral hygiene or dry mouth related to anticholinergic drugs) and accelerated keratinization (as may occur with irritation from smoking). 1 Hairy tongue appears as a hairy coating on the tongue's dorsum, sparing the tip and lateral borders. 2 The colour ranges from cream to brown to black, depending on extrinsic factors, such as diet and smoking, and intrinsic factors, such as chromogenic bacteria and fungi). 1,3 Hairy tongue is usually asymptomatic. While the diagnosis is clinical, tongue biopsy may rarely be required to clarify the diagnosis if the lesion does not respond to conservative management. 1 As with our patient, hairy tongue is frequently confused with pseudomembranous candidiasis and treated ineffectively with antifungal therapy. 3 The management of hairy tongue consists primarily of gentle débridement with a soft-bristled brush along with reassurance. 1 Aggravating agents should be discontinued, and risk factors modified where possible. Hairy tongue often resolves spontaneously.We think our patient's hairy tongue was caused by a prolonged period of limited oral intake, xerostomia related to the anticholinergic effects of quetiapine and a change in oral flora from various courses of antimicrobials. The patient's tongue improved substantially after 2 months.

Assessment of the Possible Correlation between the Presence of Helicobacter Pylori Infection and Hairy Tongue Lesion in a Group of Patients in Syria: A Cross-Sectional and Pilot Study

“…Furthermore, the color of the middle of the tongue body indicates acute changes in the gastric mucosa and is a useful noninvasive screening tool for erosive gastritis [6]. A hairy tongue is one of these lesions caused by a lack of adequate desquamation of keratin over the filiform papillae [7]. The discoloration is caused by porphyrin-producing chromogenic bacteria or yeast [8].…”

“…Xing Se Joan Mo stated that "the tongue coating is shaped via way of means of the stomach". In clinical studies, researchers have mentioned that the tongue frame modifies slowly with the improvement of chronic gastritis, but the tongue coating changes rapidly and obviously [7]. Observing the researched tongue-coating metabolic markers and the composition of microorganisms in persistent gastritis sufferers helps to determine whether there is any relationship between tongue diagnosis (noninvasive detection) and metabolic processes or microorganisms [5].…”