Oral cavity & oropharynx
Congenital anomalies
Hairy tongue


Topic Completed: 19 May 2020

Minor changes: 19 May 2020

Copyright: 2020, PathologyOutlines.com, Inc.

PubMed Search: Oral cavity hairy tongue[title]

Molly Housley Smith, D.M.D.
Page views in 2019: 122
Page views in 2020 to date: 109
Cite this page: Smith MH. Hairy tongue. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/oralcavityhairytongue.html. Accessed May 27th, 2020.
Definition / general
  • Benign condition of the dorsal tongue characterized by elongation and often staining of the filiform papilla, imparting a hairy appearance
Essential features
  • Marked elongation of the lingual filiform papillae
  • Hairy appearance of the dorsal tongue
  • Associated with cigarette use, electronic cigarette use, xerostomia, oxidizing mouthwashes, hyposalivation, radiation, older age, general debilitation, medication use, lack of coarse foods in diet and poor oral hygiene
Terminology
  • Oral hairy tongue
  • Black hairy tongue
  • Foliate papillae hypertrophy
  • Lingua villosa nigra
  • Melanoglossia
  • Similar to coated tongue
  • Not to be confused with oral hairy leukoplakia, an unrelated entity
ICD coding
  • ICD-10: K14.3 - hypertrophy of tongue papillae
Epidemiology
Sites
  • Dorsal tongue, often posterior midline area
Pathophysiology
  • Elongation of filiform papillae due to decreased sloughing or increased production of keratin
Etiology
  • Associated with cigarette use, electronic cigarette use, xerostomia, oxidizing mouthwashes, hyposalivation, radiation, older age, general debilitation, medication use, lack of coarse / crunchy foods in diet and poor oral hygiene (J Evid Based Dent Pract 2019;19:101318, World J Gastroenterol 2014;20:10845)
  • Associated medications include bismuth, penicillin, chlorpromazine, ranitidine, tetracycline, linezolid, olanzapine, interferon, prednisolone (Head Neck Pathol 2019;13:47)
  • Pigment often is caused by pigment producing bacteria or exogenous substances, such as food, medicines or tobacco
Clinical features
Diagnosis
  • Diagnosis is made clinically; biopsy is not necessary
Prognostic factors
  • Asymptomatic, although some patients may experience gagging sensation, malodor or foul taste
Case reports
Treatment
  • Treatment is not urgent or immediately necessary
  • Patients may seek treatment for foul breath, abnormal sensation
  • Includes tongue scraping / brushing, elimination of offending / contributing agents (e.g. tobacco, medications), addition of crunchy / coarse foods to diet and oral hygiene improvement (Head Neck Pathol 2019;13:47)
Clinical images

Contributed by Molly Housley Smith, D.M.D.
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Black hairy tongue

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Brown hairy tongue

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Yellow hairy tongue

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Molly Housley Smith, D.M.D.
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Hyperparakeratosis

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Superficial bacterial colonies

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Elongated filiform papilla

Molecular / cytogenetics description
  • Negative in situ hybridization for Epstein-Barr virus (EBER); there is no association with EBV
Sample pathology report
  • Dorsal tongue, incisional biopsy:
    • Hyperkeratosis and elongation of filiform papillae (see comment)
    • Comment: The histologic findings are compatible with hairy tongue.
Differential diagnosis
  • Coated tongue:
    • White, brown, black, yellow discoloration of the dorsal tongue without prominent elongation of the filiform papillae
  • Oral hairy leukoplakia:
    • Only included in differential diagnosis due to similarity of terminology
    • Most often presents as furrowed white plaques on lateral tongue
    • Associated with Epstein-Barr virus
    • Positive upon in situ hybridization with EBER
Board review style question #1

    Which of the following is true about hairy tongue, shown in the image?

  1. Hairy tongue is positive upon in situ hybridization for Epstein-Barr virus (EBER)
  2. Hairy tongue is strongly correlated with smoking and medication use
  3. Microscopic examination reveals eosinophilic condensation in a perinuclear arrangement in the superficial aspects of the epithelium
  4. Treatment varies based on the histologic grade
Board review answer #1
B. Hairy tongue is strongly correlated with smoking and medication use

Comment Here

Reference: Hairy tongue
Board review style question #2

    A tongue biopsy is shown. What is the diagnosis for this patient with marked elongation of the lingual filiform papillae and prominent superficial bacterial colonization?

  1. Acanthosis nigricans
  2. Hairy tongue
  3. Oral hairy leukoplakia
  4. White sponge nevus
Board review answer #2
B. Hairy tongue

Comment Here

Reference: Hairy tongue
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