Black hairy tongue treated with traditional Chinese medicine: A case report.

RATIONALE: Black hairy tongue (BHT) is a rare condition that is conventionally managed by discontinuing associated medications or habits and practicing good oral hygiene, including tongue brushing. Previous studies have indicated that black tongue coating is often associated with gastrointestinal discomfort, which traditional Chinese medicine (TCM) could be a potentially effective option for treating this condition with minimal side effects. We present a case of BHT diagnosed and treated within 2 weeks by using TCM methods. PATIENT CONCERNS: A 73-year-old woman presented with a chief concern of a black tongue that had persisted for 2 weeks and was accompanied by thirst and diarrhea. These symptoms were initially observed during her hospitalization for the treatment of staghorn calculi, xanthogranulomatous pyelonephritis, and urosepsis. Using the "four diagnostic methods" of TCM, we observed that her tongue had a thick black coating surrounded by a thick white coating; her tongue was of medium size with tooth marks, and its body color was light red. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: On the basis of TCM theory, we made a clinical diagnosis of BHT and "spleen Qi deficiency with turbid dampness," which may have been caused by the antibiotic treatment during hospitalization. Subsequently, we administered a Chinese herbal medicine (CHM) formula comprising a combination of Wu-Ling-San () and a modification of Da-Yuan-Yin (). After 2 weeks of CHM treatment, the patient's BHT was nearly eliminated, and the thick white coating and the corresponding symptoms were ameliorated. After 4 weeks of CHM treatment, the BHT was completely resolved. LESSON AND CONCLUSION: We present a case of BHT, a benign condition that may be caused by antibiotics. The literature does not contain reports on TCM-based diagnosis and treatment strategies for BHT. Using the 4 diagnostic methods of TCM, we observed that BHT was associated with gastrointestinal symptoms, which is consistent with the TCM theory. Moreover, CHM treatment rapidly relieved BHT and related symptoms without adverse events.

Black Tongue Discoloration.

An 80-year-old man developed asymptomatic black discoloration of the dorsal surface of his tongue 1 week after hospitalization for surgical and antibiotic treatment of septic arthritis of the shoulder. He reported no prior lingual discoloration and did not smoke cigarettes, use chewing tobacco or illicit drugs, or drink alcohol. What is the diagnosis and what would you do next?

Case of Moxifloxacin-Induced Black Hairy Tongue.

BACKGROUND Black hairy tongue (BHT) is a relatively uncommon acquired benign condition, with a prevalence ranging from 0.6% to 11.3%. It presents as a superficial black hairy carpet-like lingual growth. The exact etiology of BHT remains unclear, and both extrinsic and intrinsic factors are potentially contributive. Several types of antibiotics are also associated with BHT, but no English reports of moxifloxacin-induced BHT exist. Here, we report the first case of moxifloxacin-induced BHT. CASE REPORT A 69-year-old woman presented with a brown and hairy tongue. She was taking prednisolone for mixed connective tissue disease and developed right finger flexor tenosynovitis, which was complicated by osteomyelitis due to Mycobacterium chelonae. Based on the susceptibility results, she was treated with tobramycin, imipenem, and clarithromycin for 6 weeks, and then switched to moxifloxacin and clarithromycin. Within 10 days, she developed brown discoloration on the dorsum of the tongue, with carpet-like elongated filiform lingual papillae. The diagnosis of BHT was made. After stopping moxifloxacin, improvement was seen within 2 days, and her right finger has shown no signs of recurrence for 12 months. CONCLUSIONS Clinicians should be vigilant against agents and lifestyles that can precipitate BHT, especially moxifloxacin. It is essential to counsel patients before such treatments to avoid patient anxiety or treatment changes.

A Case of Lingua Villosa Nigra (Black Hairy Tongue) in a 3-Month-Old Infant.

BACKGROUND Black hairy tongue is a self-limiting, usually asymptomatic, benign lesion that most often affects men and people aged over 30-40 years. The lesion is extremely rare among newborns and infants. Lingua villosa nigra is characterized by the presence of elongated filiform papillae of the dorsum of the tongue, which gives a hairy appearance. The overgrown papillae can accumulate fungi, bacteria, pigments originating from food, or any other debris that can contribute to the discoloration of the tongue. The prognosis for black hairy tongue is positive. Gentle tongue brushing or scraping as well as the elimination of predisposing factors usually leads to cessation of the lesion. CASE REPORT A generally healthy, exclusively breastfed 3-month-old female baby was admitted to the Oral Pathology Department of Wroclaw Medical University due to a persistent tongue lesion. Intraorally, dark, blackish, elongated tongue papillae were observed. Three weeks earlier, the baby's pediatrician had diagnosed thrush and prescribed systemic antifungal treatment with Nystatinum, without prior mycological examination. The lesion did not resolve and the girl was referred to the Department of Oral Pathology. A meticulous medical and dietary interview revealed that since the 28th day of life the baby had been supplemented with vitamin C. This, together with an intraoral examination, led to the diagnosis of black hairy tongue. The lesion disappeared partially after 4 weeks of tongue brushing. CONCLUSIONS To prevent infants from undergoing persistent and unnecessary treatment (topical or systemic drugs) or additional diagnostic procedures, such as biopsy, it is essential to be familiar with the characteristics of lingua villosa nigra as well as its origin and management. The consideration of this condition is invaluable for babies' health and safety.

Global health challenges in treating an elderly institutionalised patient: an oral medicine perspective.

A 64-year-old institutionalised woman presented to our clinic for the management of black hairy tongue. Despite the predictable outcome in treating this disease, this case presents multiple challenges such as the patients' cognitive impairment, her family dynamics, social factors and the health system as a whole, that makes it difficult to treat.

Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment.

Black hairy tongue (BHT) is a benign condition commonly found among people who smoke, have poor oral hygiene, are immunocompromised, or have a medical condition limiting their ability to practice good oral hygiene. Though this condition is harmless, patients need to be educated on etiology as many common medications are associated with this condition. Patients being placed on certain antibiotics or antipsychotics should be educated on the importance of good oral hygiene or cessation of habits that promote BHT. Similarly, those with medical conditions increasing the risk for the development of BHT should schedule routine visits with their dentist or dental hygienist. Prognosis is good, and treatment consists of gentle brushing of the tongue, but many anecdotal reports exist demonstrating the use of medications or other products to treat this condition. This review addresses the epidemiology, clinical presentation, pathophysiology, etiology, histology, differential diagnosis, and treatment of BHT and lists all of the medications reported to cause this condition.