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.

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.

Diseases of the tongue.

The tongue is a complex organ involved in speech and expression as well as in gustation, mastication, and deglutition. The oral cavity, along with the tongue, are sites of neoplasms, reactive processes, and infections, and may be a harbinger of systemic diseases. This review includes both common and rare diseases that occur on the tongue, including: vascular and lymphatic lesions (infantile hemangiomas and oral varices), reactive and inflammatory processes (hairy tongue, pigmented fungiform papillae of the tongue, benign migratory glossitis, and fissured tongue), infections (oral hairy leukoplakia, herpes simplex and varicella-zoster virus infections, human papillomavirus, and candidiasis), premalignant lesions (leukoplakia and erythroplakia), malignant lesions (squamous cell carcinoma, Kaposi sarcoma, and lymphoproliferative diseases), and signs of systemic disease (nutritional deficiency and systemic amyloidosis).

Black hairy tongue syndrome.

Black hairy tongue (BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient's re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Complications of BHT (burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Prognosis is excellent with treatment of underlying medical conditions. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment.

Drug-induced black hairy tongue.

Black hairy tongue (BHT) is a benign, self-limiting disorder characterized by abnormally hypertrophied and elongated filiform papillae on the surface of the tongue. The prevalence of BHT is quite variable, ranging from 0-53.8% depending on the population. Many predisposing factors to BHT exist, and several drugs and drug classes have been implicated in causing this disorder. A modified Naranjo adverse drug reaction probability nomogram specific for BHT was used to rate causality for the available published case reports of drug-induced BHT. From the available data, antibiotics and drugs capable of inducing xerostomia are the drug classes that have modest evidence of causality and a rational mechanism. The presence of underlying predisposing factors in these cases along with the variable prevalence of BHT make drawing firm conclusions difficult. Treatment for BHT involves eliminating any predisposing issues and practicing scrupulous oral hygiene. Drug therapy and physical removal of the elongated filiform papillae are available for resistant cases. Clinicians should be aware of the prevalence, the predisposing factors and drug classes that may play a role in the development, and the treatment of BHT.