Hairy tongue is a relatively common condition of unknown etiology.The lesion involves the dorsum, particularly the middle and posterior one-third. Rarely are children affected. The papillae are elongated, sometimes markedly so, and have the appearance of hairs. The hyperplastic papillae then become pigmented by the colonization of chromogenic bacteria, which can impart a variety of colors ranging from green to brown to black. Various foods, particularly coffee and tea, probably contribute to the diffuse coloration.
Microscopically, the filiform papillae are extremely elongated and hyperplastic with keratosis. External colonization of the papillae by basophilic microbial colonies is a prominent feature. Otherwise, there are no pathologic findings in the remaining epithelium or in the connective tissue. The condition is so classic in its clinical presentation that biopsy is not required, and a clinical diagnosis is appropriate.
Treatment consists of having the patient brush the tongue and avoid tea and coffee for a few weeks. Since the cause is undetermined, the condition can recur.
Microscopically, the filiform papillae are extremely elongated and hyperplastic with keratosis. External colonization of the papillae by basophilic microbial colonies is a prominent feature. Otherwise, there are no pathologic findings in the remaining epithelium or in the connective tissue. The condition is so classic in its clinical presentation that biopsy is not required, and a clinical diagnosis is appropriate.
Treatment consists of having the patient brush the tongue and avoid tea and coffee for a few weeks. Since the cause is undetermined, the condition can recur.