Black Hairy Tongue

FIGURE 10-61 (see Color Plate)

Black hairy tongue is the result of hypertrophy of filiform papillae of the tongue, often seen in transplant patients after antibiotic treatment. The origin is unknown but is associated with topical or systemic antibiotics, poor oral hygiene, smoking, alcohol, and the use of mouthwashes. Most often there are no symptoms; however, nausea, gagging, taste alteration, or halitosis are reported by some patients. Treatment includes brushing with a soft brush and, occasionally, topical vitamin B, salicylic acid, gentian violet, or surgical removal. This entity is not to be confused with hairy leukoplakia, which is composed of white corrugated plaques on the lateral surface of the tongue. These lesions may be small and flat or extensive and hairy. Microscopic evaluation shows epithelial cells with herpetic viral inclusions, specifically Epstein-Barr virus. Treatment is oral acyclovir.

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