Page 8 - GP Fall 2022_Neat

hyperkeratosis of the tips and extension of teria, most likely caused by alteration in discolored hairy tongue, very gentle brush-
the papillae, reaching lengths of 12 mm to the normal mouth flora as a consequence of ing can decrease the length of the filiform
18 mm and widths of more than 2 mm, re- the antibiotics. It involves the side or tip of papillae, making it less likely that they will
sulting in an appearance of a hairy surface. the tongue. A “fake” Black Hairy Tongue remain stained or discolored. A tongue
In comparison, normal filiform papillae can occur when a patient drinks an antacid scraper can be used, however vigorous
measure less than 1 mm. containing bismuth or bismuth subsalicy- scraping may lead to an increased growth
late (Pepto-Bismol), which will temporar- of the filiform papillae and increased stain-
Etiology: Black Hairy Tongue is a true ily turn the filiform papillae black, but they ing since the filiform papillae are com-
black discoloration of the filiform papil- will return to normal color with gentile posed of keratin which can easily stain. A
lae. True black hairy tongue must be dis- brushing (Figures 8-10). toothbrush or a tongue scraper, if gently
tinguished from “hairy tongue” in which used, will decrease
there is typically a brownish-black discol- the length of the fili-
oration of the tongue without the exagger- form papillae and
ated elongation and black discoloration of remove the discol-
the filiform papillae. Black hairy tongue is oration within a few
usually limited to the dorsum of the tongue. days. The differential
Its etiology remains unclear and is likely diagnosis includes a
multifactorial, resulting from a combina- normal tongue that
tion of local and systemic insults. The pal- has been stained
ette appearance of the hairy tongue likely Figures 8-10. Black black by food or bis-
originates from differences in potentially Hairy Tongue. muth ingestion, oral
contributing extrinsic (environmental) and hairy leukoplakia,
intrinsic (chromogenic oral microflora) Age/Sex/Race: Hairy Tongue prevalence pigmented filiform papillae of the tongue,
predisposing factors. Oral antibiotics is one has been reported as high as 3.4% of the and acanthosis nigricans.
major factor for black hairy tongue. How- population. Age/sex/race are not relevant.
ever, black hairy tongue can be an indica- Herpes Simplex Virus vs. Aphthous Ulcers
tion of other serious conditions. Antibacte- Treatment: No treatment is required for
rial treatment alters the natural flora of the hairy tongue, but gentle daily debridement Herpes Simplex Virus (Herpes Labialis,
intestine, which in some cases can lead to with a tongue scraper or soft toothbrush Herpes Recurrans)
overgrowth of Clostridoides difficile. C. can remove keratinized tissue. Most pa-
difficile associated diarrhea can occur with tients with hairy tongue are asymptomatic Etiology: Herpes labialis and herpes re-
the use of nearly all antibacterial agents. and visits to the dentist or physician are due currans (herpes on the attached keratinized
C. difficile infection is a major cause of to aesthetic concerns. One significant con- mucosa) are due to reactivation of latent
morbidity and mortality, with a recent in- cern, however, is with a patient developing herpes simplex virus 1 (HSV1), which lays
crease in the number of adult and pediatric true Black Hairy Tongue following the use dormant in the trigeminal root ganglion fol-
patients affected globally. of antibiotics. The patient may have devel- lowing initial exposure to the herpes virus.
oped C. difficile and should be evaluated HSV1 is one of eight known human herpes
Clinical: Hairy Tongue is the result of by their physician to determine if they need viruses. HSV1, HSV2, and VZV are alpha
accumulation of excess keratin on the fili- to have intestinal flora reintroduced. herpes viruses. The alpha herpes viruses
form papillae of the dorsal tongue, which are neurotropic, meaning that following
leads to the formation of elongated strands Hairy Tongue vs. Black Hairy Tongue initial exposure to the virus, the virus re-
that resemble hair. The color of the tongue Comparison sides permanently within nerve tissue in a
can range from white or tan to brown to dormant or latent phase.
red to blue. This occurs most commonly In evaluating a patient for hairy tongue vs.
in smokers and in persons with poor oral black hairy tongue, the most important cri- Age/Sex/Race: Exposure to HSV1 pres-
hygiene (Figures 6, 7). A true Black Hairy teria is to rule out the possibility of the pa- ents in a biphasic pattern, most occurring
Tongue may also develop following anti- tient developing C. difficile and the poten- in early childhood with a second peak in
biotic treatment, typically penicillin, tetra- tial for a fatal condition developing due to the late teens and early twenties. Less than
cycline or any broad-spectrum antibiotics. the patient using broad spectrum antibiot- 10% of those exposed to the virus will de-
The black pigment represents porphyrins, ics and destroying their gut bacteria. Black velop primary herpetic gingivostomatitis,
which are metabolic products of oral bac- hairy tongue which develops secondary to while most will have a subacute infection
the patient using Pepto Bismol can be treat- which is not clinically evident. Following
ed as if it were hairy tongue which is dis- initial exposure, the virion travels to either
colored due to other secondary factors. It is the trigeminal root ganglion or cervical
common to see brown hairy tongue from ganglia, where it remains dormant until it is
smokers, coffee and tea drinkers and other reactivated. Race and sex are not relevant.
colored tongues secondary to sucking on
hard candies of differing colors. Patients Clinical: Stages of recurrent herpetic le-
with true black hairy tongue need to be re- sions begin with the prodromal or initial
ferred to their physician where they may be stage, which may present with burning,
hospitalized or given frozen pills of fecal tingling, itching, and swelling. Next is the
material which will reintroduce normal vesicular stage, which involves the devel-
Figures 6 and 7. Hairy Tongue. flora to the patient’s gut. In patients with opment of numerous small thin-walled

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