Black Hairy Tongue: NEJM
An 85-year-old male cigar smoker with no notable medical history presented with black discoloration and hairy appearance of the tongue, which had lasted for several years. He said he did not use bismuth-containing compounds. Black hairy tongue, also known as lingua villosa nigra, is a painless, benign disorder caused by defective desquamation and reactive hypertrophy of the filiform papillae of the tongue.

It is characterized clinically by an abnormal brownish-black coating of the dorsal surface of the tongue. The exact pathogenesis is unclear. A number of relevant etiologic factors have been assumed, including the use of topical or systemic antibiotics as well as psychotropic agents, dehydration, hyposalivation, trigeminal neuralgia, poor oral hygiene, smoking, ingestion of alcohol, and infections.

Symptoms may include nausea, halitosis, dysgeusia, and unattractive appearance of the tongue. Therapeutic options of modest benefit include increasing hydration and salivation, discontinuing smoking, brushing the tongue with a soft toothbrush enhanced by previous application of 40% urea, applying topical retinoids or salicylic acid, or undergoing surgical excision.

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