Hair tongue black K14.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Black hair tongue; Black hairy tongue; Hairy tongue; lingua nigra pilosa; lingua villosa nigra; Trichoglossia

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Dense, mat-like meshes of filamentous, hyperkeratotic, hypertrophic Papillae filiformes of the tongue surface.

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The prevalence data vary between 0-50% depending on the collective and size.

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The causes are not known with certainty. Probably a temporary imbalance is the cause of normal oral microbial colonization. Pathogenetically, the discolouration is caused by pigment-forming bacteria, detritus and storage of exogenous pigments from tobacco smoke and stained food. Candida albicans is frequently detected. However, the etiopathogenetic role remains unclear.

The black hair tongue can be observed after:

  • prolonged systemic antibiotic administration
  • Stem cell transplantation
  • long-term therapy with systemic glucocorticoids
  • keratoplastic, chemical stimuli (smoking, spicy mouthwashes, chlorhexidine, sodium perborate, H2O2)
  • continuous parenteral nutrition.

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Especially median posterior and middle areas of the tongue are affected.

Clinical features
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Usually in the rear and middle tongue sections beginning, partly also the entire tongue surface seizing, flat, blackish or brown-blackish, turf-like hairs of the tongue with up to 2 cm long, up to 0.2 cm thick, hair-like excrescences. Subjective complaints are usually absent.

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Lengthened, hyperplastic, cornified papillae filiformes.

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Focus search, mycological and bacterial smear.

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  • Smoking ban, elimination of other irritating factors. With vitamin C lozenges (e.g. Cebion 500, 1-2 tbl/day) the protein coating on the tongue can be precipitated and then brushed off with a soft toothbrush. Protein precipitation is also possible with 1-2% hydrogen peroxide R280 (do not swallow the solution!)
  • Careful oral hygiene: Rinse with stomatological products such as camomile extract (e.g. Kamillosan) or dexpanthenol solution(Bepanthen, R066 ). Dental hygiene.
  • Stop taking any medication that may cause the disease.
  • If there is a nicotinic acid deficiency: balanced protein-rich diet, if necessary oral substitution of nicotinamide (e.g. Nicotinamide 200 Jenapharm) 200 mg/day.
  • In the case of candidiasis, antimycotic therapy, see below Candidosis of the oral mucosa.

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  1. Arab JP et al (2015) Black hairy tongue during interferontherapy for hepatitis C. Ann Hepatol 14:414-415
  2. Chakraborty PP et al (2013) Black hairy tongue (lingua villosa nigra). J AssocPhysicians India 61:908
  3. Khasawneh FA et al (2013) Linezolid-induced black hairy tongue: a casereport. J Med Case Rep 7:46
  4. Nisa L et al. (2011) Black hairy tongue. On J Med 124:816-817
  5. Luo Y et al (2010) Black hairy tongue associated with all peripheral blood hematopoietic stem cell transplantation. Chin Med J 123:1807-1808
  6. Thompson DF et al (2010) Drug-induced black hairy tongue. Pharmacotherapy 30: 585-593


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020