A 61-year-old nondiabetic man presents with recent-onset darkening of the surface of his tongue. He is currently taking an antihypertensive medication. In addition, he has been taking oral doxycycline for rosacea for the past 2 weeks. He denies taking over-the-counter bismuth-containing compounds and does not smoke. He states that his sense of taste is unaffected. Examination reveals a blackish velvety coating on his tongue’s dorsal surface. His lips and buccal mucosa are unaffected.
Black hairy tongue (lingua villosa nigra) is a benign, temporary condition readily diagnosed by its classic clinical appearance. The mid and posterior sections of the tongue manifest the greatest degree of darkening. Additional symptoms are uncommon. Contributing factors include cigarette smoking, coffee drinking, and the chewing of bismuth-containing medications. This case was temporally linked to antibiotic use, which alters the flora of the filiform papillae and results in the black pigmentation. Twice-daily brushing of the teeth and tongue is usually curative.
Dr. Schleicher is director of DermDOX Center in Hazleton, Pennsylvania, a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine and Kings College in Wilkes-Barre, Pennsylvania, and an associate professor of medicine at the Commonwealth Medical School in Scranton, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
