THE CLINICAL PICTURE FÁTIMA TOUS-ROMERO, MD SARA BURILLO-MARTÍNEZ, MD MARTA PRIETO-BARRIOS, MD LIDIA MAROÑAS-JIMÉNEZ, MD Department of Dermatology, Department of Dermatology, Department of Dermatology, Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain Hospital 12 de Octubre, Madrid, Spain Hospital 12 de Octubre, Madrid, Spain Hospital 12 de Octubre, Madrid, Spain

Black hairy cured concurrently with respiratory infection

Proposed causes include medications, FIGURE 2. The condition had resolved hyposalivation, 1 week later. poor oral hygiene, FIGURE 1. At presentation, were note, during her 1-week hospital stay, she was spread across the dorsum of the tongue. treated with levofl oxacin for the respiratory smoking, infection, and she did not smoke during this and infection period. One week after her admission, the le- 54-year-old female smoker was admit- sions had disappeared (Figure 2). A ted to the hospital for fever and respira- tory infection. On the day of admission, she ■ LINGUA VILLOSA NIGRA reported lesions of the for the past (lingua villosa nigra) is a several months. She denied taking any medi- rare but benign condition caused by defec- cations recently. tive desquamation and reactive hypertrophy Physical examination showed brownish of the fi liform papillae of the tongue. Causes papillary lesions spread across the dorsum of that have been proposed include medications, the tongue; the lesions were a darker shade hyposalivation, poor oral hygiene, oxidizing proximally (Figure 1), leading to the diagno- mouthwashes (eg, hydrogen peroxide), alco- sis of black hairy tongue. Hygienic measures hol, smoking, and infection.1 were recommended, with other treatment op- The differential diagnosis includes acan- tions to be considered later, if necessary. Of thosis nigricans, oral hairy , oral doi:10.3949/ccjm.84a.16044 candidiasis, pigmented fungiform papillae, Ad-

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dison disease, and black staining over a normal with hygienic measures and smoking cessation, tongue from bismuth or food colorings. we could not completely rule out the contri- bution of antibiotics given for the respiratory ■ DIAGNOSIS AND TREATMENT infection. It is important to keep this disease Visual inspection and a detailed history are of- in mind to avoid unnecessary tests and to ap- ten suffi cient for diagnosis. The optimal treat- ply the most appropriate treatment according ment is unclear, but the condition can improve to the patient’s symptoms. ■ with hygienic measures alone, topical or oral retinoids,2 topical triamcinolone acetonide, ■ REFERENCES salicylic acid, vitamin B complex, or antifun- 1. Nakajima M, Mizooka M, Tazuma S. Black hairy tongue gals. There are isolated cases in the literature treated with oral antibiotics: a case report. J Am Geriatr in which improvement occurred with antibi- Soc 2015; 63:412–413. otics, but their role is unclear.1 Rarely, surgical 2. Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastroenterol 2014; 20:10845–10850. excision of the fi lliform papilla in black hairy 3. Stringer LL, Zitella L. Hyperpigmentation of the tongue. J tongue has been done for symptomatic relief Adv Pract Oncol 2014; 5:71–72. and cosmetic purposes.3 ADDRESS: Fátima Tous-Romero, MD, Department of Derma- While our patient presented with typical tology, Hospital 12 de Octubre, Avda de Córdoba s/n, 28041 features of black hairy tongue, which resolved Madrid, Spain; [email protected]

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