An Infant With Black Hairy tongue!

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Black hairy tongue
Infant's black hairy tongue

A 2-month-old baby girl presented with black hairy tongue- a rare presentation of Lingua villosa nigra

Parents brought their 2-month-old baby girl for routine pediatric consultation. They complained that she seems to have a black hairy tongue or dark discoloration of the tongue for the past 2 weeks. The discolouration was painless.

The baby was born at full term and the mother had no prenatal complications. However, after the birth, from one month onwards, the baby had gastroesophageal reflux and colic. The doctors had prescribed probiotics. The mother exclusively breastfed her and the baby’s weight gain was steady in the 85th percentile. Additionally, she was taking cholecalciferol.

History remained unremarkable and the patient had no significant family history or risk factors.

On presentation, apart from the discoloured tongue, the baby had no other symptoms. Moreover, the physical examination was also unremarkable except for the irregular-shaped black hairy lesion on the dorsal posterior two-thirds of the tongue.

The doctors started the baby on topical antifungal, but even after 2 weeks, the lesion showed no improvement, excluding moniliasis. The doctors advised the mother to gently brush the tongue two times a day. the lesion resolved completely after two weeks.

Lingua villosa nigra:

Black hairy tongue or Lingua villosa nigra is a rare presentation in infants. Mostly the affected patients are adults over the age of 40 years with any of the predisposing factors, including tobacco use/ smoking, alcohol, heavy coffee or black tea consumption, poor oral hygiene, cocaine, chlorhexidine or peroxidase-containing mouthwash. Coffee, dry mouth/dehydration, and radiation therapy. Additionally, some medications are also associated with, for example, linezolid, olanzapine, penicillin, erythromycin, tetracycline, doxycycline, lansoprazole, bismuth, and erlotinib.

Usually, the affected patients present with painless, asymptomatic, discoloured lesion on the tongue due to aesthetic concerns. However, some patients may complain of associated nausea, bad breath (halitosis), burning or tickling sensation in the lesion.

Although the exact pathophysiology still remains unknown, a hypothesis is that there is defective desquamation of the dorsal tongue epithelium. Consequently, normal debridement doesn’t occur and the keratinized layers accumulate. In other words, the lesion is due to hypertrophied and elongated (12-18 mm in length, as opposed to the normal 1mm) keratinized filiform lingual papilla. The papillae give a hairy appearance, hence the name.  

The condition is self-limited. In adults, it is imperative to identify and eliminate the cause- for example, stop the offending drug. The doctors should reassure the patients, and in this case, the parents. Moreover, they should educate and advise the patients/parents to gently debride the tongue. In some cases, topical antifungals or topical retinoids may help.

Reference:

Almeida TL, Fontes D (2021) Infant’s Black Hairy Tongue (Lingua Villosa Nigra). Clin Med Img Lib 6:161. doi.org/10.23937/2474-3682/1510161

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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