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Hairy Tongue Medication

  • Author: Gary L Stafford, DMD; Chief Editor: William D James, MD  more...
 
Updated: Oct 22, 2015
 

Medication Summary

In most cases, the treatment of hairy tongue does not require pharmacologic intervention. If Candida albicans is present, topical antifungal medications can be used when the condition is symptomatic (eg, glossopyrosis). Topical application of retinoids has been used with some success.[18, 19] Keratolytic agents are effective but may be irritating. Although reportedly successful, the agents listed above (with the exception of treatment of oral candidiasis) are used off label and their application should be limited to selected cases with close monitoring.

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Antifungal agents

Class Summary

These agents are used to treat oral candidiasis in association with hairy tongue.

Clotrimazole (Mycelex)

 

Clotrimazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Reevaluate the diagnosis if no clinical improvement occurs after 2 weeks. Clotrimazole is effective in the treatment of oral candidiasis; however, it has some drawbacks. It has a high sugar content and peppermint flavor to mask the bitter taste of clotrimazole. The high sugar content makes it relatively contraindicated in persons with diabetes. The dosing regimen occasionally results in poor patient compliance; nevertheless, it is an effective medication to treat oral candidiasis and is especially efficacious in treating candidal infections on the dorsal surface of the tongue.

Nystatin (Mycostatin)

 

Nystatin is a fungicidal and fungistatic antibiotic obtained from Streptomyces noursei. It is effective against various yeasts and yeastlike fungi. Nystatin changes the permeability of the fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Treatment should continue until 48 hours after the disappearance of symptoms. Nystatin is not significantly absorbed from the GI tract.

It is effective for treating oral candidiasis; however, it has some drawbacks. It has a high sugar content and licorice flavor to mask the bitter taste of nystatin. The high sugar content makes it relatively contraindicated in persons with diabetes. Some patients have an aversion to licorice flavoring. The dosing regimen occasionally results in poor patient compliance; nevertheless, it is an effective medication to treat oral candidiasis and is especially efficacious in treating candidal infections on the dorsal surface of the tongue.

Ketoconazole (Nizoral)

 

Ketoconazole has fungistatic activity. It is an imidazole broad-spectrum antifungal agent. It inhibits the synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death. It is effective in treating oral candidiasis, especially when patients do not comply with multidosing topical therapies or are unable to tolerate sugar-containing troches and pastilles. Take ketoconazole with food.

Fluconazole (Diflucan)

 

Fluconazole has fungistatic activity. It is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol, thereby disrupting cellular membranes. Fluconazole is effective in treating oral candidiasis, especially when patients do not comply with multidosing topical therapies or are unable to tolerate sugar-containing troches and pastilles. Fluconazole is normally prescribed in situations in which other topical or systemic medications have not been successful. It is especially useful in treating oral candidiasis in patients who are immunosuppressed.

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Contributor Information and Disclosures
Author

Gary L Stafford, DMD Assistant Professor and Chair, Department of General Dental Sciences, Marquette University School of Dentistry

Gary L Stafford, DMD is a member of the following medical societies: International Association for Dental Research, American Association for Dental Research, American Dental Education Association, Milwaukee Odontological Academy, The Dental Forum, National Dental Practice-Based Research Network, American College of Dentists, Greater Milwaukee Dental Association, Wisconsin Dental Association, Consortium of Operative Dentistry Educators, Pierre Fauchard Academy, Chicago Dental Society, Illinois State Dental Society, Association for Continuing Dental Education

Disclosure: Nothing to disclose.

Coauthor(s)

Denis P Lynch, DDS, PhD Professor of Oral and Maxillofacial Pathology, Associate Dean for Academic Affairs, Office of the Dean, Marquette University School of Dentistry

Denis P Lynch, DDS, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association, International Association for Dental Research, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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Brown hairy tongue in a middle-aged woman who drinks coffee. Note how the condition is limited to the mid-dorsal part of the tongue, becoming more prominent toward the posterior part.
Brown hairy tongue in a middle-aged man who smokes cigarettes. The condition is limited to the posterior two thirds of the dorsal surface of the tongue.
Close-up view of brown hairy tongue in a middle-aged man who smokes cigarettes. The condition is limited to the posterior two thirds of the dorsal surface of the tongue.
This patient is a middle-aged woman who drank coffee and smoked cigarettes for many years. Her chief complaint was a tickling sensation in the oral pharynx during swallowing. The slight greenish cast to her tongue was due to the use of a mouthwash immediately prior to her appointment.
This male geriatric patient had smoked a pipe for many years. He was unaware of the presence of his hairy tongue until it was brought to his attention during a routine dental examination.
Male geriatric patient had smoked a pipe for many years. He was unaware of the presence of his hairy tongue until it was brought to his attention during a routine dental examination. Photo 1 month following his initial examination. While he has not decreased his pipe smoking, he has gently brushed the dorsal surface of his tongue when he brushes his teeth during the intervening 4 weeks. The hairy tongue has completely resolved.
Middle-aged woman with a hairy tongue that is brown.
 
 
 
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