Hairy Tongue Medication

  • Author: Denis P Lynch, DDS, PhD; Chief Editor: William D James, MD   more...
 
Updated: Jan 17, 2012
 

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. 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.

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Clotrimazole (Mycelex)

 

Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Reevaluate diagnosis if no clinical improvement after 2 wk. Effective in the treatment of oral candidiasis; however, it has some drawbacks. Has high sugar content and peppermint flavor to mask the bitter taste of clotrimazole. High sugar content makes it relatively contraindicated in persons with diabetes. 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.

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Nystatin (Mycostatin)

 

Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei. Effective against various yeasts and yeastlike fungi. Changes permeability of fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Treatment should continue until 48 h after disappearance of symptoms. Drug is not significantly absorbed from GI tract.

Effective to treat oral candidiasis; however, it has some drawbacks. Has high sugar content and licorice flavor to mask the bitter taste of nystatin. High sugar content makes it relatively contraindicated in persons with diabetes. Some patients have an aversion to licorice flavoring. 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.

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Ketoconazole (Nizoral)

 

Fungistatic activity. Imidazole broad-spectrum antifungal agent. Inhibits synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death. 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 with food.

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Fluconazole (Diflucan)

 

Fungistatic activity. 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. 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. Normally prescribed in situations where other topical or systemic medications have not been successful. Especially useful in treating oral candidiasis in patients who are immunosuppressed.

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Contributor Information and Disclosures
Author

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, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernice R Krafchik, MBChB, FRCPC  Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto

Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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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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