eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa
Hairy Tongue: Treatment & Medication
Updated: Jun 25, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
The treatment of hairy tongue is variable. In many cases, simply brushing the tongue with a toothbrush or using a commercially available tongue scraper is sufficient to remove elongated filiform papillae and retard the growth of additional ones.5
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.
The same patient as in Image 5 one 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.
Surgical Care
Surgical removal of the papillae by using electrodesiccation, carbon dioxide laser, or even scissors is the treatment of last resort when less complicated therapies prove ineffective.
Consultations
Consultation with or referral to a general dentist may be indicated if the etiology of a patient's hairy tongue appears to be primarily one of poor oral hygiene.
Diet
Patients who are on a continuous soft diet occasionally develop hairy tongue because the consistency of the diet does nothing to mechanically debride the dorsal surface of the tongue during eating and swallowing. If adding more roughage to the patient's diet is not feasible, encourage the patient to cleanse the dorsal surface of the tongue daily by brushing or scraping.
Medication
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.
Antifungal agents
These agents are used to treat oral candidiasis in association with hairy tongue.
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.
Adult
10 mg troche dissolved in mouth 5 times/d for 2 wk; do not eat or drink for 30 min after treatment
Pediatric
Not established
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Not for treatment of systemic fungal infections; avoid contact with the eyes; discontinue use and institute appropriate therapy if irritation or sensitivity develops; caution in persons with diabetes because of high sugar content of troche; dental carries may occur in individuals who are prone; patients with xerostomia may not be able to dissolve troches
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.
Adult
200,000-400,000 U pastilles dissolved in mouth q4h for 2 wk; do not eat or drink for 30 min after treatment
Pediatric
Not established
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use to treat systemic mycoses; caution in persons with diabetes because of high sugar content of pastille; dental carries may occur in individuals who are prone; patients with xerostomia may not be able to dissolve troches
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.
Adult
200 mg PO qd for 2 wk
Pediatric
Not established
Isoniazid may decrease bioavailability; coadministration decreases effects of either rifampin or ketoconazole; may increase effect of anticoagulants; may increase toxicity of corticosteroids and cyclosporine (cyclosporine dosage can be adjusted); may decrease theophylline levels
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hepatotoxicity may occur; may reversibly decrease corticosteroid serum levels (adverse effects avoided with dose of 200-400 mg/d); administer antacid, anticholinergics, or H2-blockers at least 2 h after ketoconazole
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.
Adult
150 mg PO once or 400 mg qd, depending on severity of infection
Pediatric
Not established
Levels may increase with hydrochlorothiazide; levels may decrease with chronic coadministration of rifampin; coadministration may decrease phenytoin clearance; may increase concentrations of theophylline, tolbutamide, glyburide, and glipizide; effects of anticoagulants may increase with coadministration; increases in cyclosporine concentrations may occur when administered concurrently
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose for renal insufficiency; monitor closely if rash develops and discontinue drug if lesions progress; may cause clinical hepatitis, cholestasis, and fulminant hepatic failure (including death) with underlying medical conditions (eg, AIDS, malignancy) or while taking multiple concomitant medications; not recommended in breastfeeding
More on Hairy Tongue |
| Overview: Hairy Tongue |
| Differential Diagnoses & Workup: Hairy Tongue |
 Treatment & Medication: Hairy Tongue |
| Follow-up: Hairy Tongue |
| Multimedia: Hairy Tongue |
| References |
| Further Reading |
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References
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[Guideline] New York State Department of Health. Oral health management of children and adolescents with HIV infections. New York State Department of Health. Jun 2004.
[Guideline] Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Infectious Diseases Society of America. Mar 2009.
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Further Reading
Clinical guidelines
Oral health management of children and adolescents with HIV infections. 6
New York State Department of Health - State/Local Government Agency [U.S.]. 2003 (revised 2004 Jun). 9 pages. NGC:003891
Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. 7
Infectious Diseases Society of America - Medical Specialty Society. 2004 Jan 15 (revised 2009 Mar 1). 33 pages. NGC:007081
Nursing management of oral hygiene. 8
Singapore Ministry of Health - National Government Agency [Non-U.S.]. 2004 Dec. 33 pages. NGC:004285
Clinical Trials
Neurogenic Mechanisms in Burning Mouth Syndrome
Prevention of Oral Malodor With an Oral Sticker Containing Herbal Formula
Related eMedicine topics
Hairy Leukoplakia
Chemotherapy-Induced Oral Mucositis
Oral Examination
Oral Manifestations of Systemic Diseases
Oral Frictional Hyperkeratosis
Keywords
lingua nigra, lingua villosa, lingua villosa nigra, black hairy tongue, defective desquamation of the filiform papillae, poor oral hygiene, therapeutic radiation, glossopyrosis, burning tongue, Candida albicans, halitosis, hypertrophy of filiform papillae, tobacco use, coffee drinking, tea drinking
