Hairy Tongue Workup

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

Laboratory Studies

  • Culture of the tongue's dorsal surface may be taken if a superimposed oral candidiasis or other specific oral infection is suspected.
  • Cytologic smears stained with Gram stain or periodic acid-Schiff stain may reveal candidal organisms.
  • Potassium hydroxide preparations are useful for rapid diagnosis of oral candidiasis, as are latex agglutination-based card tests (eg, CandidaSure).
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Procedures

  • Distinguishing between oral hairy leukoplakia and hairy tongue is important if patients are found or suspected to be HIV positive. This can be accomplished by a simple mucosal punch biopsy and appropriate immunostaining of the specimen for the presence of Epstein-Barr virus, the causative agent of oral hairy leukoplakia. However, in most cases, the diagnosis is made retrospectively on the basis of the clinical response to mechanical debridement.[6]
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Histologic Findings

Histopathologic findings in hairy tongue consist of elongated filiform papillae, with mild hyperkeratosis and occasional inflammatory cells. Finding accumulated debris intermingled among the papillae and candidal pseudohyphae is not unusual. No other specific microscopic findings are associated with this entity.

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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

References

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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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