Hairy Tongue Medication

Updated: Feb 20, 2020
  • Author: Marc Zachary Handler, MD; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Medication

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. [31, 32] 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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