Hairy Tongue Workup

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



As the finding of pigmentation in the oral cavity may represent systemic disease, normal physiologic pigmentation, medication-induced hyperpigmentation, or a localized neoplasm, a biopsy may be in order to help with diagnosis. [25] A simple biopsy and histologic examination may be helpful in distinguishing between similar-appearing conditions. In HIV patients, oral hairy leukoplakia may appear similarly to hairy tongue. A mucosal punch biopsy and appropriate immunostaining of the specimen for the presence of Epstein-Barr virus may differentiate the two conditions. However, mechanical debridement of suspected hairy tongue may be the most straightforward approach. [26]


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.