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World J Gastroenterol. Aug 21, 2014; 20(31): 10845-10850
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10845
Black hairy tongue syndrome
Grigoriy E Gurvits, Amy Tan
Grigoriy E Gurvits, Department of Gastroenterology, New York University School of Medicine/Langone Medical Center, New York, NY 10016, United States
Amy Tan, New York University School of Medicine, New York, NY 10016, United States
Author contributions: Gurvits GE and Tan A contributed equally to this work.
Correspondence to: Grigoriy E Gurvits, MD, Department of Gastroenterology, New York University School of Medicine/Langone Medical Center, 530 First Avenue, SKI-9N, New York, NY 10016, United States.
Telephone: +1-212-2633095 Fax: +1-212-2633096
Received: January 25, 2014
Revised: March 8, 2014
Accepted: April 27, 2014
Published online: August 21, 2014

Black hairy tongue (BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient’s re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Complications of BHT (burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Prognosis is excellent with treatment of underlying medical conditions. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment.

Keywords: Black hairy tongue, Hyperkeratosis of the tongue, Lingua villosa nigra

Core tip: Classic descriptors and latest developments in Black Hairy Tongue syndrome. Epidemiology, pathophysiology, etiology, clinical presentation, differential diagnoses, management, complications, and prognosis of Black Hairy Tongue syndrome. First comprehensive review of the syndrome.