Mysteriously Turning Black and Hairy: Tongue After Stroke

The dermatologists, led by Dr. Puravoor Jayasree, examined him and found out that he had a medical condition lingua villosa nigra commonly known as “black hairy tongue.” In that condition, the tongue turns black and would be covered by ‘hair’ like a carpet.

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Dr. Jayasree and her team said, “The patient and caregivers were given advice regarding proper cleansing measures, and the discolouration resolved after 20 days” in that journal.

Black Hairy Tongue

Small bumps on the surface of the tongue that form the appearance of black hair tongue or lingua villosa nigra occur when blocked by bacteria, one’s filiform papillae — tiny conical protrusions on the tongue containing taste buds — become enlarged and discolored due to a buildup of debris and bacteria. Papillae have taste buds and they peel off like skin, which is called desquamation. Usually, they are about 1 mm long, but if the tongue is not cleaned — if you eat food or brushing teeth — small nodules can continue to grow and reach 18 mm in length. Later, doctors explained that bacteria and yeasts grow on the tongue and cause discoloration, leading to the appearance of hair-like structures.

According to the authors, overlonged papillae appear to produce keratins, the same proteins found in the hair that contribute to the appearance of normal hair. Over time, the tongue turns black, white and yellow.

The doctors team said, “The dorsal aspect of his tongue showed a thick black coating that was yellowish toward the medial and proximal parts. The lateral borders, tip, and central part of median sulcus were spared. Dermoscopy results showed thin, elongated, black fibers that gave the appearance of a hairy surface. Amorphous yellowish deposits were visible peripherally. Mucosal scrapings from the lingual surface grew normal bacterial flora on culture. No fungal growth was isolated. With these findings, a diagnosis of black hairy tongue (BHT) was made.“

They also said that the yellowing was a result of pureed diet or trapped food that was scattered throughout the hairs. And they advised the patient and caregivers to follow proper cleansing measures, and the condition was restored after 20 days.

Causes of Black Hairy Tongue

Lingua villosa nigra is not harmful, but it is unpredictable. Although this condition is associated with poor oral health, it can also be caused by smoking, alcohol consumption, cocaine use, coffee, dehydration and certain medications, including antibiotics.

Black hairy tongue is commonly found in people who have difficulty eating or on a pureed diet. Therefore, heath experts advise people suffering from stroke to focus on oral hygiene to reduce such complications.

An estimated 13 percent of people develop black hairy tongue at some point in their life, although it is most common in adults over 40 years of age, according to the American Academy of Oral Medicine.

Source: Medindia