Description

A 70 year old male presented with asymptomatic golden brown hairy surface over the dorsum of tongue for last 2 months. He is a chronic smoker with daily intake of 3-4 bidis since 7 years. On examination, there were elongated golden-brown filiform papillae over dorsum of the tongue with fibres directed backwards towards the midline (Figure 1). Paramedian sparing was noted with peripheral yellowish elongated papillae.

Dermoscopy shows elongated filiform papillae with color variations from pink to white and golden brown over a pinkish background resembling “sea anemone” (Figure 2).

Hairy Tongue (HT) can be brown, yellow, green, blue, or even unpigmented. It usually occurs due to secondary infection by Candida albicans or Bacillus subtilis varietas niger [1]. Normally less than 1 mm in length, the elongated papillae can reach a length of 12-18 mm and width of 2 mm [2].

Its closest differential is pseudo-hairy tongue. “Pseudo-hairy tongue” is darkly stained or coated tongue in the absence of elongated filiform papillae [3]. Dermoscopy plays a vital tool in differentiating hairy tongue from pseudo-hairy tongue.

References

1. Kumar Jha A, Vinay K, Sławińska M, Sonthalia S, Sobjanek M, et al. Application of mucous membrane dermoscopy (mucoscopy) in diagnostics of benign oral lesions-literature review and preliminary observations from International Dermoscopy Society study. Dermatol Ther. 2021; 34: e14478.
2. Pigatto PD, Spadari F, Meroni L, Guzzi G. Black hairy tongue associated with long-term oral erythromycin use. J Eur Acad Dermatol Venereol. 2008; 22: 1269-1270.
3. Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastroenterol. 2014; 20: 10845-50.