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Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment


Black hairy tongue (BHT) is a benign condition commonly found among people who smoke, have poor oral hygiene, are immunocompromised, or have a medical condition limiting their ability to practice good oral hygiene. Though this condition is harmless, patients need to be educated on etiology as many common medications are associated with this condition. Patients being placed on certain antibiotics or antipsychotics should be educated on the importance of good oral hygiene or cessation of habits that promote BHT. Similarly, those with medical conditions increasing the risk for the development of BHT should schedule routine visits with their dentist or dental hygienist. Prognosis is good, and treatment consists of gentle brushing of the tongue, but many anecdotal reports exist demonstrating the use of medications or other products to treat this condition. This review addresses the epidemiology, clinical presentation, pathophysiology, etiology, histology, differential diagnosis, and treatment of BHT and lists all of the medications reported to cause this condition.

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The authors thank Eric Ehrsam, MD, who is a dermatologist in Lille, France, for his contribution of the pictures in Figs. 1, 2, 3. We would also like to thank Dr. Bill Liss, a dermatologist in San Francisco, CA, USA, for his contribution of Fig. 4. Emma Schlager, BS, and Chelsea St. Claire, BS, are medical students at Michigan State University College of Human Medicine who are interested in a career in dermatology. Kurt Ashack, MD, is a medical graduate of Michigan State University College of Human Medicine and will also be doing a residency in dermatology at the University of Illinois at Chicago. Dr. Khachemoune is a Mohs micrographic surgeon and a dermatophathologist at the Veterans Affairs Medical Center and the Department of Dermatology at the State University of New York in Brooklyn, NY USA.

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Correspondence to Amor Khachemoune.

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No funding was received for the preparation of this review.

Conflict of interest

Emma Schlager, Chelsea St. Claire, Kurt Ashack, and Amor Khachemoune have no conflicts of interest.

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Schlager, E., St. Claire, C., Ashack, K. et al. Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment. Am J Clin Dermatol 18, 563–569 (2017).

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  • Trigeminal Neuralgia
  • Triamcinolone Acetonide
  • Acanthosis Nigricans
  • Poor Oral Hygiene
  • Edentulous Patient