Medical images tend to burst with blood and horror, from grisly wounds, festering flesh, to a relentless stream of other odious ailments. But the most disturbing sights aren’t always the most serious ailments, as a recent case in Ohio shows. A man there developed a completely benign condition. His prognosis was excellent. He made a full and quick recovery. But for any observer, a ghastly glimpse of his mild illness can cause acute discomfort and lasting trauma.
The man briefly developed an unusual condition in which a shaggy carpet of green fibers covered his tongue, according to a report in the New England Journal of Medicine. (If you dare, you can find an image of the man’s tongue here.) The thick, plush mat of dirty fur was a form of hairy tongue syndrome. The most common version of this condition is black, which is also quite disturbing. But in exceptional cases, the repugnant rug can also look tongue-colored, brown, yellow, blue or green.
The rare hue initially seemed to stun doctors, who prescribed him an antifungal medication after assuming the faint eruption was a fungal infection. But after a course of medication, his oral outgrowth remained in all its glory. Afterward, doctors at the Wright-Patterson Air Force Base Medical Center diagnosed it as hairy tongue syndrome.
So, what causes this lingual badness? And why does it come in different colors? Doctors don’t quite know, even though it was first identified in 1557. Centuries later, the primary hypothesis is that a combination of oral dysfunction prevents the top layer of the tongue from completing its normal cycles of shedding old cells, known as called defective exfoliation. This leads to a buildup of epidermal debris that can form long, hair-like structures on the tongue.
Tint and texture
The tongue is normally covered with small projections called papillae. There are four main types of papillae on the tongue: filiform, fungiform, foliate, and circumvallate papillae. The most affected by hairy tongue syndrome seem to be the filiform papillae. They are tightly packed on the top of the tongue and are the only papillae that do not have taste buds. In shape, filiform papillae are conical or cylindrical projections, covered with numerous thread-like projections called secondary papillae. Collectively, the small structures create the roughness of the tongue, increasing friction between the muscular organ and food, aiding chewing and other functions.
When defective desquamation occurs, the filiform papillae, which are normally less than 1 mm long, can reach 12 to 18 mm in length. And the thick tangle of tongue fibers that form ends up trapping bacteria, fungi, and other debris. These mat dwellers may contain pigmented food debris and colorful microorganisms, which are thought to give their hue to the fuzzy tongue. But to date, no specific microorganism has been identified as the cause or color source of hairy tongue cases.
Experts also don’t know how this whole process starts, but there are clear patterns and associations among those who develop the condition. A hairy tongue is most common in men and is associated with older age, smoking, alcohol consumption, excessive consumption of coffee or black tea, poor oral hygiene, certain cancers and the use of certain medications, mainly antibiotics. It is believed that a combination of oral irritations related to these factors causes the Technicolor nightmare coat of the tongue.
While the cause remains a mystery, the cure is simple. The condition is generally benign and self-limiting. There are often no symptoms associated with it, but some people report retching, nausea, trouble tasting, dry mouth, pain, or bad breath. Usually no drugs are needed. Standard treatment includes reassurance, oral care recommendations, and avoidance of potential triggers, such as smoking. It usually goes away in a few days to a few weeks.
In the Ohio man’s case, he was a 64-year-old smoker who had completed a course of antibiotics to treat a periodontal infection a few weeks before the tongue condition developed. His doctors advised him to stop smoking and brush his tongue four times a day to try and help the cells die. At a six-month follow-up, the man’s tongue had returned to normal, although he did not stop smoking.