Hairy Tongue
A 64-year-old man who reported current use of tobacco presented to the primary care clinic with a 2-week history of tongue discoloration. Approximately 21 days before presentation, he had completed a course of clindamycin to treat a periodontal infection. After the tongue discoloration began, a course of fluconazole was prescribed to treat possible oral candidiasis. However, the tongue changes had persisted. He reported no associated dysgeusia or tongue pain. On physical examination, the tongue had elongated filiform papillae and green discoloration. No other oral or dental lesions were noted. A diagnosis of hairy tongue was made. Hairy tongue is a benign condition that involves elongation and discoloration of the filiform papillae on the dorsal aspect of the tongue. Risk factors include smoking, dehydration, poor oral hygiene, and antimicrobial use. Although the tongue discoloration is frequently black — in which case it is called black hairy tongue or lingua villosa nigra — brown, yellow, or green discoloration is possible, as well. The patient was advised to gently scrub the surface of his tongue with a toothbrush four times daily and was counseled on smoking cessation. At 6-month follow-up, the tongue appearance had returned to normal despite the patient continuing to smoke.