Paul Seaburn March 11, 2022

Because it’s shown every year and often continuously for 24 hours straight, we are reminded annually by a famous scene in the classic holiday film, “A Christmas Story,” not to lick a flagpole in the winter or one’s tongue will freeze to it – resulting in pain, embarrassment and a bandaged licker. Unfortunately, there’s no similar movie to remind folks to avoid doing the thing that results in a hairy tongue. A what? And what can give you a hirsute oral appendage?

“A man in his 50s presented to the dermatology department with a painless thick black coating on his tongue.”

Thus begins the incredible medical tale of the man with a hairy tongue in the current edition of the journal JAMA Dermatology. The anonymous patient checked into the Medical Trust Hospital in Cochin, Kerala, on the southwest coast of India and stuck out his tongue – revealing a thick coat of black hair. (Photos here.) What kind of doctor would be able to diagnoses such a condition? Dentist? Gastroenterologist? Barber? The hospital decided on a dermatologist — they deal with hair and the tongue has skin on it. A group of them took samples of the tongue hair and came back with the diagnosis — lingua villosa nigra or “black hairy tongue.” (Isn’t that what he said he had?)

Black hairy tongue (not the one in the story)

“A black hairy tongue is caused by too much bacteria or yeast growth in the mouth. The bacteria build up on tiny rounded projections called papillae. These lie along the surface of the tongue. Instead of shedding as they normally do, the papillae start to grow and lengthen, creating hair-like projections. They can grow to 15 times their normal length.”

At that point, most people would go to WebMD, which has a page on black hairy tongue and blames it on bad oral hygiene. Fortunately, this man’s doctors looked at his medical records and found that three months before his tongue got furry, the man had a stroke that caused paralysis on the left side of his body. To help him eat until medicine and physical therapy strengthened his left arm, the man was placed on a soft diet — pureed food and liquids. While the soft food made it easy for him to eat, it eventually made it hard to look in the mirror every morning as his tongue became covered with black hair, which can grow to .7 inches (18 mm) in length.

“Brushing your tongue with a toothbrush or using a tongue scraper can remove the papillae and the food debris that might be caught in them. Other oral hygiene procedures, like brushing and flossing your teeth and regularly visiting a dentist, will also help.”

For this man, the doctors recommended using his strong right hand to clean his tongue of food debris and cut out coffee, tea, tobacco and alcohol. If that didn’t work, the Cleveland Clinic says next steps antifungal medications, a different mouthwash, drugs related to vitamin A or, as a last resort, surgical treatment using a laser or electrical current. Fortunately, the man responded to cleaning and his black hairy tongue returned to bright pink in 20 days.

Black but not hairy

You may ask: “Why should we care about this rare condition?”

“Black hairy tongue affects about 13 percent of people at some point in their lives, according to the American Academy of Oral Medicine. It happens in all population groups but is more common in men and in older people.”

According to the Cleveland Clinic, one out of eight people will get it. Think about that the next time you look in the mirror … or the next time you’re at a party where people are talking or eating. What will you be watching?

And don’t forget about the flagpole either.

MU*