Medical images tend to be bursting with blood and horror, from ghastly cuts and festering flesh to other monstrous pains that flowed mercilessly. But the most disturbing sights aren’t always the most serious illnesses – as a recent case in Ohio demonstrated. One man there developed a completely benign condition. His prognosis is excellent. He made a full, quick recovery. However, for any observer, a glimpse of his mild illness can cause acute discomfort and persistent trauma.
This man briefly developed an unusual condition in which his tongue had a shaggy carpet of green thread. a report inside New England Journal of Medicine. (If you dare, An image of the man’s tongue can be found here.) Thick, soft and foul-smelling hair is a form of hairy tongue syndrome. The most common version of this condition is black – which is also quite disturbing. However, in special cases, the offensive rug can also appear as tongue color, brown, yellow, blue or green.
The rare color seemed to baffle the doctors at first, who prescribed him an antifungal medication after assuming the faint rash was caused by a yeast infection. But after a course of medication, his oral growth was intact. Later, doctors at Wright-Patterson Air Force Base Medical Center diagnosed it as hairy tongue syndrome.
So what causes this language evil? And why is it in different colors? Doctors don’t quite know, though it was first identified in 1557. Centuries later, the main hypothesis was that a combination of several oral disorders prevented the top layer of the tongue from completing the normal cycle of shedding of old cells – aka defective sloughing. This leads to an accumulation of cuticle debris that can form long hair-like structures on the tongue.
Color and texture
The tongue is usually covered with protrusions called papillae. There are four main types of papillae on the tongue—filamentous, fungal, foliate, and circumferential. Those most affected by hairy tongue syndrome appear to be fibrous papillae. They are densely concentrated on the tip of the tongue and are the only papillae that do not stimulate the taste buds. In appearance, the filamentous papillae are conical or cylindrical protrusions, topped by numerous thread-like protrusions called secondary papillae. In general, small structures create the roughness of the tongue, increase friction between muscles and food, aid in chewing and other functions.
When defective sloughing occurs, fibrous papillae usually less than 1 mm in length can reach 12 to 18 mm in length. And the thick tangle of tongue fibers that eventually form traps bacteria, fungi, and other debris. These carpet inhabitants may include pigmented food residues and brightly colored microorganisms, which are thought to give their color to the long tongue. To date, however, no specific microorganism has been identified as the cause or source of coloration of hairy tongue cases.
Experts also don’t know how this whole process begins, but there are clear patterns and connections in people who develop the condition. Hairy tongue is more common in men and has been linked to old age, smoking, drinking alcohol, drinking too much coffee or black tea, poor oral hygiene, some cancers, and use of certain medications, mainly antibiotics. Some combination of oral irritation related to these factors is thought to cause Technicolor nightmares on the tongue.
While its cause remains a mystery, its cure is simple. This condition is generally benign and self-limiting. There aren’t usually any symptoms associated with it, but some people may experience vomiting, nausea, difficulty tasting, dry mouth, pain, or bad breath. Usually no medication is needed. Standard treatment includes reassurance, oral care recommendations, and avoidance of possible triggers, such as smoking. It usually resolves in a few days to a few weeks.
In the case of the Ohio man, the 64-year-old smoker and completed a course of antibiotics to treat a periodontal infection several weeks before the tongue condition developed. Doctors advised him to stop smoking and brush his tongue four times a day to try to help the cells slough off. After six months of follow-up, the man’s tongue was back to normal, even though he did not quit smoking.
This story originally appeared on Ars technique.
