A 52-year-old white female patient presented to our outpatient dermatology clinic with a 3-month history of black discoloration and a “hairy” appearance of the tongue. There were no associated symptoms. The patient denied using tobacco products and had tried brushing her tongue once with minimal improvement.
Intraoral inspection revealed midline papillary projections involving the dorsal tongue, causing the “hairy” appearance. A brown to black discoloration was also noted on the mid-dorsal tongue. Many of these abnormal projections measured several millimetres in length. In addition, the patient also exhibited a midline furrow of the tongue; extremely poor dentition, with broken and loose teeth; dental caries; and evidence of gingivitis.
The most likely diagnosis is
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Normal tongue stained by food or drugs
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Oral lichen planus
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Black hairy tongue
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Oral hairy leukoplakia
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Pigmented fungiform papillae of the tongue
Answer on page 440
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