Differential diagnoses for symptoms of black hairy tongue
| DIAGNOSIS | CLINICAL CHARACTERISTICS |
|---|---|
| Discoloration of the tongue | Discoloration of the tongue from food or drugs Tongue does not appear “hairy” |
| Oral hairy leukoplakia | Lateral tongue plaques with a folded, “feathery” appearance Associated with HIV and immunocompromised patients Plaques disappear and reappear spontaneously Buccal mucosa or gingiva might be involved |
| Pigmented fungiform papillae of the tongue | Normal variant in dark-skinned individuals Pigmented fungiform papillae along the lateral edges and apex of the tongue Tongue does not appear “hairy” |
| Lingua villosa nigra (black hairy tongue) | Discoloration of tongue with characteristic “hairy” papillary projections Mainly involves the dorsal surface of the tongue, where filamentous papillae predominate Associated with poor oral hygiene |
| Oral lichen planus | Chronic autoimmune inflammatory condition affecting the mucosa of the oral cavity White lacy striations (Wickham striae) found on the buccal mucosa, gingiva, tongue, and lips Tongue does not appear “hairy” nor darkly pigmented |