Medical images tend to burst forth with ferocity and terror, from fearful gores and boiling flesh to a merciless flow of other abominable torments. But the most disturbing sights aren’t always the most serious illnesses — as a recent case in Ohio shows. A man there developed a perfectly good condition. His prognosis was excellent. He recovered completely, quickly. However, for any observer, a ghastly glimpse of his mild illness can cause acute distress and lasting trauma.
The man briefly developed an unusual condition in which a rough carpet of green fibers covered his tongue, according to a report in New England Journal of Medicine. (If you dare, you can find an image of the man’s tongue here .) The thick, plush layer of dirty fur was a form of hairy tongue syndrome. The most common version of this condition is black – which is also quite disturbing. But, in exceptional cases, the disgusting carpet can also appear in the color of the tongue, brown, yellow, blue or green.
The rare color seemed to deter doctors at first, who prescribed him an antifungal drug after they assumed the cloudy breakout was a yeast infection. But after a course of drugs, his oral growth remained in all its glory. After that, doctors at Wright-Patterson Air Force Base Medical Center diagnosed it as hairy tongue syndrome.
So what causes this linguistic mischief? And why does it come in a variety of colors? Doctors don’t quite know, even though it was first identified in 1557. Centuries later, the leading hypothesis is that a combination of oral disorders prevents the top layer of the tongue from completing its normal cycles of removing old cells – otherwise known as impaired desquamation. This leads to a buildup of epidermal debris that can form long, hair-like structures on the tongue.
Color and texture
The tongue is normally covered with small protrusions called papillae. There are four main types of papillae on the tongue – filiform, mushroom, leafy and circular papillae. The most affected by hairy tongue syndrome seem to be the filiform papillae. They are densely packed on the tip of the tongue and are the only papillae that do not have taste. In terms of shape, filiform papillae are conical or cylindrical protrusions, covered with numerous thread-like projections called secondary papillae. Together, the rat’s structures create the roughness of the tongue, which increases friction between the muscular organ and food, aiding mastication and other functions.
When defective desquamation occurs, the filiform papillae that are normally less than 1 millimeter in length can reach lengths of 12 to 18 mm. And the thick tangle of tongue fibers that forms ends up trapping bacteria, fungus and other debris. These matte inhabitants may include pigmented food debris and colorful microorganisms, which are thought to give the thick tongue its color. But, to date, no specific microorganism has been identified as the cause or source of the color of hairy tongue cases.
Experts also don’t know how this whole process starts, but there are clear patterns and associations in those who develop the condition. Hairy tongue occurs more often in men and is associated with older age, smoking, alcohol use, excessive consumption of coffee or black tea, poor oral hygiene, certain types of cancer and the use of certain medications, mainly antibiotics. Some combination of oral irritations associated with these factors is thought to cause the Technicolor anxiety coating of the tongue.
While its cause remains a mystery, its cure is simple. The condition is generally benign and self-limiting. There are often no symptoms associated with it, but some people may report constipation, nausea, problems with taste, dry mouth, pain, or bad breath. Medicines are usually not needed. Standard treatment includes insurance, oral care recommendations, and avoidance of potential triggers, such as smoking. It usually resolves within a few days to a few weeks.
In the case of the Ohio man, he was a 64-year-old smoker who had finished a course of antibiotics to treat a periodontal infection several weeks before the tongue condition developed. Doctors advised him to quit smoking and brush his tongue four times a day to help the cells go away. At a six-month follow-up, the man’s tongue had returned to normal, although he did not quit smoking.
This story originally appeared on Ars Technica.
