ISSN - 0973-0958

Pediatric Oncall Journal

Lingua villosa nigra (black hairy tongue) in a 2-week-old newborn

Leonor Aires Figueiredo1, Sandra Pera2, Diogo Bacalhau3, Rui Garcia2.
1Serviço de Pediatria, Departamento da Saúde da Mulher e da Criança, Hospital do Espírito Santo de Évora, Portugal,
2USF Salus, Évora, Portugal,
3Serviço de Imagiologia, Hospital do Espírito Santo de Évora, Évora, Portugal.

Leonor Aires Figueiredo, Largo do Sr. da Pobreza, 7000-811 Évora, Portugal.
Black hairy tongue, lingua villosa nigra, newborn

A two-week-old term male was brought to a primary care appointment for a routine health assessment. Birth history was unremarkable. The patient was exclusively breastfed up to 7 days of life, when artificial formula was started due to apparent insatiability. No feeding difficulties were noted and median weight gain was 42 g/day since birth. He was receiving supplementation with 667 UI of cholecalciferol daily and parents denied any other supplementation or off-label drugs. Physical examination was unremarkable except for a brown lesion with irregular borders located on the posterior two-thirds of the tongue dorsum (Figure 1). Parents had not noticed the presence of this lesion prior to the appointment and had no knowledge of similar cases in the family.

Figure 1. Newborn’s black hairy tongue.
<b>Figure 1.</b> Newborn’s black hairy tongue.

Figure 1. Newborn black hairy tongue
  Lingua villosa nigra (black hairy tongue) in a 2-week-old newborn
What is the diagnosis?

Clinical diagnosis of lingua villosa nigra was established. Parents were advised to gently brush the tongue daily. Complete resolution occurred after 6 weeks.
Lingua villosa nigra, also known as black hairy tongue, is a benign condition characterized by hypertrophy and elongation of the filiform papillae.1,2,3 The dark pigment has been described to be caused by chromogenic microorganisms of the oral microflora.1,2,3
The condition is more frequent in adults who present predisposing factors, such as smoking, poor oral hygiene, regular consumption of coffee, alcohol or tea, while it is a rare, benign and self-limited condition in infants, with no established risk factors.1,2,3,4 Nonetheless, some cases of vitamin C supplementation or herbal tea intake have been reported.3,4
Diagnosis is based on observation of the lesion and its characteristics. Tissue biopsy or other investigations are unnecessary. Treatment consists in gently brushing the tongue and it does not respond to antifungal or antibiotic treatment.2,3,4 Parents should be informed of its benign course and absence medication need.
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None

  1. Teresa L. A, Dora F. Infant's Black Hairy Tongue (Lingua Villosa Nigra). Clinical Medical Image Library. 2021 Jan 7;7(1):161.  [CrossRef]
  2. Schwartz RH, Lee T. A Two-Week-Old Term Baby With a Black Tongue. Clinical Pediatrics. 2015 Oct 10;54(11).  [CrossRef]  [PubMed]
  3. Nogueira A, Pires S, Salgado M. A "moldy" tongue: a case of a black hairy tongue in an infant. Saúde Infantil. 2020 Apr;42:37-9.
  4. Owczarek-Drabińska JE, Radwan-Oczko M. A Case of Lingua Villosa Nigra (Black Hairy Tongue) in a 3-Month-Old Infant. American Journal of Case Reports. 2020 Dec 26;21.  [CrossRef]  [PubMed]  [PMC free article]

Cite this article as:
Figueiredo L A, Pera S, Bacalhau D, Garcia R. Lingua villosa nigra (black hairy tongue) in a 2-week-old newborn. Pediatr Oncall J. 2023;20: 161. doi: 10.7199/ped.oncall.2023.44
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