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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

Address for Correspondence: Leonor Aires Figueiredo, Largo do Sr. da Pobreza, 7000-811 Évora, Portugal.
Email: leonor.figueiredo12@gmail.com

Keywords : Black hairy tongue, lingua villosa nigra, newborn

Question :

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.

What is the diagnosis?

Discussion :

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.

References :

Teresa L. A, Dora F. Infant's Black Hairy Tongue (Lingua Villosa Nigra). Clinical Medical Image Library. 2021 Jan 7;7(1):161.
Schwartz RH, Lee T. A Two-Week-Old Term Baby With a Black Tongue. Clinical Pediatrics. 2015 Oct 10;54(11).
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.
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.

Correct Answers :

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Last Shown : Nov 2023

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

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