Língua villosa nigra in an infant

Tongue cleaning with a soft brush was recommended and a complete resolution was seen in about 2 weeks, prompting the diagnosis of lingua villosa nigra. Lingua villosa nigra is a benign and self-limited entity, extremely rare in pediatric patients, particularly in young infants.¹ Nine cases are described in the anglo-saxon literature, the youngest patient being 1 month old.^2,3 Although its precise pathogenesis is still uncertain, it is thought to be linked to alterations of desquamation and reactive hypertrophy of the filiform papillae altering the normal cleaning process of the tongue leading to a bacterial overgrowth.^1,4 Usually, this condition doesn´t involve the tip nor the side of the tongue and some patients may even refer a burning of the tongue.⁴ The tongue´s color may vary between black, brown, green, yellow or even white[3]. Triggering factors include alcohol intake, smoking, dehydration, antibiotics, hyposalivation and tea consumption. In pediatric patients a triggering factor is rarely found.⁴ Incidence increases with age and it is attributed to a cumulative increase in consumption of coffee, tea and smoking.
Main differential diagnosis includes oral candidiasis and villous leukoplakia both usually associated with human immunodeficiency virus infection. Another diagnosis to keep in mind is pigmented fungiform papillae of the tongue, a normal oral pigmentation variant usually affecting dark-skinned people.⁴ This diagnosis is thus essential to bear in mind in order to avoid unnecessary therapeutic interventions.

References :

Körber, A, Voshege N. Black hairy tongue in na infant. CMAJ. 2012;184(1). Popik E, Barroso F, Pombeiro J, Carvalho C, ALmeida A. Arch Dis Child 2018;0:1. Schlager E, St Claire C, Ashack K, Khachemoune A. Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment. Am J Clin Dermatol. 2017; 18(4): 563-9. Emmet E, McGrath MB, Philip Bardsley MD, Gurnan Basran MD. Black hairy tongue: What is your call?. CMAJ. 2008; 178(9): 1137-38.