“Furry” lesion on a young woman’s tongue

Denise Rizzolo is Clinical Assistant Professor at Seton Hall University Physician Assistant Program and is in private practice at the Care Station, Springfield, NJ. She has indicated no relationships to disclose relating to the content of this article. Joe Monroe practices in the dermatology department of the Warren Clinic, Tulsa, Okla, and is the founder and president of the Society of Dermatology Physician Assistants.

A 24-year-old woman presents to the clinic with a 2-month history of discoloration on her tongue. She says it “almost looks like there is fur” on the center of her tongue. A dermatologist treated her with nystatin suspension and clotrimazole troches, believing she had a fungal infection. The patient admits to having bad breath lately but denies any pain, change in taste, or difficulty swallowing. She has been taking doxycycline for acne for the past 3 months. She has smoked one pack of cigarettes a day for the past 3 years. She denies any history of diabetes mellitus, asthma, or anemia and states she is otherwise healthy.

Clinical examination reveals a whitish lesion encompassing the entire dorsal surface of the tongue. There are multiple elongated projections within the body of the lesion. The color and character are uniform on the entire lesion (see Figure 1). All the other oral mucosa and gingiva are pink, with no lesions or discoloration.

The most likely diagnosis is
• Squamous cell carcinoma
• Hairy tongue
• White sponge nevus

Dicussion

The patient was referred to an oral and maxillofacial surgeon, who took a biopsy of the lesion. The pathology report confirmed the presence of elongated filiform papillae. There was no dyplasia in the epithelial cells. These findings are consistent with a diagnosis of hairy tongue.

Hairy tongue is a common benign condition in which the hairlike filiform papillae on the dorsal surface of the tongue increase in length and thickness because of a slowing of the normal removal of squames from the tips of the filiform papillae.¹ Although hairy tongue is generally idiopathic, precipitating factors include fever; dehydration; medications; mouth rinses containing hydrogen peroxide, sodium perborate, or carbamide peroxide; tobacco use; and poor oral hygiene.^1,2 Patients may have a bad taste in their mouth or discoloration of the tongue but usually have no pain or discomfort.

Squamous cell carcinoma of the tongue is the most common intraoral malignancy. It appears as an indurated, nonhealing ulcer with elevated margins. Treatment ranges from surgery to radiation.

White sponge nevus is an autosomal dominant condition that usually appears on the lateral margins of the tongue as a deeply folded, white or gray lesion. Lesions are thick, have a spongy consistency, and almost always appear bilateral and symmetric. There is no specific treatment for these asymptomatic, benign lesions.

Treatment The diagnosis of hairy tongue is usually based on its classic clinical presentation, and biopsy is not indicated unless there are persistent or atypical manifestations.² A thorough history can identify any etiologic factors that may be causing the condition.

Treatment focuses on the precipitating factors. The application of 1% solution of podophyllum resin is recommended.² Once any initiating factors have been discontinued, the tongue should gradually return to its normal appearance.

REFERENCES

1. Fitzpatrick TB, Johnson RA, Wolff K, et al. Color Atlas and Synopsis of Clinical Dermatology. 3rd ed. New York, NY: McGraw Hill; 1997.

2. Regezi JA, Sciubba JJ, Jordon, RCK. Oral Pathology Clinical Correlations. 4th ed. St. Louis, Mo. WB Saunders, 2003