Medical imaging tends bursting with blood and horror, from macabre gashes and festering flesh to a merciless spurt of other heinous afflictions. But the most ominous sites are not always the most serious ailments, as a recent case in Ohio demonstrates. A man developed a very mild illness there. His prognosis was excellent. He recovered fully, quickly. Yet for any observer, a horrifying glimpse of his mild illness can cause acute discomfort and lasting trauma.
The man briefly developed an unusual condition in which a shaggy carpet of green fibers covered his tongue, according to a report in the New England Journal of Medicine. (If you dare, an image of the man’s tongue can be found here.) The thick, fluffy carpet of fetid 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 repellent mat may also appear tongue-colored, brown, yellow, blue or green.
The rare tint initially seemed to baffle doctors, who prescribed her an antifungal medication after assuming the fuzzy rash was a yeast infection. But after a course of medication, her mouth growth remained in all its glory. After that, doctors at Wright-Patterson Air Force Base Medical Center diagnosed Hairy Tongue Syndrome.
So what causes this lingual nastiness? And why does it come in a variety of colors? Doctors don’t quite know, even if it was first identified in 1557. Centuries later, the main hypothesis is that a combination of oral disorders prevents the upper layer of the tongue from completing its normal cycles of shedding old cells, i.e. defective 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 projections called papillae. There are four main types of papillae on the tongue: filiform, fungiform, foliate, and circumvallate papillae. The most affected by hairy tongue syndrome seem to be the filiform papillae. They are densely packed on top of the tongue and are the only taste buds that do not have taste buds. In terms of shape, filiform papillae are conical or cylindrical protrusions, topped with numerous filiform projections called secondary papillae. Collectively, the small structures create the roughness of the tongue, which increases friction between the muscular organ and food, facilitating chewing and other functions.
In defective desquamation, the filiform papillae which 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 eventually traps bacteria, fungi, and other debris. These carpet dwellers can include pigmented food residue and colored microorganisms, which are believed to give the bushy tongue its hue. But, to date, no specific microorganism has been identified as the cause or color source of hairy tongue cases.
Experts also don’t know how this whole process begins, but there are clear patterns and associations in those who develop the disease. Hairy tongue appears most often in men and is associated with advanced age, smoking, alcohol consumption, excessive consumption of coffee or black tea, poor oral hygiene, certain cancers and the use of certain medications, mainly antibiotics. It is believed that a combination of mouth irritations related to these factors triggers the nightmarish Technicolor coat of the tongue.
Although its cause remains a mystery, its cure is simple. The condition is usually mild and self-limiting. Often there are no symptoms associated with it, but some people may report retching, nausea, taste problems, dry mouth, pain, or bad breath. No medication is usually needed. Standard treatment is reassurance, referral for oral care, and avoidance of possible triggers, such as smoking. It usually resolves within a few days to a few weeks.
The Ohio man was a 64-year-old smoker who had undergone a course of antibiotics to treat a periodontal infection weeks before the tongue disease developed. Her doctors advised her to quit smoking and brush her tongue four times a day to try to help the cells come loose. At a six-month follow-up, the man’s tongue had returned to normal, although he had not quit smoking.
This story originally appeared on Ars-Technica.