Brown-black carpet over the tongue

A 30-year-old man presented to our clinic with asymptomatic, confluent, hair-like projections over the dorsum of the tongue which gave a brown-black carpet-like appearance [Figure 1]. The patient was a known case of rheumatic heart disease with severe mitral stenosis on long-term antibiotic therapy from multiple private practitioners. We made a final diagnosis of lingua villosa nigra. Lingua villosa nigra or black hairy tongue is due to the accumulation of keratin on the dorsum of the tongue. This accumulation may be due to inadequate desquamation following reduced food intake or a liquid/soft-food-based diet. Other associated factors include smoking, poor oral hygiene, oxidizing mouthwash usage, and hot beverage intake. It is a benign condition and requires no treatment. The patient can be counseled to scrape the tongue with a tongue scraper or toothbrush.^[1]

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Figure 1:

Confluent, hair-like projections over the dorsum of the tongue with a brown-black carpet-like appearance.

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