The Tale of Two Tongues: Hairy Tongue and Geographic Tongue—Two Bizarre Conditions





The tongue is a strange organ, a source of wonder and pleasure both for the possessor and receiver of its peculiar qualities.  If that sounds unconvincing, just watch a dog.  Watch how he gleefully licks himself in places I shouldn’t mention, and you’ll see he hasn’t a care in the world; it’s very Zen-like in its simplicity.  We all should be that fortunate to simply enjoy the moment or be limber enough to…well that’s another topic for someone else’s website.  Putting that aside, the tongue may exhibit a few intriguing anomalies, depending on your point of view.  There are a whole variety of tongue ailments resulting from medical disease which would fill an entire textbook.  This segment only covers two conditions that may be familiar to you, or perhaps not:  “Hairy Tongue” and “Geographic Tongue”--strange-sounding medical terms which may leave you wondering whether these are serious abnormalities or simple curiosities.

Hairy Tongue
Believe it or not, this is a bona fide, for-real medical term.  It actually looks like hair, but really it’s not.  This condition occurs on the “dorsal” tongue, the top part of the tongue that usually has a finely textured surface.   The smooth undersurface is called the “ventral tongue,” in case you’re wondering.  On closer inspection, perhaps with a magnifying glass, you’ll notice tiny projections that cover the dorsal tongue--these are the thousands of small “papillae” (the plural form of “papilla”) that cover the surface.  Papillae can vary in appearance from person to person, so don’t despair if your papillae look different from someone else’s, and if for some bizarre reason you have a tendency to compare your tongue to the tongue of others, please stop or suffer the consequences of Papillae Envy, a pseudo-medical term I just made up.
Brown Hairy Tongue

Sometimes these papillae become elongated due to buildup of keratin—a substance normally produced by the lining tissue of the mouth that usually sloughs off and is cleared by your saliva—which accumulates on the papillae, making them longer than usual and giving the appearance of hair.  Bacteria or yeast that normally live in the mouth can accumulate in these elongated papilla, and are the source of a variety of colors—black, brown, green or white.  Certain medications can also do this, staining those long papillae.  “What the heck is going on there with my tongue?” you may cry out if you’re one of the lucky people to have this.  It can be more prevalent in those with dry mouths, after antibiotic treatment or in people who smoke—so stop smoking if you do.  It’s a benign condition however (ie, it’s not cancer and it won’t kill you) though in some case it looks really gnarly.  Good oral hygiene such as regular teeth and tongue brushing can help resolve this condition. 

Geographic tongue
This term perfectly describes this other benign condition.  The dorsal tongue usually is quite uniform and regular, other than when it gets “hairy” as discussed above.  Yet here are times when groups of these fine papillae get larger or shorter or disappear entirely, sometimes forming patches, and giving rise to a map-like appearance—hence the term “Geographic Tongue.”  Sometimes the pattern can change in appearance.  Sometimes this is painful or sore.  The cause of this is idiopathic—a fancy medical term meaning “unknown” or “we don’t have a clue.”  Treatment is symptomatic to help relieve any discomfort: other the counter pain medications or topical anesthetics (i.e., a numbing spray), and avoidance of hot, spicy foods and tobacco. 

Both of these conditions usually do not require a biopsy (removal of a piece of the tissue to obtain a diagnosis).  Of course, if the condition persists or worsens, the tongue gets more painful or uncomfortable, please see your doctor or dentist to have this evaluated further to make sure it isn’t something more serious. 

If indeed you have one of these two conditions and no other concerns are raised by your doc or dentist, then profit from these features:  Stick your tongue out and show it around to friends and family the next time you’re at a party or other social event.  It’ll be a show-stealer!

As an aside: the tongue is much larger than you think.  I happen to know this since I at times must operate on the tongue.  When you pull it way out, it’s remarkable the amount of length and bulk it has.  Even our small dog has a large tongue, and if I’m fortunate to perchance get a hold of his tongue while he’s happily lapping it about, I can pull it way out before he recoils back.  WARNING: Don’t try this at home.  Your dog may be entirely different and his/her mouth is much larger than you think.  So if you find your head tightly locked in the jaws of some innocent canine…well, I told you so…

©Randall S. Fong, M.D. 

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