|THROUGH THE DERMOSCOPE
|Ahead of print publication
“Sea anemone” appearance in dermoscopy of black hairy tongue
Abheek Sil, Avik Panigrahi
Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
|Date of Submission||01-Feb-2021|
|Date of Decision||02-Mar-2021|
|Date of Acceptance||09-Apr-2021|
|Date of Web Publication||02-Aug-2021|
Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, 1, Khudiram Bose Sarani, Kolkata - 700 004, West Bengal
Source of Support: None, Conflict of Interest: None
A 63-year-old gentleman presented with complaints of dysgeusia and discoloration of tongue for past 4 weeks. He was a chronic smoker but without any known comorbidities, systemic ailments, any relevant drug, or excessive coffee/tea intake. Examination of oral cavity revealed poor oral hygiene. A well-demarcated yellowish-brown to brownish-black patch with prominent hair-like filiform lingual papillae overlying the dorsum of tongue, immediately anterior to the circumvallate papillae was observed [Figure 1]. Dermoscopic examination showed yellowish-brown and brownish-black hair-like projections (elongated filiform papillae) in aggregates resembling “sea anemone” with interspersed white structureless areas over a pinkish background. A distinct color variation was appreciated in individual filiform papilla with the base being a lighter shade than the tip (yellow/brown base with brown/black tip respectively) [Figure 2]. Cultures of tongue scrapings were negative for yeast and bacteria. A diagnosis of black hairy tongue (BHT) was established and he was advised regular tongue brushing and maintenance of proper oral hygiene. His tongue reverted back to its normal color with regression of elongated papillae in 3 weeks.
|Figure 1: A yellowish-brown to brownish-black patch with prominent filiform lingual papillae over dorsum of tongue|
Click here to view
|Figure 2: Dermoscopy (Dermlite DL4, 10×, contact/polarized mode) showing yellowish-brown and brownish-black hair-like projections (elongated filiform papillae) in aggregates resembling “sea anemone” (yellow circle) and white structureless areas (white star) over a pinkish background (black arrow). A distinct color variation was appreciated in individual filiform papilla with the base (green arrow) being a lighter shade (yellow/brown) than the tip (brown/black, red arrow)|
Click here to view
BHT is a benign medical condition characterized by elongated filiform lingual papillae over dorsum of tongue, with black, yellowish, or brown discoloration. Multiple predisposing factors associated with this condition include smoking, poor oral hygiene, excessive coffee/tea intake, general debilitation, xerostomia, and drugs. Differential diagnoses includes pigmented fungiform papillae of the tongue (localized hyperpigmentation limited to fungiform papillae; rose petal appearance on dermoscopy), oral lichen planus
(tri-colored pattern with modified Wickham's striae, well-demarcated glossy red erosions, and violaceous-to-brown clods), and median rhomboid glossitis (atrophic filiform papillae in the affected area)., Kobayashi et al. reported the first dermoscopic description of BHT as brownish hair-like elongation of filiform papillae with whitish lingual papillae. Histopathologically, this corresponds to hyperkeratosis with pronounced parakeratosis at the tip of filiform papillae. Scanning electron microscopy studies have shown that the lengthening of the filiform papillae is because of accumulated keratinized layer. We hypothesize that this pronounced parakeratosis occurred in layers, with increased accumulation toward the tip of the projections compared to its base, which probably let to the color variation as seen in our case. However, histopathological examination would better substantiate or refute this finding.
Thus, dermoscopic examination is a useful adjunct to the diagnosis of this benign disorder of the tongue, demonstrating exact changes in shape and color of filiform papillae. We document here the “sea anemone” appearance as a characteristic dermoscopic finding in BHT.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sil A, Bhanja DB, Chakraborty S. Black carpet over tongue. Postgrad Med J 2020;96:506.
Sil A, Panigrahi A, Bhanja DB. Rose petal appearance: The dermoscopic finding in pigmented fungiform papillae of the tongue. Indian Dermatol Online J 2021;12:490-1
Sonthalia S, Varma S, Jha AK, Jakhar D, Kaliyadan F. Case Report: Dermoscopic features of oral lichen planus - the evolution of mucoscopy. F1000Res 2018;7:284.
Sil A, Panigrahi A, Bhanja DB. Tongue discoloration in a young girl. J Pediatr 2020;219:276-7.
Kobayashi K, Takei Y, Sawada M, Ishizaki S, Ito H, Tanaka M. Dermoscopic features of a black hairy tongue in 2 Japanese patients. Dermatol Res Pract 2010;2010:145878.
Wang X, Yang S, Wang Y. Image gallery: Black hairy tongue in a patient receiving enteral feeding. Br J Dermatol 2019;181:e91.
Harada Y, Gaafar H. Black hairy tongue. A scanning electron microscopic study. J Laryngol Otol 1977;91:91-6.
[Figure 1], [Figure 2]