Fungus likely cause of discolored tongue

August 08, 2004|By Allen Douma, M.D., Tribune Media Services.

Q. After I developed a black, hairy tongue, I saw an ENT specialist who prescribed a CAT scan. It showed that I had a fungal infection.

Since then, many medical professionals all have asked me the same question: Had I taken antibiotics within the last year? I had, when my primary doctor gave me some antibiotics for the flu. What kind of fungus could it be, and is it related to antibiotics?

--E.K., Buffalo

A. The information you presented in your letter is a little confusing. Let me explain.

A "hairy" tongue is typically due to the overgrowth of certain structures of the tongue called papillae. This makes the tongue look as if it's covered with fur. This usually occurs in relation to antibiotic therapy, dry mouth, dehydration with fever or excessive use of some mouthwashes.

A black or brown tongue typically is due to the overgrowth of bacteria that normally are present on the tongue. This, too, can be caused by the killing of some bacteria with antibiotics so other bacteria overgrow.

But the most common cause of discoloration of the tongue is the overgrowth of a fungus. The most common fungus is called candida. But overgrowth of the candida fungus turns the tongue white. Infection with candida is called candidiasis, and when it happens on the tongue the condition is called thrush.

To determine what's causing your coated tongue would require it be looked at by a health professional, as you have done, and perhaps even have samples or biopsies taken. But because you have been told by an ENT specialist that you have a fungal infection, I'll provide you information about thrush and what to do about that condition.

Oral thrush causes creamy white patches to form over reddened and sometimes swollen mucous membranes in the mouth and throat. The white substance can be easily rubbed or scraped off, but the patches usually are painful.

Underlying causes of candidiasis include antibiotic therapy, poor denture hygiene, immune deficiencies, diabetes and anemia. People being treated with steroids, chemotherapy or radiation also may develop candidiasis.

Thrush is easily diagnosed and usually easily treated. Often the condition can be diagnosed on the basis of symptoms and appearance alone. A health care professional easily can confirm a diagnosis of thrush by taking scrapings and looking at it under a microscope or culturing the material for candida. In all of your visits to doctors, has a doctor taken a scraping to look at under a microscope?

If you have thrush you can try treating it with mouth rinses of half-strength hydrogen peroxide. If you wear dentures, sprinkling your dentures with the antibiotic nystatin three or four times a day for a few weeks may also work.

If these treatments don't work, you may need stronger antifungal medicine such as fluconazole, ketoconazole, clotrimazole or nystatin. They can be taken orally or they can be used as an ointment directly on the tongue. Many antifungal drugs also are available as mouthwashes.

Fluconazole has proved effective and safe and often is the first choice for treatment. In addition to being an antifungal agent, fluconazole has been shown to reduce the sticking of the fungus to the cells that cover the tongue and line the mouth.

The next time you talk with a doctor about your problem or any medical problem, find out what he or she thinks it might be, regardless of whether treatment is recommended.

For those of you who have a black or brown tongue caused by overgrowth of bacteria, you can try home treatment before seeing a doctor. This simply requires that you brush your tongue twice a day followed by antiseptic mouthwash. If this doesn't work within a few days, or if the problem returns, have it checked by a physician.


Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at This column is not intended to take the place of consultation with a health-care provider.