Psychotropic agent-induced black hairy tongue.

A black, hairy-looking tongue typically is caused by an overgrowth of bacteria and sometimes yeast in the mouth.
Psychotropic agent-induced black hairy tongue.
Cutis. 2000 Jul;66(1):25-6.


Division of Dermatology, Cooper Health System, Marlton, New Jersey, USA.


Black hairy tongue is characterized by an abnormal coating of the dorsal surface of the tongue. Although the cause is unknown, several precipitating factors may be implicated in the pathogenesis of this disorder. A case is presented in which black hairy tongue appeared subsequent to the administration of fluoxetine hydrochloride, thiothixene hydrochloride, benztropine mesylate, and clonazepam for bipolar affective disorder.

[PubMed – indexed for MEDLINE]
Mt Sinai J Med. 2006 Oct;73(6):891-4.

Black hairy tongue associated with olanzapine treatment: a case report.


Department of Psychiatry, Cukurova University Faculty of Medicine, Balcali, 01330 Adana, Turkey.


Olanzapine is an atypical antipsychotic drug approved for acute and long-term treatment of bipolar disorder. Although relatively safe as compared to other classical antipsychotic medications, there are a number of uncommon adverse effects of olanzapine such as oral cavity lesions. In addition to the relatively common side effect of dry mouth, several articles have reported an association between olanzapine treatment and the development of oral lesions such as apthous stomatitis, pharyngitis, glossitis and oral ulceration. Although there are several cases in which the tongue was affected in conjunction with stomatitis or pharyngitis, we could not find a case report indicating a direct relationship between olanzapine use and a tongue lesion. We present here the case of a patient with bipolar disorder, who developed recurrent black hairy tongue on two different occasions following the addition of olanzapine to lithium treatment. In the present case, xerostomia (dry mouth), which is an adverse reaction of both olanzapine and lithium, may have played a role in the development of black hairy tongue. All agents with a possible side effect of xerostomia may predispose patients to black hairy tongue, especially when they are administered in combination. To preclude the development of this complication with such drugs, extra time and effort should be given to improving oral hygiene.

[PubMed – indexed for MEDLINE]
Ned Tijdschr Geneeskd. 2004 May 15;148(20):984.

[Diagnostic image (189). A man with a tongue disorder. Black hairy tongue].

[Article in Dutch]


Amphia Ziekenhuis, locatie Langendijk, afd. Interne Geneeskunde, Postbus 90.157, 4800 RL Breda.


In a 59-year-old man with a swallowing problem and loss of weight, who used fluoxetine because of depression, gastroscopy revealed a black hairy structure on the dorsum of the tongue, known as black hairy tongue.

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