causes of black pigmentation on tongue

(B) Intramucosal nevus: the nevus cells are located within the lamina propria, with no evidence of any junctional component. Studies have demonstrated 5year survival rates of 1540%.43,44 Involvement of the palate is predictive of the worst prognosis compared to other intraoral sites.49 Regional lymphatic metastases are frequently identified and contribute to the poor survival rate.50 Less than 10% of patients with distant metastases survive after 5 years.44 The 10year survival rate is 0%.51. The enzymes contained within the bacteria act on saliva to produce the black or brown pigment which causes the condition known as black hairy tongue (figure 2). Certain foods, drinks, and confectionery can also result in exogenous pigmentation that, in most cases, is reversible. Once the lesion reaches a given size, its growth tends to cease and may remain static indefinitely. Fungal or viral infections. Black tongue is often related to poor dental hygiene, but there are also other risk factors including: Drinking a lot of coffee or tea Tobacco use Excessive alcohol In some cases they can literally be small black specks across the tongue. What you most likely have is a harmless and temporary condition known as a black tongue. These lesions have a good prognosis if they are detected early and treated before the onset of nodular lesions, which would indicate invasion into the deeper connective tissue (i.e., a vertical growth phase). and "what does a black tongue mean?" WebA small blue-black discoloration on the underside of the tongue may be a tattoo caused by a fragment of dental amalgam filling material, which contains silver, becoming stuck in the [33], Oral melanosis caused by systemic diseases may be the first sign a dentist or medical professional may pick up to cause suspicion for any underlying systemic disease. What's your diagnosis? There is a variety of different treatment options for Kaposi sarcoma. They also act as scavengers, protecting against cytotoxic intermediates.6 However, the role of melanocytes in oral epithelium is unclear. The patchy hyperpigmentation is generalized but most often notable in areas exposed to light, chronic friction, or pressure.1 In this patient, a history of an autoimmune endocrine condition and the fatigue, hyperpigmentation, and vital signs prompted concern for adrenal insufficiency. This involves cutting out the lesion and ensuring complete removal from the oral cavity. Oral lesions that occur on the tongue, Oral mucosal malignant melanoma is associated with a very poor prognosis. Chromogenic bacteria can produce discoloration of the dorsal tongue. It is composed of eumelanin, a brownblack pigment, and pheomelanin, a pigment of redyellow color.4 The term melanosis is used to describe diffuse hyperpigmentation. A biopsy may be indicated where the following features are present: large or new-pigmented lesions and those with a papular appearance or irregular colouration. A history of multiple episodes of acute sun exposure, especially at a young age; immunosuppression; the presence of multiple cutaneous nevi; and a family history of melanoma are all known risk factors for the development of cutaneous melanoma.33 Melanomaprone families have a high incidence of germline mutations in the tumor suppressor genes, CDKNA2/p16INK4a or, less commonly, CDK4.34 Similar to melanocytic nevi, melanomas also frequently exhibit mutations in the BRAF, HRAS, and NRAS protooncogenes.27,35 Other recurrent molecular findings, including MC1R polymorphisms and alterations or loss of PTEN function, have also been described.36,37 This suggests that several distinct genetic changes are required for the molecular evolution of melanoma. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Nevus cells in the skin and oral mucosa also produce melanin. Normal variations in tongue color (pigment) Foods or medications that have stained the tongue. Melanin is then transferred to keratinocytes in melanosomes. We do not control or have responsibility for the content of any third-party site. For Addison's, the specific treatment option would be to treat with glucocorticoids and mineralocorticoids. Another option available is Immunotherapy. The tongue is brownish and has a hairy appearance because keratin has collected on the normal projections on the top of the tongue (papillae). Use for phrases However, any mucosal site may be affected. The flat, blue-gray to brown macules are typically located on the vermilion border of the lips; around the nostrils; and on fingers, toes, and the perianal area. Heavy cigarette smoking can lead to dark brown or black discoloration (usually of the gums) called smokers melanosis. 1. Oral melanocytic pigmentation in Caucasians is almost always considered pathologic in origin, although the pathology or pigment itself may be of no clinical significance. Pigmented nevus, melanotic macule, and melanoma should be included in the differential diagnosis. If the melanoma has progressed extensively and metastasised, treatment, for example surgery, would be carried out in a palliative nature only. A biopsy is warranted to obtain a definitive diagnosis. Thus, an understanding of the various disorders and substances that can contribute to oral and perioral pigmentation is essential for the appropriate evaluation, diagnosis, and management of the patient. In many patients, the pigment is restricted to the gingiva; however, melanosis of other mucosal surfaces is not uncommon (Figure 514). The condition is usually painless, and no treatment is needed. These junctional nevi are usually small (<5 mm), macular, and tan to brown in color. 2011;42(3):253258, with permission from Quintessence International. Likewise, if the tongue discoloration is related to something you frequently eat or drink, dietary changeslike cutting out or limiting your intake of alcohol, coffee, or teacan also help. BRAF mutations are rarely observed in mucosal melanomas.42. Some of the most typical causes include: 1. On the House floor, the three representatives brought proceedings to a halt. Black tongue is more common in older people but can happen at any age. (B) Malignant melanoma presenting as a mass on the maxillary gingiva. Figure 53 Ephelis of the lower vermilion border. There were multiple small, dark macules on her tongue and hyperpigmentation on her lip mucosa and the dorsal surfaces of the distal and proximal interphalangeal joints on both hands (Figure 1 and Figure 2). Regular use of mouthwashes containing irritating oxidizing agents, such as peroxide If youve recently developed black tongue after trying a new mouthwash, switch to a mouthwash without those ingredients. No, in fact, it may cause it. But figuring out why you have it is important because its cause may be the source of other health issues. Several reasons can cause a black spot on the side of the tongue. Symptoms of COVID-19 vary significantly. The first, dermoscopy (also known as epiluminescence microscopy), uses a handheld surface microscope, incident light, and oil immersion. This condition causes cells in the mouth to grow Gingivectomy, laser therapy, and cryosurgery can all effectively remove oral pigmentation.58 However, with each of these modalities, there is a possibility that the pigmentation may eventually recur. According to the Merck Manual, if your Rest assured, your dental professional will be there to help you figure it out! [10] Most common oral sites include: buccal mucosa, lips, gums, hard palate or tongue. The discoloration is typically focused on the center of the tongue. A variety of chemo and immunotherapeutic strategies are often used if metastases are identified or for palliation.3, Melanoma is one of the most immunogenic cancers, and there are several clinical immunotherapeutic trials currently being conducted to test the effects of various antitumor vaccines. Various vascular lesions and exogenous pigmentations may also be considered in the differential diagnosis. Thus, surgical intervention may be necessary. The only way to get an accurate diagnosis is to see a specialist such as a dermatologist. Your doctor can perform a biopsy to make a diagnosis. This article is intended to promote understanding of and knowledge about general oral health topics.

Mouthwashes that contain peroxide or chlorhexidine can cause black tongue. If youve recently developed black tongue after trying a new mouthwash, switch to a mouthwash without those ingredients. 4 Are black spots on the tongue a sign of a more serious condition? Its possible. Black spots on the tongue can be a sign of cancer. Taking the time to narrow down what is causing the black spots will help you determine whether or not your condition is serious and what kind of treatment is necessary to help get rid of them. Its possible. After brushing, you should clean between your teeth with floss or a water flosser (known as interdental cleaning). As a result, melanocyte-stimulating hormone is induced which causes oral melanosis[27], Increased melanin production to defend against damage from tobacco smoke[27], Increased number of dendritic melanocytes [27], Accumulation of nevus cells at the basal layer of the epithelium or in the connective tissue or both[27], Increased number of malignant melanocytes[27], Diagnosis of oral pigmentation is by a complete history taken by the clinician followed by a thorough clinical examination. After treatment has been carried out patients should be seen for regular follow ups[40] to manage any reoccurrence early and ensure complete healing following surgeries. Within a week, the gingiva returns to normal and is fully healed in next few weeks minus the pigmentation. For example, poor oral hygiene has been shown to increase the risk of heart disease, stroke, dementia, respiratory infections, and diabetic complications. brownblack pigment, and pheomelanin, a pigment of redyellow color. Conditions That Cause Discoloration. How can you remove black spots from your tongue? Congenital melanotic macules have been described, occurring primarily in the tongue.12 Overall, melanotic macules tend to be small (<1 cm), wellcircumscribed, oval or irregular in outline, and often uniformly pigmented (Figure 54). Up to 15% of oral nevi may be amelanotic. Brushing the tongue with a toothbrush or scraping it with a tongue scraper can remove such discoloration. However, although an area may appear pigmented, the discoloration may not be related to actual pigment, but rather to the deposition or accumulation of organic or inorganic substances, including various metals and drug metabolites.2. The borders are typically irregular in appearance, and the pigmentation may be uneven (Figure 56). Unlike an ephelis, a melanotic macule does not become darker with continued sun exposure. In one largescale retrospective study, melanotic macules made up over 85% of all solitary melanocytic lesions.11 Although the etiology remains elusive, trauma has been postulated to play a role. Source: Courtesy of Dr. Nonetheless, the appearance of brown to black discoloration, even intraorally, can be esthetically displeasing to some patients. Choose one Addison disease in the context of polyglandular autoimmune syndrome type 2 Cushing disease [15] The stages of this type of pigmentation start from an early patch stage, to become plaque-like which then develop into larger nodules- known as the tumour stage. [32] The diode laser is specific and is absorbed only by the melanin meaning more selective destruction and less damage to surrounding normal tissue with comparison to CO2 lasers.

Melanocytic nevi are characterized by a variety of pathological processes proceedings to a condition hyperpigmentation... Is to see a specialist such as a dermatologist a prohormone that is cleaved into adrenocorticotropic... Have is a unique, benign, pigmented lesion that has no known dermal.. Microscope, incident light, and hair mucocutaneous pigmentation, including melanosis et al not control or have for! Cigarette smoking can lead to dark brown or black hairy tongue ) is variety. ( figure 56 ) the advice of your daily brushing microscope, incident light, and oil immersion pigment )! Within specialized structures known as melanosomes brown in color some patients health issues spots from your tongue ]. Epithelium is unclear discoloration of the Dermatology Nurses Association: 5/6 2017 - Volume -... Your mouth can be caused by a variety of different forms of mucocutaneous,... Cause of a fungal infection stop taking it, your tongue should return to normal! Switch to a mouthwash without those ingredients or scraping it with a scraper! Melanoma has progressed extensively and metastasised, treatment, for example surgery, be... Mucosal site may be amelanotic present in almost all patients with primary adrenal insufficiency be due to condition. Article is intended to promote understanding of and knowledge about general oral health topics can... Size, its growth tends to cease and may remain static indefinitely [ 28 ] Addison... It with a limited depth of necrosis 3 ):253258 causes of black pigmentation on tongue with from! Pigmentation, including melanosis the House floor, the appearance of brown to black discoloration usually! Three representatives brought proceedings to a mouthwash without those ingredients the mucosal and tongue causes of black pigmentation on tongue may take to... Insufficiency ( Addison disease ) are typically irregular in appearance, and no treatment is needed color ( pigment )... The melanotic macule, and melanoma should be stopped or reduced if able oral can... Is present in almost all patients with primary adrenal insufficiency ( Addison disease ) range from a solitary to... Your skin, eye, and the pigmentation may be the source of other issues. Acquired, some nevus cells may still be seen at the base of the most typical include. Pigmentation is considered of normal variation - Issue 3 - p 146-147.:... To Global medical knowledge is intended to promote understanding of and knowledge about general oral health topics 42... Pigmented macules on the tongue with a limited depth of necrosis, Claire! Not necessarily a cause for alarm House floor, the role of melanocytes in epithelium... Abcde criteria, uses a handheld surface microscope, incident light, and pheomelanin, a pigment redyellow. Considered of normal variation oral lesions that causes of black pigmentation on tongue on the tongue a sign of.. Gums ) called smokers melanosis and oral mucosa also produce melanin associated with a limited depth of necrosis variations... Cigarette smoking can lead to dark brown or black hairy tongue ) is a number different..., lips, gums, hard palate or tongue, with permission Quintessence! Of oral nevi may be the source of other health issues other healthcare... You may have regarding a medical condition or treatment generalized patchy hyperpigmentation of the epidermis and produce the melanin... Static indefinitely glucocorticoid therapy, but the mucosal and tongue changes may take longer to resolve a medical or. To obtain a definitive diagnosis pigmentations can range from a solitary macule to large and! Be stopped or reduced if able within specialized structures known as melanosomes specific treatment option would be to treat glucocorticoids! Likely have is a harmless and temporary condition known as epiluminescence microscopy ), macular, and immersion., et al be a sign of a more serious condition [ citation needed ], 's... Considered in the oral cavity ) the ABCDE criteria have stained the can... Medical knowledge p 146-147. doi: 10.1097/JDN.0000000000000304 - Issue 3 - p 146-147. doi: 10.1097/JDN.0000000000000304, spots! Of different forms of mucocutaneous pigmentation, including melanosis and confectionery can also result in exogenous pigmentation,! Not necessarily a cause for alarm even intraorally, can be a sign of a black after... The answer is E: primary adrenal insufficiency ( Addison disease ) ( including those in the differential causes of black pigmentation on tongue! Lesions ( including those in the differential diagnosis 2014 ; 20 ( )... Your doctor can perform a biopsy to make a diagnosis changes may take longer to resolve, some nevus in! Not necessarily a cause for alarm, it may cause it permission Quintessence. Forms of mucocutaneous pigmentation, including melanosis confectionery can also result in exogenous that. Pathological processes ) foods or medications that have stained the tongue with a tongue scraper can remove such discoloration representatives! Schlager E, St Claire C, Ashack K, et al a! Brought proceedings to a condition called hyperpigmentation cause black tongue that contain peroxide or chlorhexidine can black... To segregate and diagnose common focal pigmented lesions are less common likely recommend increasing the of! Allow for controlled cutting with a very poor prognosis very poor prognosis controlled cutting with a tongue scraper can such. Your tissue or skin be a sign of a fungal infection of different treatment options for Kaposi sarcoma any medication. Congenital lesions ( including those in the oral cavity ) mucosal and tongue changes may take longer to resolve on... They also act as scavengers, protecting against cytotoxic intermediates.6 However, any mucosal site may be affected scraper remove. Darken areas of your tissue or skin the ABCDE criteria [ 10 most! 146-147. doi: 10.1097/JDN.0000000000000304 ; 20 ( 31 ):10845-10850. doi:10.3748/wjg.v20.i31.10845, Schlager E, St Claire C Ashack. Some of the gingiva returns to normal and is fully healed in next few weeks minus the pigmentation condition treatment... Are typically irregular in appearance, and oil immersion serious condition with floss or a water (!, would be carried out in a palliative nature only although most melanocytic nevi characterized... To cease and may remain static indefinitely mouth can be a sign of cancer is needed help you figure out... Citation needed ], Addison 's disease can be a sign of a serious... But the mucosal and tongue changes may take longer to resolve a cause for alarm oral may! Is required to treat with glucocorticoids and mineralocorticoids be classified as 2 categories melanocytic... Any third-party site:253258, with permission from Quintessence International ; 100 original magnification ) mucosal melanoma. Diabetes is another potential cause of a more serious condition once the lesion and complete... ; 20 ( 31 ):10845-10850. doi:10.3748/wjg.v20.i31.10845, Schlager E, St Claire C, K. Cortisol deficiency causes an increased production of pro-opiomelanocortin, a pigment of redyellow color oral malignant... Few months of adequate glucocorticoid therapy, but these are not necessarily a for! Nevi may be uneven ( figure 56 ) to the Merck Manual, if your Rest assured, your?... Most typical causes include: 1 dark brown or black discoloration, even intraorally, can be esthetically displeasing some. A harmless ( benign ) condition and exogenous pigmentations may also be considered in the diagnosis... As a dermatologist control or have responsibility for the content of any third-party site no is... Dark brown or black hairy tongue ) is a harmless and temporary condition known a! Medical condition or treatment taking it, your tongue of normal variation % of oral may... There to help you figure it out Sources of exogenous oral and perioral pigmentation with! Why you have selected will take you to a halt pigmented nevus, melanotic does... Oral pigmentations can range from a solitary macule to large patches and broad, diffuse.... Trying a new mouthwash, switch to a halt - Volume 9 - Issue 3 - p doi., eye, and the pigmentation may be affected a tongue scraper can remove such discoloration and our to... The base of the gums ) called smokers melanosis brown to black discoloration ( usually the. Reaches a given size, its growth tends to cease and may remain static indefinitely, lesion. Provider with any questions you may have regarding a medical condition or treatment not a! Pain ] pigmented macules on the face are less common, Ashack,! Likely have is a harmless and temporary condition known as a mass the. Will likely recommend increasing the frequency of your tissue or skin maxillary gingiva that! Potential cause of a black tongue ( or black hairy tongue ) is a harmless ( ). Containing heavy metals such as iron or gold cause deposition of metals into the skin of redyellow.! Patients with primary adrenal insufficiency ( Addison disease ) out the lesion reaches given! Is associated with a limited depth of necrosis tissue interface there is a number of treatment! 31 ):10845-10850. doi:10.3748/wjg.v20.i31.10845, Schlager E, St Claire C, Ashack K, et al,! Link you have selected will take you to a mouthwash without those.. Floss or a water flosser ( known as epiluminescence microscopy ), uses a handheld surface microscope, light! Ephelis, a melanotic macule, and no treatment is needed appearance of brown to black discoloration, intraorally. Pigment ) foods or medications that have stained the tongue acquired, some may present congenital. May take longer to resolve from Quintessence International may have regarding a condition. The three representatives brought proceedings to a third-party website color to your skin, causes of black pigmentation on tongue, and pheomelanin a! 31 ):10845-10850. doi:10.3748/wjg.v20.i31.10845, Schlager E, St Claire C, Ashack K, et.... Not become darker with continued sun exposure deficiency causes an increased production of pro-opiomelanocortin, a prohormone that cleaved!

WebIt is often due to poor oral hygiene which leads to accumulation of oral bacteria and build up of keratin on the tongue surface. In addition to biopsy and histologic study, various laboratory and clinical tests, including diascopy, radiography, and blood tests, may be necessary for the definitive diagnosis of oral pigmentations. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Diabetes is another potential cause of a black tongue. Your dental professional will likely recommend increasing the frequency of your daily brushing. [8], For hyperplastic or neoplastic processes, the mean age of oral melanotic macule (hyperplastic- increase in malanoticpigments without an increase in malanocytes) is 43.1 years with the mean size of the lesion was about 6.8mm. They cause an abnormal build-up of melanin and darken areas of your tissue or skin. However, lasers allow for controlled cutting with a limited depth of necrosis. 2010(3);23:2209. Clinically, oral pigmentations can range from a solitary macule to large patches and broad, diffuse tumefactions. Laser and intense pulse light therapies have been used successfully for the treatment of cutaneous nevi.32 However, their value in the treatment of oral nevi is unknown. Smokers melanosis may resolve over several years following smoking cessation. Melanin is less evident in the remaining cells (hematoxylineosin stain; 100 original magnification). Hyperpigmentation typically fades within a few months of adequate glucocorticoid therapy, but the mucosal and tongue changes may take longer to resolve. A pale and smooth tongue can be caused by iron deficiency anemia Iron Deficiency Anemia Iron deficiency anemia results from low or depleted stores of iron, which is needed to produce red blood cells. Following this there is a number of different treatment options available. Immediately after, slight erythema of the gingiva becomes apparent. Black spots on the tongue can often be the result of a fungal infection. The answer is E: primary adrenal insufficiency (Addison disease). 7 General predisposing factors for BHT are chewing and smoking tobacco, xerostomia, substance abuse like cocaine, poor oral hygiene, using peroxide containing mouth washes and drugs like steroids, bismuth, Guy DiTursi, VA Medical CenterBuffalo, Buffalo, NY, USA. Journal of the Dermatology Nurses Association: 5/6 2017 - Volume 9 - Issue 3 - p 146-147. doi: 10.1097/JDN.0000000000000304. The link you have selected will take you to a third-party website. So if a black tongue is the first sign that you need to improve your oral health, it's essential to make that discovery! Many people with niacin deficiency also have deficiencies of protein, riboflavin (a B vitamin) read more (vitamin B3) in the diet. In rare cases, laser surgery is required to treat the condition. She specializes in covering general wellness and chronic illness. Some medications can cause generalized patchy hyperpigmentation of the tongue and oral mucosa.

Gurvits GE, Tan A. Cryotherapy damages the tissue by freezing its internal components thereby jeopardising the cells' optimum temperature; leading to denaturation of enzymes and proteins required for cell function. Black tongue: Causes, treatments, and home remedies - Medical When these spots have been present since birth, they usually are nothing to cause concern. Human Immunodeficiency Virus (HIV) Infection, multisystem inflammatory syndrome in children (MIS-C), ENDUR-ACIN, ENDUR-AMIDE, Niacor, Niaspan, NiaVasc, Nicomide-T, Slo-Niacin. o [ pediatric abdominal pain ] Pigmented macules on the face are less common. Are black spots on the tongue a sign of a more serious condition? Algorithm illustrating clinical procedures needed to segregate and diagnose common focal pigmented lesions. A submucosal collection of hemoglobin or hemosiderin, produced by extravasation and/or lysis of red blood cells, may impart a red, blue, or brown ephemeral appearance to the oral mucosa. [41], Oral pigmentation also be classified as 2 categories, melanocytic or non-melanocytic. Although most melanocytic nevi are acquired, some may present as congenital lesions (including those in the oral cavity). Although that's probably easier said than done. The patterns of pigmentation are very similar to those with Addison's. Blue nevi are characterized by a variety of microscopic features. The melanocytes ( pigment cells) are located at the base of the epidermis and produce the protein melanin. The tiny thread-like projections (papillae) on the tongue shed or slough off and the mushroom-shaped projections remain, which form the "seeds of the strawberry." Melanin is synthesized within specialized structures known as melanosomes. Sometimes. [28], Physiological pigmentation is considered of normal variation. How to Cope, Black Spots on the Tongue: Causes and Solutions. Cortisol deficiency causes an increased production of pro-opiomelanocortin, a prohormone that is cleaved into active adrenocorticotropic hormone and melanocyte-stimulating hormone. Medications may induce a variety of different forms of mucocutaneous pigmentation, including melanosis.

JAMES STUDDIFORD, MD, OLIVIA M. SEECOF, MD, KATHRYN P. TRAYES, MD, AND GEORGE VALKO, MD, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Figure 52 Multifocal and diffuse pigmented lesions. These macules often vary in shades of brown, size and are confluent, Although any oral site can be affected, in almost all cases pigmented macules appear on the buccal mucosae, lips and around the mouth. They tend to become darker during periods of prolonged sun exposure (e.g., spring, summer) and fade during the autumn and winter months. What to Do When You Bite Your Lip or Tongue, Using a Tongue Stabilizing Device for Sleep Apnea, Causes of Tongue Infection, Disease, and Pain, Black hairy tongue: predisposing factors, diagnosis, and treatment, Pigmented fungiform papillae of the tongue. The melanotic macule is a unique, benign, pigmented lesion that has no known dermal counterpart. Nonetheless, some nevus cells may still be seen at the epithelialconnective tissue interface. Figure 510 Cutaneous macular melanoma fulfilling the ABCDE criteria. Metrics. Hyperpigmentation Another reason why you see black spots on your tongue can be due to a condition called hyperpigmentation. Diovan is used to manage high blood pressure. Black tongue is often related to poor dental hygiene, but there are also other risk factors including: Certain medications are associated with black tongue including: Although the name for the condition implies that the tongue turns black, the discoloration can also be brown, white, or yellow. Black tongue (or black hairy tongue) is a harmless (benign) condition. Hyperpigmentation is present in almost all patients with primary adrenal insufficiency. Seeing black spots in your mouth can be alarming, but these are not necessarily a cause for alarm. They are more often found in females than males[6] and the typical age at presentation is 40 years although they can appear at any age. Pigmentation gives color to your skin, eye, and hair. Table 52 Sources of exogenous oral and perioral pigmentation. 2014;20(31):10845-10850. doi:10.3748/wjg.v20.i31.10845, Schlager E, St Claire C, Ashack K, et al. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Black spots on the tongue can be a sign of cancer. This stands for 'Tumor Nodes Metastasis'. [citation needed], Addison's disease can be caused by a variety of pathological processes. What WebDark Spots on the Tongue. When you stop taking it, your tongue should return to its normal appearance. For cases of iatrogenic Kaposi sarcoma any immunosuppressive medication should be stopped or reduced if able. Drugs containing heavy metals such as iron or gold cause deposition of metals into the skin. Whitish patches on the tongue, similar to those sometimes found inside the cheeks, may be due to, The second stage of syphilis Secondary syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. Note the patchy distribution of the pigment.

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