Pantoprazole induced black hairy tongue: a case report


  • Divya G. Krishnan Department of Pharmacology, KMCT Medical College, Kerala University of Health Sciences, Kerala, India
  • Anukesh Vasu Keloth Department of Surgery, KMCT Medical College, Kerala University of Health Sciences, Kerala, India
  • Neethu P. Department of Pharmacology, KMCT Medical College, Kerala University of Health Sciences, Kerala, India



BHT, Pantoprazole, Adverse drug reaction, Surgical wound infection


Black hairy tongue (BHT) is characterized by abnormally hypertrophied and elongated filiform papillae, appearing as blackish discoloration on the dorsal surface of the tongue. BHT has been reported as an adverse drug reaction to different categories of drugs. However, pantoprazole induced BHT has been rarely reported. We present the case of a 42-year-old female, admitted in the surgery ward with postoperative wound infection, for which she was prescribed oral clarithromycin and pantoprazole. On the third day of starting medications, she complained of blackish discoloration on the dorsal surface of the tongue with an alteration of taste sensation, which was clinically and microscopically diagnosed as BHT. Suspecting BHT as an adverse drug reaction to pantoprazole, it was stopped, while clarithromycin was continued for the full course. She was also advised to scrape her tongue thrice daily, drink adequate fluids and maintain good oral hygiene. On the third day after stopping pantoprazole, black discoloration and alteration of taste sensation resolved completely. WHO-UMC causality assessment scale showed a ‘probable’ association of the adverse drug reaction with pantoprazole. Physicians should be aware of the possibility of BHT with the use of pantoprazole and that it completely resolves on stoppage of the drug, mechanical debridement and good oral hygiene.


Schlager E, St Claire C, Ashack K, Khachemoune A. Black hairy tongue: predisposing factors, diagnosis, and treatment. Am J Clin Dermatol. 2017;18:563-9.

Vano-Lalvan S, Jaen P. Black Hairy Tongue. Cleveland Clin J Med. 2008;75(12):847-48.

Rajarammohan K, Narayan M, Ravikumar PT. Hairy tongue - a series of 4 cases. J Evolution Med Dent Sci 2020;9(35):2567-70.

Nisa L, Giger R. Black hairy tongue. Am J Med. 2011;124:816-7.

Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastroenterol. 2014;20:10845-850.

Aryal E, Rajbhandari M, Bhattarai S. Lansoprazole-Induced Black Hairy Tongue- A Case Report. Nepal J Dermatol Venereol Leprol. 2017;15(1):52-4.

Jhaj R, Gour PR, Asati DP. Black hairy tongue with a fixed dose combination of olanzapine and fluoxetine. Indian J Pharmacol. 2016;48:318-20.

Sowmya HK. Hairy tongue: A case report and review of literature. Int J Curr Res. 2016;8(7):35022-4.

Proton pump inhibitors and tongue discoloration. 2009. Available at: https://databankws.lareb.Nl/Downloads/kwb_2009_4_ppis.pdf. Accessed on 20 May, 2023.

Vautier G, Scott BB. A one-week quadruple eradication regimen for Helicobacter pylori in routine clinical practice. Aliment Pharmacol Ther. 1997;11(1):107-8.

Bradshaw DJ, Marsh PD. Analysis of pH-driven disruption of oral microbial communities in-vitro. Caries Res. 1998;32(6):456-62.

Thompson DF, Kessler TL. Drug-induced Black hairy tongue. Pharmacotherapy. 2010;30:585-93.

Manabe M, Lim HW, Winzer M, Loomis CA. Architectural organization of filiform papillae in normal and black hairy tongue epithelium: dissection of differentiation pathways in a complex human epithelium according to their patterns of keratin expression. Arch Dermatol. 1999;135:177-81.

Jing R, Yao Z, Hui D, Shan W, Linna L, Wanshi D et al. Antibiotic-induced black hairy tongue: two case reports and a review of the literature. J Int Med Res. 2020;48(10):1-11.




How to Cite

Krishnan, D. G., Keloth, A. V., & P., N. (2023). Pantoprazole induced black hairy tongue: a case report. International Journal of Basic & Clinical Pharmacology, 12(5), 745–748.