numerous oral mucosal lesions are quite frequently encountered , the two most common hairy lesions of the human tongue being hairy leukoplakia and hairy tongue . these two conditions need to be differentiated because of their different clinical , histopathological , and biological behavior . hairy tongue ( ht)(lingua villosa)is the name given to a benign condition characterised by a hair - like coating on the dorsum of the tongue . the color of the coating , though variable , is often brownish - black and hence , is referred to as black hairy tongue ( lingua villosa nigra ) . although usually asymptomatic , anxiety over this condition prompts the patient to seek medical advice . we present here a rare case of ht where scrape cytology helped in its rapid diagnosis . a 52 year - old male patient presented with a hairy coating on the tongue that he had observed for the past 15 days . besides the grotesque appearance of the tongue , the hairy coating neither caused any hindrance in swallowing nor any abnormal sensation . the patient gave a history of persistence of growth in spite of repeated attempts to scrape it off . the patient was hiv - negative and was not on any medicines like erythromycin , anti - glaucoma drugs , or steroids . examination revealed a brownish - black hairy growth on the posterior third of the dorsum of the tongue [ figure 1 ] . the hairy projections were approximately one centimetre in length ; the central part of the tongue was heavily coated . scrape cytology had been advised by the referring clinician to rule out any malignant potential of this unusual condition . no draining lymph nodes were palpable but poor oral hygiene and halitosis was noted on examination . arrow showing hairy growth on posterior third of dorsum of the tongue scrape smears were prepared using a wooden spatula . when performing the scrape , it was noted that while superficial material could be easily scraped off , the hairy projections were firmly adherent to the site . the wet - fixed smears were stained with hematoxylin and eosin and papanicolaou ( pap ) stains ; one air - dried smear was stained with may - grnwald - giemsa stain . squamous cells did not show any nuclear enlargement , multinucleation , pleomorphism , or perinuclear halo . many bacterial colonies and fungal bodies were evident along with abundant extraneous material in the background . some prominent , elongated , hair - like structures , the hall mark of this disease , were also noted [ figure 2 ] . periodic acid schiff ( pas ) stain confirmed the fungal bodies whereas gram stain showed many gram - positive bacterial colonies . scrape smears from the hairy lesion on the tongue : squamous cell with bacterial colonies , fungal bodies ( pap , 1000 ) . inset : hair - like structure , the hall mark of this disease ( pap , 100 ) normally , each papilla is approximately one millimetre in length and has a dome - shaped , primary papilla that is surmounted by three to eight elongated secondary papillae . the secondary papillae are composed of a central column of epithelial cells that express hair - type keratin . defective desquamation of these cells along with their marked retention , results in the formation of the  hairs  which are the hallmark of this disease . thus , the hairs seen in hairy tongue , that may measure even more than 15 mm in length , are highly elongated and cornified filiform papillae . normal papillae , which are minimally keratinised , appear pinkish - white . however , hair may appear in a variety of hues ( brown , black , white , green , pink ) depending on pigments retained from various food stuffs , beverages , or personal habits . in the present case , the patient was a chronic tobacco - chewer which probably led to the brownish - black color of the hairs . bacterial and fungal overgrowth have also been thought to play a role in the color of hairy tongue . the prevalence of hairy tongue varies widely , with adult males being more commonly affected . however , hairy tongue was reported in a two month - old infant . of the various etiological factors associated with this condition , poor oral hygiene and chronic tobacco use were noted in the present case . besides these , other social habits such as heavy drinking of coffee , tea , use of mouthwashes , drugs like long - term , oral erythromycin , tropical or systemic antibiotics , and steroids have also been implicated . in the present case , halitosis that was noted during examination was probably due to entrapped food debris and the bacterial and fungal overgrowth between the elongated papillae . while performing the scrapes , this was the material that could be easily scraped off along with few papillae . this also correlated with the microscopic features of the presence of the abundant extraneous material , bacteria , and fungal bodies . although usually asymptomatic , complaints due to the hairy growth range from halitosis and altered taste to tickling or gagging sensation and nausea . the condition may occasionally be very persistent , as was observed in this case where repeated attempts to remove the growth proved futile . however , cure has been reported with application of 40% solution of urea , scraping , topical triamcinolone acetonide , gentian violet , thymol , salicylic acid , vitamin b complex , and in very persistent cases , surgical excision of the papillae . hairy tongue needs to be differentiated from oral hairy leukoplakia , especially in patients who are hiv - positive . besides , oral hairy leukoplakia which is caused by epstein - barr virus shows ballooned epithelial cells with a distinct perinuclear halo this case , along with its cytological details , is being reported to create awareness of this unusual condition .
hairy tongue ( ht ) is a benign condition that causes concern over its abnormal appearance . 
 ht is most commonly seen in adults and is seen as an abnormal coating of the tongue due to hyperkeratosis of filiform lingual papillae . 
 cytological scraping of the lesion on the tongue was done which showed squamous cells , extraneous material , bacterial colonies , fungal bodies , and hair - like projections , which are the hall mark of the disease . 
 we present a case along with its scrape cytology findings .