Black Spots on Tongue: Lingual Keratosis and Its Causes

There are small black spots (approximately 0.3 mm in diameter) on the tip of the tongue?

Hello, I have noticed some dark brown spots distributed on the tip of my tongue, which I discovered during my sophomore year of high school, about 7 to 8 years ago.
Initially, the spots were very prominent, but now they have changed to a dark brown color.
My younger sister, who is currently a freshman in college and is 5 years younger than me, has also developed similar symptoms on the tip of her tongue.
Recently, she visited the dermatology department at Cheng Kung University, and the doctor diagnosed it as a keratosis, which typically occurs on the epidermis of the male scrotum and requires electrosurgery for treatment.
Could you please explain why this is happening? (I do not smoke or chew betel nut.) Thank you for taking the time to answer my question.

Qingcai, 20~29 year old female. Ask Date: 2006/05/16

Dr. Ye Dawei reply Otolaryngology

Miss, your issue does not seem to be a malignant tumor, but it is best to visit the clinic for a doctor's examination.

Reply Date: 2006/05/16

More Info

Black spots on the tongue can be a source of concern for many individuals, especially when they persist over time. In your case, the presence of black-brown spots on the tongue for several years, along with a similar condition observed in your sister, raises some interesting points for discussion.

Firstly, it is essential to understand that the tongue is a complex organ with various structures, including papillae, which can sometimes undergo changes due to a variety of factors. The spots you describe could potentially be related to a condition known as lingual keratosis, which is characterized by thickening of the keratin layer on the tongue's surface. This condition can lead to the formation of dark spots or patches, and while it is often benign, it can be associated with irritation or friction from various sources, such as rough foods or dental appliances.

The diagnosis of "角化瘤" (keratosis) made by the dermatologist you consulted may refer to a benign growth of keratin on the skin or mucous membranes. While keratosis is more commonly associated with sun-exposed areas of the skin, it can also occur in the oral cavity, including the tongue. The fact that this condition is noted to occur more frequently in males, particularly on the scrotum, suggests that there may be specific risk factors or genetic predispositions involved. However, it is not exclusive to those areas and can manifest elsewhere, including the tongue.

In your case, the absence of smoking or betel nut chewing habits is noteworthy, as these are common risk factors for various oral lesions. Other potential causes of black spots on the tongue can include:
1. Pigmented Fungiform Papillae: As mentioned in previous discussions, these can appear as dark spots due to melanin deposition. This condition is generally harmless and can be influenced by genetic factors.

2. Oral Melanotic Macules: These are flat, brown or black spots that can occur on the oral mucosa, including the tongue. They are usually benign and can be caused by various factors, including sun exposure and hormonal changes.

3. Fungal Infections: Certain fungal infections can lead to discoloration of the tongue. Oral thrush, for example, can cause white patches that may darken over time.

4. Trauma or Irritation: Chronic irritation from rough foods, dental appliances, or even habits like biting the tongue can lead to localized changes in pigmentation.

5. Systemic Conditions: In some cases, systemic conditions such as Addison's disease or Peutz-Jeghers syndrome can lead to pigmentation changes in the oral cavity.

Regarding treatment, if the spots are determined to be benign keratosis, they may not require any intervention unless they cause discomfort or cosmetic concerns. In cases where the keratosis is more pronounced or bothersome, dermatological procedures such as electrosurgery or laser treatment may be considered to remove the lesions.

It is crucial to continue monitoring the spots for any changes in size, shape, or color, and to maintain regular check-ups with your healthcare provider. If there are any new symptoms, such as pain, swelling, or difficulty swallowing, these should be addressed promptly.

In conclusion, while the presence of black-brown spots on the tongue can be alarming, understanding the potential causes and seeking professional evaluation can help alleviate concerns. It is always advisable to consult with a healthcare professional for a thorough examination and personalized advice based on your specific situation.

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