Why Does My Tongue Have Purple or Blueish Spots

Purple or blue tongues are common among those with certain types of cancers. The cause is not known but there may be several factors which could include:

Cancerous cells have been found in the mouth and throat area. These cells produce a substance called prostaglandin E2 (PGE2). PGE2 causes blood vessels to dilate causing pain when swallowing.

This is one reason why some people develop a purple tongue after having surgery on their mouths or throats. Other reasons could be from chemotherapy drugs used to treat cancer. Some medications such as those used to treat HIV/AIDS, hepatitis C, and tuberculosis can damage the liver. This could lead to a condition called hepatic encephalopathy (HE), which would result in loss of memory and other cognitive functions. HE is rare but if it occurs, treatment will likely help restore normal function.

Some people may experience a purple tongue after having surgery on their mouths or throats. This condition is called pharyngocele. Pharyngoceles are large, hard masses of tissue that form in the back of your throat and upper airway.

They can occur anywhere along the neck, including behind your ear, between your nose and cheekbone, and sometimes in front of your eye. The exact cause is unknown, although trauma to the area may contribute. People with Behçet’s disease or sarcoidosis may experience this condition.

Anytime you have a change in color or texture of your tongue, it could be a sign of something serious. Some people may naturally have a dark tongue or may develop harmless conditions like white patches, raised areas, or small red dots called Fordyce spots. However, if you or someone you know has a blue-black or purple tongue without an obvious cause such as surgery or a dental procedure, you should see a doctor immediately.

It can be a sign of a more serious underlying medical condition.

The first step is to determine what’s causing the change in color. This may require some testing and possibly treatment. A dark purple or bluish color on your tongue could simply be due to something you ate or an artificial coloring agent.

If you’ve consumed something that has an artificial coloring agent in it, the agent could be staining your tongue rather than being absorbed into your body. Cleaning your tongue and/or brushing your teeth may remove the stain. Otherwise, it should wear off in a day or two. However, a sudden change in tongue color could also be a sign of a more serious medical condition. A blue-black or purple color that doesn’t go away could be due to bleeding in your mouth.

When bleeding occurs inside the mouth, the blood hasn’t had time to oxidize and take on a brownish color. It’s still a bright red. Fresh blood can drip down from your mouth into your throat while you’re swallowing, which is one way this condition can manifest.

Another way is when food or other objects irritate the delicate tissue inside your mouth and cause bleeding.

These are all reasons why you should see your doctor if you notice any fresh blood in your saliva. If there’s a large amount of blood, you’re likely to have other symptoms as well. Those could include:

Severe sore throat with pain on swallowing

Difficulty swallowing

A lump anywhere in your neck

Swollen lymph nodes in your neck



General ill feeling (malaise)

Trouble breathing

Hoarseness You may also have other symptoms specific to the cause of the bleeding.

One common cause of this condition is mouth and throat cancers. These can be difficult to identify and are sometimes only found during an autopsy after someone has died from them. These types of cancer often manifest in other ways, such as a painless lump or a smoker’s cough that doesn’t go away.

However, bleeding can also happen without any pain or warning. This is particularly true in the case of ulcers that have eroded through the walls of the esophagus or stomach and caused bleeding into the throat.

Other potential causes of fresh blood in your mouth include acid reflux disease, throat infections, and autoimmune diseases. Your doctor will know how to differentiate between these possibilities and may refer you to a specialist for further testing. One common test used to rule out various diseases is a barium swallow, where a contrast dye is ingested and pictures are taken of your throat, esophagus, and stomach as the dye passes through.

You may need treatment if you’ve been bleeding in your mouth or if it’s unclear what the cause is. Possible treatments include antibiotics if you have an infection, surgery to repair any ulcers or other internal damage, or a tonsillectomy to remove diseased tonsils.

Even if the bleeding does stop on its own and your tongue returns to its normal color, see a doctor right away! There are many possible causes for a sudden change in tongue color and they all need to be ruled out.

Some of these causes are harmless; a few of them aren’t. For this reason, it’s not a good idea to guess and self-diagnose over the internet. If you see something that just doesn’t look right or isn’t normal for you, don’t be afraid to get it checked out by your doctor.

They won’t be upset or think any less of you for being proactive about your health.

If you do have fresh blood in your mouth, don’t try to rinse it away with common household products. These can irritate your mouth and cause further bleeding. Instead, rinse your mouth out with salt water (1/2 teaspoon of table salt in an 8 ounce glass of warm water).

Do not:

1. Swallow this water.

2. Use warm or hot water.

3. Use straight peroxide.

4. Use vinegar or alcohol.

5. Bite or chew on the sore area.

6. Exercise right after the bleeding episode, since you may damage the tissues that are already injured due to lack of oxygen.

If you have any of the following risk factors, or have other concerning symptoms, it’s especially important to see a doctor right away:

1. You’re over the age of 40.

2. You smoke or use tobacco in any form.

3. You’ve had heavy coffee, tea, or alcohol intake that day.

4. There’s a history of heavy alcohol use or smoking in your family.

5. You have a history of heavy alcohol use or smoking.

6. You suffer from migraine headaches.

7. You have a family history of autoimmune diseases (such as rheumatoid arthritis, lupus, MS, or cancer).

8. You have asthma.

9. You have diabetes or are at risk for developing diabetes.

10. You have a compromised immune system due to illness or treatment (such as chemotherapy).

11. You take steroid medication on a regular basis.

12. There’s a history of stomach ulcers, bleeding, or perforation in your family.

13. You have red or purple spots on your lips or in your mouth that hurt when you chew.

14. You have fresh red or purple spots on your tongue that hurt when you chew.

15. Your gums are bleeding.

16. You have a pain on the roof of your mouth.

If you’re still not sure if you should see a doctor after reviewing this list, err on the side of caution and make that appointment. Better safe than sorry!

Sources & references used in this article:

Bilateral nevus Ota associated with nevus Ito: a case of pigmentation on the lips by MM Ko, JA Lee, BK Kang, TY Park, J Lee… – … and Alternative Medicine, 2012 – Hindawi

Study on the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease by A HIDANO, H KAJIMA, Y ENDO – Archives of dermatology, 1965 – jamanetwork.com

Traumatic asphyxia: experimental and clinical observations with a report of a case with concomitant paraplegia by Y Feng, H Xu, D Qu, F Zheng, D Shi, K Chen – Chinese Journal of …, 2011 – Springer

Cutis marmorata telangiectatica congenita and extensive mongolian spots: type 5 phacomatosis pigmentovascularis by FL Reichert, JW Martin – Annals of surgery, 1951 – ncbi.nlm.nih.gov

Systemic significance of oral pigmentation and discoloration by A Torrelo, A Zambrano, R Happle – British Journal of …, 2003 – Wiley Online Library

Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations by CO Dummett – Postgraduate medicine, 1971 – Taylor & Francis