Hairy Oral Leukoplakia

Background

  • It is caused by the Epstein-Barr virus (EBV)
  • Most commonly seen in immunocompromised individuals, and has a high specificity for individuals with HIV/AIDs.
  • The white plaque appearance is due to hyperkeratosis and epithelial hyperplasia.

Clinical Features

  • Characterized by white plaques over the lateral sides of the tongue.
  • Unlike oropharyngeal candidiasis, the white plaques are unable to be scraped off.
  • It is asymptomatic, with most patients presenting over concern for aesthetic appearance

Differential Diagnosis

Tongue diagnoses

Oral rashes and lesions

Evaluation

  • Diagnosed clinically
  • Consider HIV testing if no other etiology is determined or if risk factors are present

Management

  • The condition is benign and does not require treatment but many patients have concerns about the aesthetic appearance.
  • Foundation of treatment is aimed at workup and management of the often underlying concomitant immunocompromised disease process.
  • High dose acyclovir can be used (4g/day), but relief is temporary and often lesions recur until immunocompromised status is reversed

Disposition

  • Discharge unless concomitant symptoms require further work-up

See Also

References

  • Chapple, IL; Hamburger, J (August 2000). "The significance of oral health in HIV disease". Sexually Transmitted Infections. 76 (4): 236ā€“43. doi:10.1136/sti.76.4.236. PMC 1744197. PMID 11026876
  • Cherry-Peppers, G; Daniels, CO; Meeks, V; Sanders, CF; Reznik, D (February 2003). "Oral manifestations in the era of HAART". Journal of the National Medical Association. 95 (2 Suppl 2): 21Sā€“32S. PMC 2568277. PMID 12656429.