DISEASE : Oral Hairy Leukoplakia (OHL)

Oral hairy leukoplakia (OHL) is a painless, white, nonremovable, plaque like lesion typically located on the lateral aspect of the tongue.

PHYSICAL FINDINGS & CLINICAL

• Varying morphology and appearance, which may change daily.
• May be unilateral or bilateral.
• White plaques can be small with fine, vertical corrugations on the lateral margin of the tongue
• Irregular surface; may have prominent folds or projection, occasionally markedly resembling hairs.
• May spread to cover the entire dorsal surface or spread onto the ventral surface of the
• Rarely, lesions can manifest on the soft palate, buccal mucosa, or posterior oropharynx.
• Usually asymptomatic, but some patients have mouth pain, soreness, or a burning sensation; impaired taste; or difficulty eating; others complain of its unsightly appearance.
• OHL may progress to oral squamous cell carcinoma, which has a poor prognosis.

ETIOLOGY

EBV is implicated in its etiology, and OHL is a result of replication EBV in the epithelium of keratinized cells. OHL differs from most EBVrelated diseases in that infection is predominantly lytic rather than latent.

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

• Candida albicans
• Lichen planus
• Idiopathic leukoplakia
• White sponge nevus
• Dysplasia
• Squamous cell carcinoma

WORKUP

Requires physical examination and evaluation of HIV disease

LABORATORY TESTS

The provisional diagnosis is clinical and based on:

• Visual inspection
• Inability to scrape the lesion off the tongue with a blade
• Failure to respond to antifungal therapy

The presumptive diagnosis requires biopsy and histologic demonstration of:

• Epithelial hyperplasia with hairs
• Absence of inflammatory cell infiltrate

The definitive diagnosis requires:

• In situ hybridization of histologic or cytologic specimens revealing EBV DNA or
• Electron microscopy of specimens revealing herpes-like particles
• Measurement of the DNA content in cells of oral leukoplakia may be used to predict the risk of oral carcinoma

Note: Specimens obtained from lesions may demonstrate hyphae of Candida albicans, which may coexist and potentiate EBV-induced OHL.

TREATMENT

NONPHARMACOLOGIC THERAPY

OHL is usually asymptomatic and requires no specific therapy. It may resolve spontaneously and has no known premalignant potential.

ACUTE GENERAL Rx

• Antiretroviral therapy (ART) has considerably changed the frequency of oral lesions caused,by opportunistic infections in HIV-seropositive, individuals.
• Topical retinoids (0.1% vitamin A) may improve the appearance of OHL-affected oral surfaces through their dekeratinizing and immunomodulation effects; however, they are expensive and prolonged use may result in a burning sensation over the treated area.
• Topical podophyllin resin 25% solution has been reported to induce resolution.
• Surgical excision and cryotherapy may help, but the lesions may recur.
• High-dose acyclovir 800 mg five times per day, valacyclovir 1000 mg tid, famciclovir 500 mg tid, ganciclovir 1000 mg tid, or foscarnet 40 mg/kg IV t.i.d will cause lesions to resolve but only temporarily.