hairy leukoplakia

Introduction

Whitish discoloration of the tongue that does not scrap off easily.

Etiology

• mucosal epithelial infection with Epstein-Barr virus (EBV)

Epidemiology

• common in patients with HIV1 infection
• also occurs in patients taking immunosuppressive agents

Clinical manifestations

• painless patches of white, linear, frond-like lesions on the buccal mucosa & tongue
  • white, corrugated, adherent plaque on the lateral surface of the tongue
• lesions do not scrap off easily as does thrush (Candida)
• lesions may wax & wane over time or resolve spontaneously

Laboratory

• none generally needed
• biopsy shows changes typical for EBV
• scrapings from lesions may show colonization with Candida

Complications

• not a premalignant lesion

Differential diagnosis

• squamous cell carcinoma of the mouth
  • white, corrugated, adherent plaque on the lateral surface of the tongue may be white exudate concealing ulcerated nodular lesion on the ventral surface of the tongue
  • ulcer for >= 2 months with increasing pain (hairy leukoplakia is painless)
  • history of heavy alcohol & tobacco use
• oral lichen planus
  • white, lacy pattern on dorsal tongue or as shallow red ulcers
  • generally due to medications or chronic trauma in elderly
• Behcet disease
  • generally manifests in patients in their 20s
  • recurrent oral ulcers may last 3 weeks, not 2 months
• secondary syphilis:
  • whitish, wart-like lesions (condyloma latum) on mucous membranes
  • resolution in 3-6 weeks

Management

• may resolve spontaneously
• resolution with antiviral therapy
  • acyclovir
  • zidovudine (AZT)

More general terms

• viral infection

Additional terms

• Epstein-Barr virus (EBV); human herpesvirus 4 (HHV4)