Oral Hairy Leukoplakia

Aka: Oral Hairy Leukoplakia, Hairy Leukoplakia

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II. Causes

  1. Epstein-Barr Virus (Mononucleosis)
  2. Severe Immunodeficiency (including HIV)

III. Signs

  1. Vertical white, hyperkeratotic striations on Tongue appear similar to hairs
  2. Distributed over lateral dorsum of Tongue (unilateral or bilateral)

IV. Labs: Indicated if No Pre-diagnosed Immunodeficiency

  1. Monospot
  2. HIV Test

V. Differential Diagnosis

  1. Oral Candidiasis
    1. Hairy Leukoplakia cannot be scraped from the Tongue (unlike Thrush)

VI. Management

  1. No treatment needed in asymptomatic patients
  2. May respond to Antiviral Agents (may also recur after course completed)
    1. Acyclovir 800 mg 5 times daily for 1-3 weeks
    2. Ganciclovir 100 mg 3 times daily for 1-3 weeks
  3. Other treatments in refractory symptomatic cases
    1. Podophyllin Resin and Acyclovir cream
    2. Moura (2010) Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110(5):611-7 +PMID: 20813564 [PubMed]

VII. References

  1. Reamy (2010) Am Fam Physician 81(5): 627-34 [PubMed]
  2. Straub (2024) Am Fam Physician 110(5): 467-75 [PubMed]

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