Hairy Leukoplakia Differential Diagnoses
- Author: Denis P Lynch, DDS, PhD; Chief Editor: Dirk M Elston, MD more...
Squamous cell carcinoma
Human papillomavirus (HPV)–induced neoplasia
Syphilitic mucous patch
White sponge nevus candidiasis or thrush typically occurs as a flat lesion, removable by scraping that reveals an erythematous base. However, hyperplastic candidiasis lesions are adherent and do not wipe off, making this disease especially difficult to distinguish from hairy leukoplakia. Resolution of the lesion with antifungal therapy suggests candidiasis over hairy leukoplakia. However, hairy leukoplakia lesions are commonly also infected with Candida, further confusing the clinical diagnosis.
Frictional keratosis typically occurs on the lateral borders of the tongue as a consequence of tongue biting by the molar teeth or some other abrasive irritant (eg, from rubbing upon poorly fitting dental work). This lesion should quickly resolve after removal of the provoking stimulus.
Tobacco-induced leukoplakia occurs in smokers and individuals who chew tobacco. These lesions are typically not shaggy like hairy leukoplakia, and they may occur anywhere in the oral cavity. They are often premalignant and should be evaluated by biopsy and histologic examination.
Lichen planus or lichenoid eruptions occur as autoimmune or allergic reactions to an unknown stimulus. In HIV-infected patients, lichen planus often occurs on the buccal mucosa, typically with a reticulated pattern. Oral lichen planus may also be associated with cutaneous lesions.
Lesions that clinically and histologically mimicked oral hairy leukoplakia (OHL) but were not associated with EBV were recently characterized as pseudo-hairy leukoplakia.
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