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Hairy Leukoplakia Differential Diagnoses

  • Author: Denis P Lynch, DDS, PhD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 12, 2014
 
 

Diagnostic Considerations

Geographic tongue

Frictional keratosis

Squamous cell carcinoma

Lichen planus

Tobacco-associated leukoplakia

Pseudo–hairy leukoplakia

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.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Denis P Lynch, DDS, PhD Professor of Oral and Maxillofacial Pathology, Associate Dean for Academic Affairs, Office of the Dean, Marquette University School of Dentistry

Denis P Lynch, DDS, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association, International Association for Dental Research, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Gary L Stafford, DMD Assistant Professor and Chair, Department of General Dental Sciences, Marquette University School of Dentistry

Gary L Stafford, DMD is a member of the following medical societies: International Association for Dental Research, American Association for Dental Research, American Dental Education Association, Milwaukee Odontological Academy, The Dental Forum, National Dental Practice-Based Research Network, American College of Dentists, Greater Milwaukee Dental Association, Wisconsin Dental Association, Consortium of Operative Dentistry Educators, Pierre Fauchard Academy, Chicago Dental Society, Illinois State Dental Society, Association for Continuing Dental Education

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Sanjiv S Agarwala, MD Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, European Society for Medical Oncology, American Society of Clinical Oncology, Eastern Cooperative Oncology Group

Disclosure: Received honoraria from BMS for speaking and teaching; Received consulting fee from Novartis for consulting; Received consulting fee from Merck for consulting.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Samer Bleibel, MD; Hunter Sams, MD; Alan Boyd, MD; Olga Kozyreva, MD; and Sarah K. May, MD, to the development and writing of this article.

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