Hairy Leukoplakia Medication

  • Author: Denis P Lynch, DDS, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 13, 2012
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Antiviral agents

Class Summary

Nucleoside analogs initially are phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate.

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Acyclovir (Zovirax)

 

Has affinity for viral thymidine kinase and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase. Patients experience less pain and faster resolution of lesions when used within 48 h from onset of outbreak. May prevent recurrent outbreaks. Early initiation of therapy is imperative.

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Valacyclovir (Valtrex)

 

Prodrug rapidly converted to active drug acyclovir. More expensive but has more convenient dosing regimen than acyclovir.

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Famciclovir (Famvir)

 

Prodrug that when biotransformed into active metabolite, penciclovir, may inhibit viral DNA synthesis/replication.

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Ganciclovir (Cytovene, Vitrasert)

 

Indication is for CMV retinitis and prevention of CMV infection in individuals who are HIV positive.

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Foscarnet (Foscavir)

 

Indicated only for acyclovir-resistant mucocutaneous herpes simplex virus, which occurs almost exclusively in individuals who are HIV positive.

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Keratolytic agents

Class Summary

These agents cause cornified epithelium to swell, soften, macerate, and then desquamate.

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Podophyllum resin (Pod-Ben-25, Podofin, Podocon-25)

 

Major active constituent, podophyllotoxin, is a lipid-soluble compound that easily crosses cell membranes. Podophyllotoxin and its derivatives are potent cytotoxic agents that inhibit cell mitosis and deoxyribonucleic acid (DNA). Cell division is arrested, and other cellular processes are impaired, gradually resulting in the disruption of cells.

Arrests mitosis in metaphase; active agent is podophyllotoxin; type of podophyllum resin used determines strength. American podophyllum contains one fourth the amount of Indian source. Used in symptomatic OHL.

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Antifungals

Class Summary

These agents reduce Candida superinfection.

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Nystatin (Nilstat, Mycostatin, Nystex)

 

Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei; effective against various yeasts and yeastlike fungi. Changes permeability of fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Treatment should continue until 48 h after disappearance of symptoms. Drug is not absorbed significantly from GI tract.

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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, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Society for Head and Neck Surgery, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, and European Society for Medical Oncology

Disclosure: BMS Honoraria Speaking and teaching; Novartis Consulting fee Consulting; Merck Consulting fee Consulting

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, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine 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.

References

  1. Schmidt-Westhausen A, Gelderblom HR, Reichart PA. Oral hairy leukoplakia in an HIV-seronegative heart transplant patient. J Oral Pathol Med. Apr 1990;19(4):192-4. [Medline].

  2. Daniels TE, Greenspan D, Greenspan JS, et al. Absence of Langerhans cells in oral hairy leukoplakia, an AIDS-associated lesion. J Invest Dermatol. Aug 1987;89(2):178-82. [Medline].

  3. Gondak RO, Alves DB, Silva LF, Mauad T, Vargas PA. Depletion of Langerhans cells in the tongue from patients with advanced-stage acquired immune deficiency syndrome: relation to opportunistic infections. Histopathology. Dec 14 2011;[Medline].

  4. Bravo IM, Correnti M, Escalona L, et al. Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population. Med Oral Patol Oral Cir Bucal. Jan 1 2006;11(1):E33-9. [Medline].

  5. Ramirez-Amador V, Esquivel-Pedraza L, Sierra-Madero J, Anaya-Saavedra G, Gonzalez-Ramirez I, Ponce-de-Leon S. The Changing Clinical Spectrum of Human Immunodeficiency Virus (HIV)-Related Oral Lesions in 1,000 Consecutive Patients: A 12-Year Study in a Referral Center in Mexico. Medicine (Baltimore). Jan 2003;82(1):39-50. [Medline].

  6. Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ. Sep 2005;83(9):700-6. [Medline].

  7. Gasparin AB, Ferreira FV, Danesi CC, et al. [Prevalence of oral lesions in persons with HIV and associated factors in a southern Brazilian city]. Cad Saude Publica. Jun 2009;25(6):1307-15. [Medline].

  8. Guteta S, Feleke Y, Fekade D, Neway M, Diro E. Prevalence of oral and perioral manifestations in HIV positive adults at Tikur Anbessa Teaching Hospital Addis Ababa, Ethiopia. Ethiop Med J. Oct 2008;46(4):349-57. [Medline].

  9. Lopez-Pintor R, Hernandez G, de Arriba L, de Andres A. Comparison of oral lesion prevalence in renal transplant patients under immunosuppressive therapy and healthy controls. Oral Dis. Jul 27 2009;[Medline].

  10. Miziara ID, Weber R. Oral candidosis and oral hairy leukoplakia as predictors of HAART failure in Brazilian HIV-infected patients. Oral Dis. Jul 2006;12(4):402-7. [Medline].

  11. De Souza YG, Freese UK, Greenspan D, Greenspan JS. Diagnosis of Epstein-Barr virus infection in hairy leukoplakia by using nucleic acid hybridization and noninvasive techniques. J Clin Microbiol. Dec 1990;28(12):2775-8. [Medline].

  12. Schofer H, Ochsendorf FR, Helm EB, Milbradt R. Treatment of oral 'hairy' leukoplakia in AIDS patients with vitamin A acid (topically) or acyclovir (systemically). Dermatologica. 1987;174(3):150-1. [Medline].

  13. Resnick L, Herbst JS, Ablashi DV, eet al. Regression of oral hairy leukoplakia after orally administered acyclovir therapy. JAMA. Jan 15 1988;259(3):384-8. [Medline].

  14. Gowdey G, Lee RK, Carpenter WM. Treatment of HIV-related hairy leukoplakia with podophyllum resin 25% solution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 1995;79(1):64-7. [Medline].

  15. Goh BT, Lau RK. Treatment of AIDS-associated oral hairy leukoplakia with cryotherapy. Int J STD AIDS. Jan-Feb 1994;5(1):60-2. [Medline].

  16. Coulter ID, Heslin KC, Marcus M, et al. Associations of self-reported oral health with physical and mental health in a nationally representative sample of HIV persons receiving medical care. Qual Life Res. Feb 2002;11(1):57-70. [Medline].

  17. Alessi E, Berti E, Cusini M, et al. Oral hairy leukoplakia. J Am Acad Dermatol. Jan 1990;22(1):79-86. [Medline].

  18. Aquilina C, Viraben R, Denis P. Secondary syphilis simulating oral hairy leukoplakia. J Am Acad Dermatol. Oct 2003;49(4):749-51. [Medline].

  19. Bodhade AS, Ganvir SM, Hazarey VK. Oral manifestations of HIV infection and their correlation with CD4 count. J Oral Sci. 2011;53(2):203-11. [Medline].

  20. Brehmer-Andersson E, Lucht E, Lindskog S, Ekman M, Biberfeld P. Oral hairy leukoplakia: pathogenetic aspects and significance of the lesion. Acta Derm Venereol. Mar 1994;74(2):81-9. [Medline].

  21. Corso B, Eversole LR, Hutt-Fletcher L. Hairy leukoplakia: Epstein-Barr virus receptors on oral keratinocyte plasma membranes. Oral Surg Oral Med Oral Pathol. Apr 1989;67(4):416-21. [Medline].

  22. Dios PD, Ocampo A, Miralles C, Limeres J, Tomas I. Changing prevalence of human immunodeficiency virus-associated oral lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 2000;90(4):403-4. [Medline].

  23. Eisenberg E, Krutchkoff D, Yamase H. Incidental oral hairy leukoplakia in immunocompetent persons. A report of two cases. Oral Surg Oral Med Oral Pathol. Sep 1992;74(3):332-3. [Medline].

  24. Eversole LR, Jacobsen P, Stone CE, Freckleton V. Oral condyloma planus (hairy leukoplakia) among homosexual men: a clinicopathologic study of thirty-six cases. Oral Surg Oral Med Oral Pathol. Mar 1986;61(3):249-55. [Medline].

  25. Fowler CB, Reed KD, Brannon RB. Intranuclear inclusions correlate with the ultrastructural detection of herpes-type virions in oral hairy leukoplakia. Am J Surg Pathol. Feb 1989;13(2):114-9. [Medline].

  26. Greenspan D, Gange SJ, Phelan JA, et al. Incidence of oral lesions in HIV-1-infected women: reduction with HAART. J Dent Res. Feb 2004;83(2):145-50. [Medline].

  27. Greenspan D, Greenspan JS, Hearst NG, et al. Relation of oral hairy leukoplakia to infection with the human immunodeficiency virus and the risk of developing AIDS. J Infect Dis. Mar 1987;155(3):475-81. [Medline].

  28. Greenspan D, Greenspan JS, Overby G, et al. Risk factors for rapid progression from hairy leukoplakia to AIDS: a nested case-control study. J Acquir Immune Defic Syndr. 1991;4(7):652-8. [Medline].

  29. Greenspan D, Komaroff E, Redford M, et al. Oral mucosal lesions and HIV viral load in the Women's Interagency HIV Study (WIHS). J Acquir Immune Defic Syndr. Sep 1 2000;25(1):44-50. [Medline].

  30. Herbst JS, Morgan J, Raab-Traub N, Resnick L. Comparison of the efficacy of surgery and acyclovir therapy in oral hairy leukoplakia. J Am Acad Dermatol. Oct 1989;21(4 Pt 1):753-6. [Medline].

  31. Husak R, Garbe C, Orfanos CE. Oral hairy leukoplakia in 71 HIV-seropositive patients: clinical symptoms, relation to immunologic status, and prognostic significance. J Am Acad Dermatol. Dec 1996;35(6):928-34. [Medline].

  32. Kabani S, Greenspan D, deSouza Y, Greenspan JS, Cataldo E. Oral hairy leukoplakia with extensive oral mucosal involvement. Report of two cases. Oral Surg Oral Med Oral Pathol. Apr 1989;67(4):411-5. [Medline].

  33. Lifson AR, Hilton JF, Westenhouse JL, et al. Time from HIV seroconversion to oral candidiasis or hairy leukoplakia among homosexual and bisexual men enrolled in three prospective cohorts. AIDS. Jan 1994;8(1):73-9. [Medline].

  34. Longnecker R. Epstein-Barr virus latency: LMP2, a regulator or means for Epstein-Barr virus persistence?. Adv Cancer Res. 2000;79:175-200. [Medline].

  35. Lozada-Nur F. Podophyllin resin 25% for treatment of oral hairy leukoplakia: an old treatment for a new lesion. J Acquir Immune Defic Syndr. 1991;4(5):543-6. [Medline].

  36. Lozada-Nur F, Costa C. Retrospective findings of the clinical benefits of podophyllum resin 25% sol on hairy leukoplakia. Clinical results in nine patients. Oral Surg Oral Med Oral Pathol. May 1992;73(5):555-8. [Medline].

  37. Lozada-Nur F, Robinson J, Regezi JA. Oral hairy leukoplakia in nonimmunosuppressed patients. Report of four cases. Oral Surg Oral Med Oral Pathol. Nov 1994;78(5):599-602. [Medline].

  38. Mabruk MJ, Antonio M, Flint SR, et al. A simple and rapid technique for the detection of Epstein-Barr virus DNA in HIV-associated oral hairy leukoplakia biopsies. J Oral Pathol Med. Mar 2000;29(3):118-22. [Medline].

  39. Migliorati CA, Jones AC, Baughman PA. Use of exfoliative cytology in the diagnosis of oral hairy leukoplakia. Oral Surg Oral Med Oral Pathol. Dec 1993;76(6):704-10. [Medline].

  40. Nichols CM, Flaitz CM, Hicks MJ. Role of podophyllin resin therapy in oral hairy leukoplakia in HIV infection: Clinicopathologic study. Abstract published in the Proceedings of the XI International Conference on AIDS; Vancouver, Canada, [ThB4274]. 1996.

  41. Riccardi R, Pimpinelli N, Ficarra G, et al. Morphology and membrane antigens of nonlymphoid accessory cells in oral hairy leukoplakia. Hum Pathol. Sep 1990;21(9):897-904. [Medline].

  42. Sample C, Kieff E. Molecular basis for Epstein-Barr virus induced pathogenesis and disease. Springer Semin Immunopathol. 1991;13(2):133-46. [Medline].

  43. Scully C, Porter SR, Di Alberti L, Jalal M, Maitland N. Detection of Epstein-Barr virus in oral scrapes in HIV infection, in hairy leukoplakia, and in healthy non-HIV-infected people. J Oral Pathol Med. Nov 1998;27(10):480-2. [Medline].

  44. Shiboski CH, Neuhaus JM, Greenspan D, Greenspan JS. Effect of receptive oral sex and smoking on the incidence of hairy leukoplakia in HIV-positive gay men. J Acquir Immune Defic Syndr. Jul 1 1999;21(3):236-42. [Medline].

  45. Thorley-Lawson DA. Basic virological aspects of Epstein-Barr virus infection. Semin Hematol. Jul 1988;25(3):247-60. [Medline].

  46. Walling DM, Flaitz CM, Nichols CM, Hudnall SD. Non-lytic productive EBV replication in normal tongue epithelial cells in vivo. Abstract presented at the Ninth Biennial Meeting of the International Association for Research on Epstein-Barr Virus and Associated Diseases, 2000; New Haven, Connecticut.

 
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