Hairy Leukoplakia Treatment & Management
- Author: Denis P Lynch, DDS, PhD; Chief Editor: Dirk M Elston, MD more...
As a benign lesion with low morbidity, oral hairy leukoplakia (OHL) does not require specific treatment in every case. Indications for treatment include symptoms attributable to the lesion, or a patient's desire to eliminate the lesion for cosmetic reasons. The variable natural history of the lesion and its tendency toward spontaneous resolution should be considered in any management decision. Several treatment options are available.
Systemic antiviral therapy usually achieves resolution of the lesion within 1-2 weeks of therapy. Oral therapy with acyclovir requires high doses (800 mg 5 times per day) to achieve therapeutic levels. Valacyclovir (1000 mg 3 times a day) and famciclovir (500 mg 3 times a day) are newer antiviral drugs with higher oral bioavailability than acyclovir and can be dosed less often. Antiviral drugs inhibit productive EBV replication but do not eliminate the latent state of infection. Hairy leukoplakia often recurs several weeks after the cessation of antiviral therapy.
Topical therapy with podophyllin resin 25% solution usually achieves resolution after 1-2 treatment applications. The treatments may temporarily cause local pain, discomfort, and alteration of taste. Podophyllin has cellular cytotoxic effects, but the mechanism of action in resolving hairy leukoplakia is not known. Again, hairy leukoplakia often recurs several weeks after successful podophyllin therapy.
Topical therapy with retinoic acid (tretinoin) has been reported to resolve hairy leukoplakia. Retinoic acids are known to inhibit EBV replication in vitro and induce epithelial cell differentiation. As with the antiviral agents and podophyllin, hairy leukoplakia often recurs several weeks after successful retinoic acid therapy.
Ablative therapy can also be considered for small hairy leukoplakia lesions. Cryotherapy has been reported as successful but is not widely used.
Institution of HAART, considered to be the standard care in the United States, is useful in eliminating the lesions of oral hairy leukoplakia.
Superinfection with Candida can be addressed with medical therapy.
Consultations with dentists, dermatologists, or infectious disease specialists may be in order depending upon the underlying disease process resulting in oral hairy leukoplakia.
Diet may be as tolerated.
Schmidt-Westhausen A, Gelderblom HR, Reichart PA. Oral hairy leukoplakia in an HIV-seronegative heart transplant patient. J Oral Pathol Med. 1990 Apr. 19(4):192-4. [Medline].
Sachithanandham J, Kannangai R, Pulimood SA, Desai A, Abraham AM, Abraham OC, et al. Significance of Epstein-Barr virus (HHV-4) and CMV (HHV-5) infection among subtype-C human immunodeficiency virus-infected individuals. Indian J Med Microbiol. 2014 Jul-Sep. 32(3):261-9. [Medline].
Daniels TE, Greenspan D, Greenspan JS, et al. Absence of Langerhans cells in oral hairy leukoplakia, an AIDS-associated lesion. J Invest Dermatol. 1987 Aug. 89(2):178-82. [Medline].
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. 2011 Dec 14. [Medline].
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. 2006 Jan 1. 11(1):E33-9. [Medline].
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). 2003 Jan. 82(1):39-50. [Medline].
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. 2009 Jun. 25(6):1307-15. [Medline].
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. 2008 Oct. 46(4):349-57. [Medline].
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. 2009 Jul 27. [Medline].
Miziara ID, Weber R. Oral candidosis and oral hairy leukoplakia as predictors of HAART failure in Brazilian HIV-infected patients. Oral Dis. 2006 Jul. 12(4):402-7. [Medline].
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. 1990 Dec. 28(12):2775-8. [Medline]. [Full Text].
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].
Resnick L, Herbst JS, Ablashi DV, eet al. Regression of oral hairy leukoplakia after orally administered acyclovir therapy. JAMA. 1988 Jan 15. 259(3):384-8. [Medline].
Goh BT, Lau RK. Treatment of AIDS-associated oral hairy leukoplakia with cryotherapy. Int J STD AIDS. 1994 Jan-Feb. 5(1):60-2. [Medline].
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. 2002 Feb. 11(1):57-70. [Medline].
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].