eMedicine Specialties > Oncology > none
Hairy Leukoplakia: Treatment & Medication
Updated: Jul 18, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
As a benign lesion with low morbidity, hairy leukoplakia 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.
Superinfection with Candida can be addressed with medical therapy.
Consultations
Consultations with dentists, dermatologists, or infectious disease specialists may be in order depending upon the underlying disease process resulting in OHL.
Diet
Diet may be as tolerated.
Medication
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Antiviral agents
Nucleoside analogs initially are phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate.
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.
Adult
400 mg PO bid/qid
Pediatric
20-40 mg/kg PO bid
Probenecid or zidovudine prolongs half-life and increases CNS toxicity
Documented hypersensitivity
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Caution in renal failure or when using nephrotoxic drugs
Valacyclovir (Valtrex)
Prodrug rapidly converted to active drug acyclovir. More expensive but has more convenient dosing regimen than acyclovir.
Adult
1 g/d PO tid
Pediatric
Not established
Probenecid, zidovudine, or cimetidine prolongs half-life and increases CNS toxicity
Documented hypersensitivity
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Caution in renal failure and coadministration of nephrotoxic drugs; associated with onset of hemolytic uremic syndrome
Famciclovir (Famvir)
Prodrug that when biotransformed into active metabolite, penciclovir, may inhibit viral DNA synthesis/replication.
Adult
500 mg/d PO bid
Pediatric
Not established
Probenecid or cimetidine may increase toxicity; increases bioavailability of digoxin
Documented hypersensitivity
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Caution in renal failure or coadministration of nephrotoxic drugs
Ganciclovir (Cytovene, Vitrasert)
Indication is for CMV retinitis and prevention of CMV infection in individuals who are HIV positive.
Adult
1000 mg PO tid
Pediatric
Not established
Cytotoxic drugs such as dapsone, vinblastine, doxorubicin, pentamidine, flucytosine, vincristine, amphotericin B, trimethoprim/sulfamethoxazole combinations, or other nucleoside analogs may result in additive toxicity in bone marrow, spermatogonia, and germinal layers of skin and GI mucosa (coadminister only if potential benefits outweigh risks); imipenem-cilastatin may cause generalized seizures (use only if potential benefits outweigh risks); cyclosporine or amphotericin B may increase serum creatinine; probenecid reduces renal clearance; administration of didanosine either 2 h prior to or simultaneously may increase bioavailability; zidovudine may decrease bioavailability, while ganciclovir increases bioavailability of zidovudine
Documented hypersensitivity
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Clinical toxicity includes granulocytopenia, anemia, and thrombocytopenia; since oral ganciclovir associated with higher rate of CMV retinitis progression than IV formulation, use only when benefits outweigh risks (advanced HIV disease); half-life and plasma/serum concentrations may be increased as result of reduced renal clearance; dosages >6 mg/kg IV may result in increased toxicity; rapid infusions may result in increased toxicity; initially, reconstituted solutions of IV ganciclovir have a high pH (11); phlebitis or pain may occur at site of IV infusion despite further dilution in IV fluids; administration should be accompanied by adequate hydration; photosensitization (photoallergy or phototoxicity) may occur
Foscarnet (Foscavir)
Indicated only for acyclovir-resistant mucocutaneous herpes simplex virus, which occurs almost exclusively in individuals who are HIV positive.
Adult
40 mg/kg IV tid
Pediatric
Not established
Potentially nephrotoxic drugs (eg, aminoglycosides, amphotericin B, IV pentamidine) may increase nephrotoxicity (do not administer unless potential benefits outweigh risks); IV pentamidine may cause hypocalcemia
Documented hypersensitivity
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
May cause decline in renal function; for correct dosing, obtain 24-h serum creatinine at baseline and continue to monitor (discontinue if serum creatinine <0.4 mL/min/kg); hydration may reduce nephrotoxicity
Carefully monitor electrolytes (eg, calcium, magnesium); assess for electrolyte and mineral level abnormalities if mild perioral numbness, paresthesia symptoms, or seizures; granulocytopenia and anemia may occur (regularly monitor CBC)
Infuse foscarnet solutions into veins with adequate blood flow to avoid local irritation; to avoid toxicity do not administer by rapid or bolus IV injection
Keratolytic agents
These agents cause cornified epithelium to swell, soften, macerate, and then desquamate.
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.
Adult
Apply 25% liquid for 20 min
Pediatric
Not established
None reported
Documented hypersensitivity; diabetes; impaired peripheral circulation; avoid use on mucous membranes, eyes, bleeding warts, moles, birthmarks, or unusual warts with hair
Pregnancy
X - Contraindicated in pregnancy
Precautions
Powerful caustic and severe irritant; do not use if surrounding tissue swollen or irritated; 25% solution should not be applied near mucous membranes; do not use large amounts; avoid contact with cornea; avoid use on mucous membranes, eyes, bleeding warts, moles, birthmarks, or unusual warts with hair
Antifungals
These agents reduce Candida superinfection.
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.
Adult
200,000 U lozenges; 1-2 lozenges, 4-5 times daily
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Do not use to treat systemic mycoses
More on Hairy Leukoplakia |
| Overview: Hairy Leukoplakia |
| Differential Diagnoses & Workup: Hairy Leukoplakia |
 Treatment & Medication: Hairy Leukoplakia |
| Follow-up: Hairy Leukoplakia |
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Further Reading
Keywords
oral hairy leukoplakia, OHL, AIDS, HIV, Epstein-Barr virus, EBV, immunosuppression, immunocompromise, homosexual men, IV drug users, acute lymphocytic leukemia, ALL, heart transplant, bone marrow transplant, kidney transplant, hematological malignancy, tongue plaque, Behçet syndrome, ulcerative colitis, cigarette smoking
