Hairy Leukoplakia Clinical Presentation

Updated: Jun 11, 2021
  • Author: James E Cade, DDS, FACD; Chief Editor: Jeff Burgess, DDS, MSD  more...
  • Print


Patients with oral hairy leukoplakia (OHL) may report a nonpainful white plaque along the lateral tongue borders. The appearance may change daily. The natural history of hairy leukoplakia is variable. Lesions may frequently appear and disappear spontaneously. Hairy leukoplakia is often asymptomatic, and many patients are unaware of its presence. Some patients with hairy leukoplakia do experience symptoms including mild pain, dysesthesia, alteration of taste, and the psychological impact of its unsightly cosmetic appearance.


Physical Examination

Unilateral or bilateral nonpainful white lesions can be seen on the margins, dorsal or ventral surfaces of the tongue, or on buccal mucosa, as shown in the image below. Oral hairy leukoplakia (OHL) lesions may vary in appearance from smooth, flat, small lesions to irregular "hairy" or "feathery" lesions with prominent folds or projections.

Lateral tongue in oral hairy leukoplakia. Lateral tongue in oral hairy leukoplakia.

Lesions may be either continuous or discontinuous along both tongue borders, and they are often not bilaterally symmetric. Lesions are adherent, and only the most superficial layers can be removed by scraping. There is no associated erythema or edema of the surrounding tissue. Hairy leukoplakia may also involve dorsal and ventral tongue surfaces, the buccal mucosa, or the gingiva. On the ventral tongue, buccal mucosa, or gingiva, the lesion may be flat and smooth, lacking the characteristic "hairy" appearance. [2]

See the image below.

Oral leukoplakia. Oral leukoplakia.


The complication associated with oral hairy leukoplakia (OHL) is an occasional candidal superinfection, which often results in an uncomfortable glossopyrosis (burning tongue).

Altered taste sensation is a rare complication.

The presence of oral lesions has a significant impact on health-related quality of life, because oral health is associated with physical and mental health. [25]