Sections

Hairy Leukoplakia

Medication

Medication Summary

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

Class Summary

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

Acyclovir (Zovirax)

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Acyclovir 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 hours from onset of an outbreak. Acyclovir may prevent recurrent outbreaks. Early initiation of therapy is imperative.

Valacyclovir (Valtrex)

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Valacyclovir is a prodrug that is rapidly converted to the active drug acyclovir. It is more expensive but has a more convenient dosing regimen than acyclovir.

Famciclovir (Famvir)

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Famciclovir is a prodrug that when biotransformed into the active metabolite, penciclovir, may inhibit viral DNA synthesis/replication.

Ganciclovir (Cytovene, Vitrasert)

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Ganciclovir is indicated for CMV retinitis and the prevention of CMV infection in individuals who are HIV positive.

Foscarnet (Foscavir)

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

Class Summary

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

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

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The 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.

Podophyllum resin arrests mitosis in the metaphase; the active agent is podophyllotoxin; the type of podophyllum resin used determines strength. American podophyllum contains one fourth the amount of Indian sources. It is used in symptomatic OHL.

Class Summary

These agents reduce Candida superinfection.

Nystatin (Nilstat, Mycostatin, Nystex)

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Nystatin is a fungicidal and fungistatic antibiotic obtained from Streptomyces noursei; it is effective against various yeasts and yeastlike fungi. Nystatin changes the permeability of the fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Treatment should continue until 48 hours after the disappearance of symptoms. Nystatin is not absorbed significantly from the GI tract.

Questions

Khammissa RA, Fourie J, Chandran R, Lemmer J, Feller L. Epstein-Barr Virus and Its Association with Oral Hairy Leukoplakia: A Short Review. Int J Dent. 2016. 2016:4941783. [QxMD MEDLINE Link].
Mangold AR, Torgerson RR, Rogers RS 3rd. Diseases of the tongue. Clin Dermatol. 2016 Jul-Aug. 34 (4):458-69. [QxMD MEDLINE Link].
Darling MR, Alkhasawneh M, Mascarenhas W, Chirila A, Copete M. Oral Hairy Leukoplakia in Patients With No Evidence of Immunosuppression: A Case Series and Review of the Literature. J Can Dent Assoc. 2018 May. 84:i4. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Greenspan JS, Greenspan D, Webster-Cyriaque J. Hairy leukoplakia; lessons learned: 30-plus years. Oral Dis. 2016 Apr. 22 Suppl 1:120-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. 1999 Jul 1. 21 (3):236-42. [QxMD MEDLINE Link].
Shanahan D, Cowie R, Rogers H, Staines K. Oral hairy leukoplakia in healthy immunocompetent patients: a small case series. Oral Maxillofac Surg. 2018 Sep. 22 (3):335-339. [QxMD MEDLINE Link].
Alramadhan SA, Bhattacharyya I, Cohen DM, Islam MN. Oral Hairy Leukoplakia in Immunocompetent Patients Revisited with Literature Review. Head Neck Pathol. 2021 Jan 11. [QxMD MEDLINE Link].
Chambers AE, Conn B, Pemberton M, Robinson M, Banks R, Sloan P. Twenty-first-century oral hairy leukoplakia--a non-HIV-associated entity. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Mar. 119 (3):326-32. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Ottria L, Lauritano D, Oberti L, Candotto V, Cura F, Tagliabue A, et al. Prevalence of HIV-related oral manifestations and their association with HAART and CD4+ T cell count: a review. J Biol Regul Homeost Agents. 2018 Jan-Feb. 32 (2 Suppl. 1):51-59. [QxMD MEDLINE Link].
King GN, Healy CM, Glover MT, Kwan JT, Williams DM, Leigh IM, et al. Prevalence and risk factors associated with leukoplakia, hairy leukoplakia, erythematous candidiasis, and gingival hyperplasia in renal transplant recipients. Oral Surg Oral Med Oral Pathol. 1994 Dec. 78 (6):718-26. [QxMD MEDLINE Link].
Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ. 2005 Sep. 83(9):700-6. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
El Howati A, Tappuni A. Systematic review of the changing pattern of the oral manifestations of HIV. J Investig Clin Dent. 2018 Nov. 9 (4):e12351. [QxMD MEDLINE Link].
Vale DA, Martins FM, Silva PH, Ortega KL. Retrospective analysis of the clinical behavior of oral hairy leukoplakia in 215 HIV-seropositive patients. Braz Oral Res. 2016 Nov 28. 30 (1):e118. [QxMD MEDLINE Link].
Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ. 2005 Sept. 83:700-6. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
Little JW, Miller CS, Rhodus NL. AIDS, HIV Infection, and Related Conditions. Little JW, Miller CS, Rhodus NL, Eds. Little and Falace's Dental Management of the Medically Compromised Patient. 9th ed. St. Louis, Missouri: Elsevier, Inc; September 22, 2017. 326.
Greenspan JS, Greenspan D, Webster-Cyriaque J. Hairy leukoplakia; lessons learned: 30-plus years. Oral Dis. 2016 Apr. 22 Suppl 1:120-7. [QxMD MEDLINE Link].
Baccaglini L, Atkinson JC, Patton LL, Glick M, Ficarra G, Peterson DE. Management of oral lesions in HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Mar. 103 Suppl:S50.e1-23. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Brasileiro CB, Abreu MH, Mesquita RA. Critical review of topical management of oral hairy leukoplakia. World J Clin Cases. 2014 Jul 16. 2(7):253-6. [QxMD MEDLINE Link]. [Full Text].
Goh BT, Lau RK. Treatment of AIDS-associated oral hairy leukoplakia with cryotherapy. Int J STD AIDS. 1994 Jan-Feb. 5(1):60-2. [QxMD MEDLINE Link].

Media Gallery

Oral leukoplakia.
Lateral tongue in oral hairy leukoplakia.
Morsicatio linguarum, or tongue biting.
Ventral tongue in oral leukoplakia.
Lateral tongue in lichen planus.
Proliferative verrucous leukoplakia of the lateral tongue; biopsy showed squamous cell carcinoma.
Proliferative verrucous leukoplakia of the gingiva; biopsy showed squamous cell carcinoma.
White sponge nevus.
Hyperplastic candidiasis.
Oral hairy leukoplakia (OHL) on left lateral tongue in patient who used topical steroid inhaler.

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Author

James E Cade, DDS, FACD Associate Professor, Chair, Department of Oral Diagnostic Sciences, Meharry Medical College School of Dentistry; Private Practice, Honeycutt Family Dentistry

James E Cade, DDS, FACD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Dental Association

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

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

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.

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, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

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.

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.

Hairy Leukoplakia Medication

Medication Summary

Antiviral agents