Hairy Leukoplakia Treatment & Management

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

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.

With highly active antiretroviral therapy (HAART) therapy, oral hairy leukoplakia usually decreases, but can return when HAART is decreased. Direct treatment of oral hairy leukoplakia with antivirals usually is not necessary. [28, 29]

Systemic antiviral therapy usually achieves resolution of the lesion within 1-2 weeks of therapy. [30] Oral therapy with acyclovir requires high doses (800 mg 5 times per day) to achieve therapeutic levels. [31] 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 Epstein-Barr virus (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. [32]

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. [33]

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 (OHL).



Diet may be as tolerated.