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

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

Diet may be as tolerated.

Medication

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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 Treatment & Management

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