Oral hair leukoplakia K13.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Hair tongue white; Hairy leukoplakia; Oral hair leukoplakia; Oral hairy leukoplakia (e); White hair tongue

History
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Greenspan et al., 1984h

Definition
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Clinically characteristic whitish changes of the tongue mucosa described in the context of HIV infection. However, the clinical picture can also be observed in non-HIV patients.

Occurrence/Epidemiology
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  • In about 18% of HIV-infected and 36% of AIDS patients.
  • Also in kidney or bone marrow transplant patients under immunosuppression
  • More common in patients who use steroid inhalers for long periods of time due to pulmonary problems
  • Patients with autoimmune diseases that are under long-term immunosuppressive therapy (coincidence with candia infections)

Etiopathogenesis
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Infection with EBV viruses.

Localization
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Tongue

Clinical features
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Several millimetres thick, white, mostly asymptomatic, non-wipeable mat-like deposits on the lateral edge of the tongue and the lower surface of the tongue.

Histology
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Hyperparakeratosis with hair-like projections on the surface. Large, ballooned cells with pynotic nuclei. Lack of dermal inflammatory response. Electron microscopic and immunohistochemical evidence of Epstein-Barr virus in the lesions.

Differential diagnosis
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Therapy
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If necessary, brush off and vitamin C (e.g. Cebion) Tbl. 400-1000 mg/day, let Tbl. melt on the tongue. In cases of severe suffering, therapy with acyclovir (e.g. Zovirax) 5 times/day 400 mg p.o. is possible. This includes rapid regression of the hair leukoplakia, but after discontinuation, it often leads to rapid recurrence. Alternatively, Valaciclovir (Valtrex) 3 times/day 1 g p.o. (off-label use; according to studies well effective, lower risk of relapse than under Aciclovir).

Progression/forecast
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Depends on the underlying disease; 80% of patients develop full-blown AIDS within 1-2 years after the onset of oral hair leukoplakia

Literature
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  1. Chambers AE et al (2014) Twenty-first-century oral hairy leukoplakia--a non-HIV-associated entity. Oral Surg Oral Med Oral Pathol Oral Radiol 119:326-332

  2. Greenspan D et al (2004) Incidence of Oral Lesions in HIV-1-infected Women: Reduction with HAART. J Dent Res 83: 145-150
  3. Greenspan D, Greenspan JS et al (1984) Oral "hairy" leucoplakia in male homosexuals: evidence of association with both papillomavirus and a herpes-group virus. Lancet 2: 831-834
  4. Greenspan JS, Greenspan D et al (1985) Replication of Epstein-Barr virus within the epithelial cells of oral "hairy" leukoplakia, an AIDS-associated lesion. N Engl J Med 313: 1564-1571
  5. Greenspan D (1985) Oral viral leukoplakia ("hairy" leukoplakia): a new oral lesion in association with AIDS. Compend Contin Educ Dent 6:204-206
  6. Madeley CR (1984) Viruses and oral "hairy" leucoplakia. Lancet 2: 1279
  7. Itin P et al (1991) Oral hairy leukoplakia in kidney transplant patients. Dermatologist 42: 487-491
  8. Walling DM et al (2003) Epstein-Barr virus replication in oral hairy leukoplakia: response, persistence, and resistance to treatment with valacyclovir. J Infect Dis 188: 883-890
  9. Winemaker M et al (1988) Hairy lesions of the oral cavity. Am J Dermatopathol 10: 155-159

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020