Summary about Disease
Hairy leukoplakia (HL) is a white, corrugated, or "hairy" lesion that typically occurs on the lateral (side) border of the tongue. It's almost always associated with Epstein-Barr virus (EBV) infection, most commonly seen in individuals with weakened immune systems, particularly those with HIV/AIDS. HL itself is not cancerous, but it can be an indicator of underlying immunosuppression.
Symptoms
Appearance: White or grayish white, slightly raised plaques or lesions with a corrugated or "hairy" texture.
Location: Most commonly on the lateral borders of the tongue. Can also occur on the ventral (underside) tongue, buccal mucosa (inner cheeks), or palate.
Feel: Typically asymptomatic and painless. However, in some cases, it can cause mild discomfort or altered taste sensation.
Cannot be scraped off: Unlike oral thrush (candidiasis), hairy leukoplakia lesions cannot be easily scraped off.
Causes
Epstein-Barr Virus (EBV): HL is primarily caused by EBV. Most people are exposed to EBV in childhood, and it usually remains dormant in the body.
Immunosuppression: HL typically manifests when the immune system is weakened, allowing EBV to reactivate. Common causes of immunosuppression include:
HIV/AIDS
Organ transplantation (and use of immunosuppressant drugs)
Certain medical conditions affecting the immune system
Medicine Used
Antiviral Medications: In cases of severe or symptomatic HL, antiviral medications that target EBV may be prescribed. Examples include:
Valacyclovir
Acyclovir
Ganciclovir
Topical Treatments: In some cases, topical treatments may be used to reduce the size or appearance of the lesions. These can include:
Podophyllin resin (applied by a healthcare professional)
Retinoids (Tretinoin) - May provide symptomatic relief but often cause irritation
Addressing Underlying Immunosuppression: The most important aspect of treatment is addressing the underlying cause of immunosuppression. For example, in people with HIV/AIDS, antiretroviral therapy (ART) is essential. Improving the immune system often leads to the resolution of HL.
Is Communicable
Hairy leukoplakia itself is not directly communicable. It is a manifestation of EBV reactivation in individuals with weakened immune systems. EBV, however, is communicable and can be spread through saliva (e.g., kissing, sharing utensils). Most people are already infected with EBV. Hairy leukoplakia develops only in those with compromised immune systems.
Precautions
Maintain Good Oral Hygiene: Brush and floss regularly to prevent secondary infections.
Avoid Irritants: Avoid smoking, alcohol, and spicy or acidic foods, as they can irritate the lesions.
Manage Immunosuppression: If you have HIV/AIDS or another condition that weakens your immune system, follow your doctor's recommendations for treatment and management.
Regular Dental Checkups: See your dentist regularly for checkups and to monitor the lesions.
Healthy Lifestyle: Eat a balanced diet, get enough sleep, and manage stress to support your immune system.
How long does an outbreak last?
The duration of a hairy leukoplakia outbreak varies.
Untreated: If the underlying immunosuppression is not addressed, HL can persist for months, years, or even indefinitely.
With Treatment: With effective treatment of the underlying cause of immunosuppression (e.g., ART for HIV/AIDS), the lesions may resolve within weeks or months. Antiviral medications can also help shorten the duration of an outbreak.
Recurrence: HL can recur if the immune system becomes weakened again.
How is it diagnosed?
Clinical Examination: A dentist or doctor can often diagnose HL based on its characteristic appearance and location.
Medical History: A thorough review of the patient's medical history is important, particularly regarding HIV status, other immune-compromising conditions, and medications.
Biopsy: A biopsy (tissue sample) may be taken to confirm the diagnosis, especially if the appearance is atypical or if other conditions need to be ruled out. The biopsy will be examined under a microscope to look for characteristic changes associated with HL and EBV infection.
EBV Testing: Tests to detect EBV within the lesion may be performed, such as in situ hybridization or PCR.
HIV Testing: If the patient's HIV status is unknown, HIV testing is strongly recommended.
Timeline of Symptoms
Initial Stage: A subtle, slightly raised, white or grayish-white area appears on the side of the tongue. It might be smooth initially.
Progression: Over time (weeks to months), the lesion becomes more prominent and develops a corrugated or "hairy" appearance. It typically remains painless.
Persistence: Without treatment of the underlying immunosuppression, the lesion can persist indefinitely.
Fluctuations: The size and appearance of the lesion may fluctuate depending on the level of immunosuppression. The lesion may get bigger when the immune system is weaker and smaller when the immune system is stronger.
Important Considerations
Indicator of Immunosuppression: HL is a strong indicator of underlying immunosuppression, particularly HIV/AIDS. Its presence should prompt evaluation for these conditions if the patient's status is unknown.
Not Precancerous: HL is not considered precancerous and does not transform into oral cancer.
Differential Diagnosis: It's important to differentiate HL from other white lesions of the oral cavity, such as oral thrush (candidiasis), lichen planus, and leukoplakia (which can be precancerous).
Psychological Impact: Although usually asymptomatic, the appearance of HL can be distressing for some individuals.
Monitoring: Regular monitoring by a dentist or doctor is important to assess the stability of the lesion and to detect any changes.