HIV-Associated Oral Hairy Leukoplakia

Oral hairy leukoplakia is a marker of HIV infection that is thought to be caused by Epstein-Barr virus infection of the oral mucosa. It is rarely seen in patients receiving HAART (see Chapter 21: Disorders of the Oral Cavity, Lips, and Tongue for a detailed discussion).

Clinical Manifestations ⬆ ⬇

Lesions are usually asymptomatic.
Patients occasionally complain of a burning sensation of the tongue.
White plaques resembling “corrugated cardboard” (Fig. 33.17; see also Fig. 21.14) are fixed to the mucosa; they are not friable, as in candidiasis (see below).

Other Information ⬆

Distribution of Lesions

Management

Treatment is necessary only in symptomatic cases.
Surgical excision can be performed, but lesions recur at the margins.
Acyclovir (3.2 g per day) is given with recurrence of lesions on cessation of treatment. The use of acyclovir for oral hairy leukoplakia may result in the development of acyclovir-resistance of concurrent HSV infection.
Topical tretinoin 0.05% solution may be applied for 15 minutes once daily using a gauze sponge.
Podophyllin 25% solution is applied sparingly to one side of the tongue at a time and is allowed to air dry. This is repeated once weekly.