Hairy leukoplakia

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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179 Hairy leukoplakia

Instruction

Look at this patient’s tongue.

Salient features

History

• Usually asymptomatic

• Patients may complain of pain or voice changes

• Tell the examiner that you would like to know whether the patient is immunocompromised (caused by HIV or immnosuppressive treatment particularly in kidney transplant recipients).

Examination

• Shaggy, hairy, white lesions on the lateral margins of the tongue (remember that it does not affect the vaginal or anal mucosa) (Fig. 179.1).

image

Fig. 179.1 Hairy leukoplakia.

Note: Oral hairy leukoplakia may be difficult to distinguish from oral candidiasis, but, in contrast to oral candidiasis, it does not rub off, does not respond to antifungal therapy and may change its appearance daily.

Diagnosis

This patient has whitish hairy lesions on the lateral edges of the tongue (lesions), which is oral hairy leukoplakia caused by the Epstein–Barr virus (aetiology).

Questions

What is the cause of this lesion?

Hairy leukoplakia is caused by the Epstein–Barr virus (N Engl J Med 1985;313:1564–71)

Advanced-level questions

What is the significance of this lesion?

In HIV-seropositive subjects, usually it is a harbinger of rapid progression to AIDS. It is rarely seen in non-HIV immunosuppressed patients.

What are the histological features of this condition?

• Hyperkeratosis

• Hyperplasia and ballooning of prickle cells (acanthosis)

• Depletion of Langherhans cells.

Why is the tongue dark colored?

The dark colour is secondary to porphyrin pigment deposition by bacterial metabolism.

How would you treat this condition?

Treatment is seldom indicated, but ganciclovir or aciclovir may be helpful if the patient has discomfort. Also podophyllin and retinoin has been used (Lancet 1996;348:729–33).

P Langerhans (1847–1888), German pathologist and dermatologist.

Oral ‘hairy’ leukoplakia was initially reported in the Lancet in 1984 (Lancet 1984;ii:831–34).

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179 Hairy leukoplakia

Instruction

Look at this patient’s tongue.

Salient features

History

• Usually asymptomatic

• Patients may complain of pain or voice changes

• Tell the examiner that you would like to know whether the patient is immunocompromised (caused by HIV or immnosuppressive treatment particularly in kidney transplant recipients).

Examination

• Shaggy, hairy, white lesions on the lateral margins of the tongue (remember that it does not affect the vaginal or anal mucosa) (Fig. 179.1).

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