Definition:
An oral infection caused by the
Epstein-Barr virus, appearing as white, corrugated lesions on the lateral
surfaces of the tongue. The infection may spread across the tongue's entire
dorsal surface, onto the ventral surface, and may occasionally be found on buccal mucosa.
S: Patient notices new,
white lesions on the tongue which cannot be removed with a toothbrush. Pain is not generally associated with oral
hairy leukoplakia.
O: PE: Unilateral
or bilateral white lesions on the margins, dorsal or ventral surface of the
tongue or on buccal mucosa. The lesions may vary in appearance from
smooth, flat, small lesions to irregular, "hairy" or
"feathery" lesions with prominent folds or projections.
LABS: CD4
count usually < 300
A: Partial
differential: oral candidiasis, squamous cell carcinoma, geographic tongue, lichen planus, smoker's leukoplakia,
epithelial dysplasia, or white sponge nevus.
P: LABS/PROCEDURES:
1. Biopsy
lesion only if it is unusual in appearance or ulcerated, to distinguish it from
cancer or CMV.
2. Demonstrate Epstein-Barr with electron micropsy or in-situ hybridization.
TX:
1. Since
hairy leukoplakia is usually asymptomatic, no
treatment is generally necessary.
2. Treat associated candidal
infections if present (see OralCandidiasis, in
this section)
3. If tx
becomes necessary due to lack of "taste", Acyclovir 800mg 5 X day for
2-3 weeks will often temporarily relieve symptoms. Relapses are common; maintenance high-dose
acyclovir is sometimes used for patients who have recurrent symptomatic OHL.
Patient Education:
1. Instruct patient to comply with regular
dental and medical care regimens.
2. If
on acyclovir, drink plenty of water to prevent dehydration and potential kidney
damage.
References:
Greenspan JS, Greenspan D.
Oral Complications of HIV Infection. In Sande MA and Volberding PA (eds) 1999. Medical
Management of AIDS, 6 ed.
Sande MA, Gilbert DN, Moellering
RC Jr. The
Greenspan D. Oral manifestations of AIDS.
AIDS Clinical Care. 1989;