History

Patients with oral hairy leukoplakia (OHL) may report a nonpainful white plaque along the lateral tongue borders. The appearance may change daily. The natural history of hairy leukoplakia is variable. Lesions may frequently appear and disappear spontaneously. Hairy leukoplakia is often asymptomatic, and many patients are unaware of its presence. Some patients with hairy leukoplakia do experience symptoms including mild pain, dysesthesia, alteration of taste, and the psychological impact of its unsightly cosmetic appearance.

Physical Examination

Unilateral or bilateral nonpainful white lesions can be seen on the margins, dorsal or ventral surfaces of the tongue, or on buccal mucosa, as shown in the image below. Oral hairy leukoplakia (OHL) lesions may vary in appearance from smooth, flat, small lesions to irregular "hairy" or "feathery" lesions with prominent folds or projections.

Lateral tongue in oral hairy leukoplakia.

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Lesions may be either continuous or discontinuous along both tongue borders, and they are often not bilaterally symmetric. Lesions are adherent, and only the most superficial layers can be removed by scraping. There is no associated erythema or edema of the surrounding tissue. Hairy leukoplakia may also involve dorsal and ventral tongue surfaces, the buccal mucosa, or the gingiva. On the ventral tongue, buccal mucosa, or gingiva, the lesion may be flat and smooth, lacking the characteristic "hairy" appearance.^[2]

See the image below.

Oral leukoplakia.

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Complications

The complication associated with oral hairy leukoplakia (OHL) is an occasional candidal superinfection, which often results in an uncomfortable glossopyrosis (burning tongue).

Altered taste sensation is a rare complication.

The presence of oral lesions has a significant impact on health-related quality of life, because oral health is associated with physical and mental health.^[25]

Differential Diagnoses

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Schmidt-Westhausen A, Gelderblom HR, Reichart PA. Oral hairy leukoplakia in an HIV-seronegative heart transplant patient. J Oral Pathol Med. 1990 Apr. 19(4):192-4. [QxMD MEDLINE Link].
Greenspan JS, Greenspan D, Webster-Cyriaque J. Hairy leukoplakia; lessons learned: 30-plus years. Oral Dis. 2016 Apr. 22 Suppl 1:120-7. [QxMD MEDLINE Link].
Sachithanandham J, Kannangai R, Pulimood SA, Desai A, Abraham AM, Abraham OC, et al. Significance of Epstein-Barr virus (HHV-4) and CMV (HHV-5) infection among subtype-C human immunodeficiency virus-infected individuals. Indian J Med Microbiol. 2014 Jul-Sep. 32(3):261-9. [QxMD MEDLINE Link].
Daniels TE, Greenspan D, Greenspan JS, et al. Absence of Langerhans cells in oral hairy leukoplakia, an AIDS-associated lesion. J Invest Dermatol. 1987 Aug. 89(2):178-82. [QxMD MEDLINE Link].
Gondak RO, Alves DB, Silva LF, Mauad T, Vargas PA. Depletion of Langerhans cells in the tongue from patients with advanced-stage acquired immune deficiency syndrome: relation to opportunistic infections. Histopathology. 2011 Dec 14. [QxMD MEDLINE Link].
Miziara ID, Weber R. Oral candidosis and oral hairy leukoplakia as predictors of HAART failure in Brazilian HIV-infected patients. Oral Dis. 2006 Jul. 12(4):402-7. [QxMD MEDLINE Link].
Bravo IM, Correnti M, Escalona L, et al. Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population. Med Oral Patol Oral Cir Bucal. 2006 Jan 1. 11(1):E33-9. [QxMD MEDLINE Link].
Shiboski CH, Neuhaus JM, Greenspan D, Greenspan JS. Effect of receptive oral sex and smoking on the incidence of hairy leukoplakia in HIV-positive gay men. J Acquir Immune Defic Syndr. 1999 Jul 1. 21 (3):236-42. [QxMD MEDLINE Link].
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Media Gallery

Oral leukoplakia.
Lateral tongue in oral hairy leukoplakia.
Morsicatio linguarum, or tongue biting.
Ventral tongue in oral leukoplakia.
Lateral tongue in lichen planus.
Proliferative verrucous leukoplakia of the lateral tongue; biopsy showed squamous cell carcinoma.
Proliferative verrucous leukoplakia of the gingiva; biopsy showed squamous cell carcinoma.
White sponge nevus.
Hyperplastic candidiasis.
Oral hairy leukoplakia (OHL) on left lateral tongue in patient who used topical steroid inhaler.

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Author

James E Cade, DDS, FACD Associate Professor, Chair, Department of Oral Diagnostic Sciences, Meharry Medical College School of Dentistry; Private Practice, Honeycutt Family Dentistry

James E Cade, DDS, FACD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

Disclosure: Nothing to disclose.

Additional Contributors

Sanjiv S Agarwala, MD Chief of Oncology and Hematology, St Luke's Cancer Center, St Luke's Hospital and Health Network; Professor, Temple University Shool of Medicine

Sanjiv S Agarwala, MD is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, European Society for Medical Oncology, American Society of Clinical Oncology, Eastern Cooperative Oncology Group

Disclosure: Received honoraria from BMS for speaking and teaching; Received consulting fee from Novartis for consulting; Received consulting fee from Merck for consulting.

Denis P Lynch, DDS, PhD Professor of Oral and Maxillofacial Pathology, Associate Dean for Academic Affairs, Office of the Dean, Marquette University School of Dentistry

Denis P Lynch, DDS, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association, International Association for Dental Research, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Gary L Stafford, DMD Assistant Professor and Chair, Department of General Dental Sciences, Marquette University School of Dentistry

Gary L Stafford, DMD is a member of the following medical societies: International Association for Dental Research, American Association for Dental Research, American Dental Education Association, Milwaukee Odontological Academy, The Dental Forum, National Dental Practice-Based Research Network, American College of Dentists, Greater Milwaukee Dental Association, Wisconsin Dental Association, Consortium of Operative Dentistry Educators, Pierre Fauchard Academy, Chicago Dental Society, Illinois State Dental Society, Association for Continuing Dental Education

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Samer Bleibel, MD; Hunter Sams, MD; Alan Boyd, MD; Olga Kozyreva, MD; and Sarah K. May, MD, to the development and writing of this article.

Hairy Leukoplakia Clinical Presentation

History

Physical Examination

Complications

References

Tables

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