For Healthcare Professionals Only
Oral hairy leukoplakia (OHL) has to date been pathognomonic of immunosuppression usually due to HIV infection. OHL is caused by infection with the Epstein-Barr virus (EBV), and usually presents as corrugated white lesions of the lateral tongue. Since the EBV infection is chronic and lifelong, therapy will clear but will not cure lesions, and OHL will usually reappear once treatment is stopped. Therapy is usually not indicated, as OHL is asymptomatic. Pseudo-OHL is clinically similar but does not contain EBV, allowing differentiation by histological examination.
1. Patients with OHL must be evaluated for the presence of HIV infection and other forms of immunosuppression if HIV tests are negative. Successful HIV treatment will be accompanied by resolution of OHL.
2. In addition, treat the frequently associated thrush, if present, with oral nystatin suspension or clotrimazole troches.
3. Topical retinoic acid 0.1% cream applied twice daily, or
4. Topical acyclovir ointment applied to the lesion 4 times daily.
1. Oral acyclovir 2.0-3.2 g/day (400 mg 5 times daily, or 800 mg 4 times daily). for 10-14 days.
2. OHL will resolve with intravenous acyclovir, but this is rarely indicated.
3. Lesions that don't improve with acyclovir may clear with 9-(1,3-dihydroxy-2-propoxymethyl guanine (DHPG). DHPG is potentially toxic and is not indicated for treating OHL alone.
Chronic suppression with retinoic acid or topical oral acyclovir may be used. However, as OHL is totally asymptomatic and hidden, suppressive therapy has no proven benefit.
1. Failure to evaluate for HIV infection.
2. Side effects from oral acyclovir are rare. They include rashes and mild GI upset. Intravenous acyclovir may precipitate in the kidney and decrease renal function, so renal function tests should be followed.
3. HIV-positive individuals also may develop true precancerous or cancerous leukoplakia like oral lesions. The diagnosis of OHL should be considered only when in its characteristic location (lateral tongue bilaterally). A biopsy is required to establish the diagnosis of OHL when seen at other locations in the oral cavity.
4. OHL is a clinical diagnosis. Epstein-Barr virus serologies play no role in the management or diagnosis of OHL.
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