Oral Hairy Leukoplakia

Oral hairy leukoplakia (OHL) is a benign condition characterized by white patches on the lateral borders of the tongue, primarily caused by Epstein-Barr virus (EBV). It is most commonly seen in immunocompromised individuals, particularly those with HIV/AIDS.

Classification

1. Primary OHL: Occurs in immunocompromised patients, often as the first sign of EBV infection.
2. Secondary OHL: Seen in patients with other immunosuppressive conditions (e.g., organ transplant recipients).

Causes

• Epstein-Barr Virus (EBV): The primary causative agent.
• Immunosuppression: Common in individuals with HIV/AIDS, particularly with CD4 counts <200 cells/mm³.
• Other Factors: Chemotherapy, autoimmune diseases, and chronic steroid use.

Investigation

1. Clinical Evaluation: Identification of characteristic white patches on the tongue.
2. Histopathology: Biopsy may show hyperkeratosis and EBV-infected cells.
3. Serology: EBV antibody testing can confirm past infection.
4. CD4 Count: Important for assessing immunosuppression in HIV patients.

Management

1. Antiviral Therapy: Acyclovir or ganciclovir for severe cases.
2. HIV Management: Initiating or optimizing antiretroviral therapy (ART) to improve immune function.
3. Symptomatic Relief: Topical anesthetics for discomfort.
4. Monitoring: Regular follow-up to assess immune status and lesion resolution.

References

1. Greenspan JS, et al. “Oral hairy leukoplakia: a clinical and histopathologic study.” Oral Surgery, Oral Medicine, Oral Pathology. 1984.
2. Kauffman CA. “Oral hairy leukoplakia: a marker for HIV infection.” The New England Journal of Medicine. 1995.
3. Kahn J, et al. “Oral hairy leukoplakia in HIV-infected patients: a review.” Oral Diseases. 2005.