Oral hairy leukoplakia (OHL) is a disease of the lingual squamous epithelium caused by the Epstein-Barr virus (EBV). OHL generally affects the lateral portion of the tongue, although the floor of the mouth, palate, or buccal mucosa may also be involved. The lesions are white corrugated plaques that, unlike Candida, cannot be scraped from the surface to which they adhere. Most often OHL is asymptomatic, although occasionally this condition can be painful. Diagnosis is usually clinical, although definitive diagnosis can be made by biopsy characteristically revealing acanthosis and parakeratosis.
Management and Disposition
Patients who are known to be HIV seropositive can be educated about the disease and reassured. OHL is not considered to be a premalignant lesion. If the patient is not known to be infected with HIV, primary care provider referral and HIV screening, if available, should be offered.
Oral candidiasis can be distinguished from OHL by using a swab in an attempt to remove the exudate characteristic of thrush and by observing pseudohyphal elements microscopically with Candida. OHL cannot be scraped off and usually involves the lateral aspect of the tongue.
OHL is fairly specific for HIV infection as it is rarely observed in patients with other immunodeficiencies. If OHL is identified in a patient not known to be HIV infected, risk factors and HIV screening options should be discussed and performed.
Oral Hairy Leukoplakia. Typical-appearing lesions on side of tongue in this patient with HIV. (Photo contributor: Robert Brandt, MD.)
Oral Hairy Leukoplakia. Exudate does not scrap off the tongue in oral hairy leukoplakia, differentiating it clinically from oral thrush. (Photo contributor: Kevin J. Knoop, MD, MS.)