What is Hairy Leukoplakia?
Hairy leukoplakia is a viral infection that involves the oral mucosa. It is characterized by the development of white patches usually on the sides of the tongue but can occur elsewhere in the tongue.
Hairy leukoplakia is also known as oral hairy leukoplakia and is a type of leukoplakia that is often associated with HIV infection. The disease was first described in the year 1984 and regarded as the most common viral induced disease among HIV positive patients although it can occur in HIV negative individuals which was first accounted in 1999. It was later reported that patients who received transplants of the bone marrow, heart and kidney are also affected with hairy leukoplakia including those with hematological malignancies.
Hairy leukoplakia mostly affects individuals who are HIV positive. It can occur to anyone regardless of race and is found to be more common among HIV positive homosexual men particularly those who are smoking cigarettes. The incidence of hairy leukoplakia can also affect people from any age levels as the disease has not established age predilection.
Oral hairy leukoplakia in itself is a self-limiting disease and is benign. The cause for concern however is the underlying condition which may have a diagnostic and prognostic relevance. It is therefore advised to seek medical consultation when oral hairy leukoplakia occurs as the disease can affect even healthy individuals.
The term hairy leukoplakia is coined after its appearance where the white patches appear to have a hair growth along with its whitish color. It is distinct from other condition of the oral mucosa such as the oral thrush or hairy tongue as the white patches in hairy leukoplakia cannot be wiped off from the tongue.
Symptoms of Hairy Leukoplakia
The onset of hairy leukoplakia itself has no associated signs and symptoms. The varied signs and symptoms that exist are usually related to the underlying condition that triggered the onset of hairy leukoplakia.
The lesion itself in hairy leukoplakia does not cause any discomfort and does not alter the ability of a person to taste. The onset of the disease may not cause any discomfort although there are cases where hairy leukoplakia can cause mild pain and discomfort. It may also alter the taste in food and liquids and there may be an increase sensitivity to taste.
Hairy leukoplakia develops on the sides of the tongue, although it can occur elsewhere in the tongue. The lesions change its appearance everyday and often come and go unexpectedly. It may not be a harmless and may not cause any discomfort but hairy leukoplakia can cause embarrassment due to its unappealing appearance.
The common signs of hairy leukoplakia may include the following:
- Appearance of unilateral or bilateral lesions along the sides of the tongue or elsewhere in the tongue
- The lesion may be small and flat with smooth texture or it may be irregular in shape with hairy appearance and may have a prominent projection or folds
- The lesions or patches may be in a continuous or irregular pattern along the sides of the tongue
- The patches or lesions are similar to the lesions of oral thrush except that the hairy leukoplakia cannot be wiped off or moved away from the surface of the tongue
- The patches may extend to other areas of the tongue, buccal mucosa and the gingival although this seldom happens
Hairy leukoplakia is believed to be triggered by Epstein-Barr virus that causes infectious mononucleosis or glandular fever. It is being linked with the weakening of the immune system after the infection from Epstein-Barr virus. The virus primarily infects the basal epithelial cells of the pharynx then goes through a replicative state then discharges the virus into the saliva and will then remain in the infected person for life. The Epstein-Barr virus stays for life once an individual is infected with it. The virus then remains dormant for some time until the immune system of a person weakens from diseases and other factors. This can then reactivate the dormant Epstein-Barr virus subsequently hairy leukoplakia.
People suffering from HIV or AIDS are mostly affected with hairy leukoplakia. This is due to their weakened immune system brought by HIV. The incidence of hairy leukoplakia is considered to be the first sign of an existing HIV or AIDS. The report on the incidence of hairy leukoplakia has found the incidence to be common among HIV positive homosexual men. It is, however, vague if the incidence of hairy leukoplakia occurs after infection with Epstein-Barr virus or after activation of the dormant virus that remains in the body.
Behcet syndrome is an uncommon disease characterized by formation of mouth ulcers, genital ulcers including eye problems and lesions is also considered to cause hairy leukoplakia. This is also due to a weakened immune system as a result of the syndrome.
Cigarette smoking of over a pack each day is also implicated in the cause of hairy leukoplakia particularly in individuals with HIV or AIDS.
It has been reported that hairy leukoplakia is seen in patients who underwent transplantation such as in the heart, kidney and bone marrow. People taking immunosuppressive drugs are also found to suffer from hairy leukoplakia.
Hairy leukoplakia in itself is a harmless and benign condition that spontaneously resolves without the need for treatment. Treatment on the other hand is an option for cosmetic reasons as the lesion is basically unappealing. The treatment is also indicated for those with widespread lesion and that has altered the ability to taste and has caused significant discomfort.
The treatment for hairy leukoplakia includes the following:
Systemic antiviral medication is regarded to give the best result in treating the lesions. The treatment usually takes about 1 week to 2 weeks before it can give a resolution to the lesion. Acyclovir is a safe oral medication that has been in use for many years for the treatment of hairy leukoplakia. Valacyclovir and Famciclovir are also systemic antiviral medication indicated for the treatment of hairy leukoplakia.
Tretinoin such as Retinoic acid directly applied on the affected area of the tongue has been reported to treat hairy leukoplakia.
However treated, hairy leukoplakia usually recurs after several weeks from the time of treatment. A regular follow-up visit to the doctor is therefore necessary to monitor the changes following a successful treatment.