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First reported in 1984, it was described in immunosuppressed young male homosexuals.
It is now well documented that it occurs in all risk groups for HIV, including HIV-2, as well as in transplant patients and drug-induced immunosuppression .
The incidence has been estimated between 7.5% and 25% of AIDS patients.
Asymptomatic benign epithelial hyperplasia is associated with the Epstein-Barr virus, almost always in immunocompromised patients.
Recent studies have shown that monocytes, macrophages, and Langerhans cells infected with the Epstein-Barr virus migrate and infect the differentiated cells of the spinous layer of the tongue and trigger extensive viral replication and shedding.
The Epstein-Barr virus strains that replicate in the oral hairy leukoplakia lesion are different from those that shed into the oral cavity, which had been transported hematogenously to the lingual epidermis.
Another alternative name for hairy leukoplakia is: smoker’s keratosis.
Causes
Leukoplakia affects the mucous membranes of the mouth and although the exact cause is still unknown. It can be caused by irritation due to:
- Chipped teeth
- Irritating areas on dentures, dental work like fillings and crowns.
- The habit of smoking or some other tobacco product, especially the use of pipes (smoker’s keratosis).
- The alcoholism.
This condition is much more common in older adults.
A type of leukoplakia is seen in the mouth that is caused by the Epstein-Barr virus and is especially seen in the HIV-infected population.
Hairy leukoplakia is seen relatively frequently, appearing before or after an established AIDS diagnosis. This can be one of the initial symptoms of HIV infection.
People whose immune systems are not working well are more sensitive to oral hairy leukoplakia, which can also appear after a bone marrow transplant.
Symptoms of hairy leukoplakia
It is characterized by raised, bilateral white patches with a warty or filiform irregular surface that cannot be scraped on the lateral edges and the back of the tongue.
These lesions are asymptomatic and non-malignant, which have also been found on the ventral surfaces of the tongue, the buccal mucosa, the floor of the mouth, the palatal mucosa, and the oropharynx.
The presence of koilocytes in the superficial epithelial layers is the histological pathognomonic sign.
Other unique histopathologic features include the lack of a marked inflammatory infiltrate in the associated submucosa and deep acanthosis, often with koilocytic changes.
Oral hairy leukoplakia is the only chronic disease related to the Epstein-Barr virus where the virus replicates profusely.
The amount of viral replication is directly proportional to the degree of differentiation of keratinocytes.
Furthermore, in permissive herpesvirus infections, where abundant virus production results in cell lysis, the epithelial cells harboring this replicative activity remain intact.
Hairy leukoplakia is a lesion seen almost exclusively in HIV-infected individuals, although it is occasionally seen in patients with other immunosuppressive disorders and rarely in apparently immunocompetent patients.
It represents an opportunistic infection with the Epstein-Barr virus and presents as an asymptomatic white patch that may be flat, vertically corrugated, or papillate (hairy).
It has a great predilection for the lateral margin of the anterior half of the tongue or on the inside of the cheek. It can be quite extensive and is often bilateral and involves the dorsal tongue.
The lesions usually develop on the tongue on the sides of the tongue and in the inner area of the cheeks and present the following characteristics:
- The color of the lesions are white to gray.
- They have an irregular shape.
- They are slightly raised and have a hardness on the surface.
- They become painful when they come in contact with spicy or acidic foods.
Incidence and location
Less than 10% of HIV-infected patients receiving highly active antiretroviral therapy.
Non-HIV-associated hairy leukoplakia has been reported in solid organ transplant recipients and less frequently in patients with hematologic malignancies, autoimmune diseases, and other systemic inflammatory conditions.
Hairy leukoplakia has been reported in immunocompetent patients on long-term use of inhaled, topical, and systemic corticosteroids.
Identified particularly in HIV-positive men and has no racial or age predilection.
Diagnosis of hairy leukoplakia
The diagnosis is made with an average history and a physical examination, later tests such as a biopsy of the lesion are performed to confirm the diagnosis.
Examination of the biopsy can find changes that indicate oral cancer.
Treatment
The main goal of hairy leukoplakia treatment is to remove the lesion caused by the condition.
Because it is a benign lesion with low morbidity, oral hairy leukoplakia does not require specific treatment, although it may be necessary to treat a secondary Candida.
However, the patient may wish to reduce symptoms such as discomfort, mild pain, and paresthesia, or treat the injury for cosmetic reasons.
By eliminating the source of irritation, the lesion or patch tends to disappear, so it is advisable to take the following measures:
- Causes such as rough or uneven tooth surfaces or fillings should be treated as soon as possible.
- Stop smoking or using other tobacco by-products.
- Do not consume alcoholic beverages.
The doctor may suggest the use of another type of treatment such as the application of topical medications or the use of surgery to eliminate it.
One of the drugs used is acyclovir and it should be prescribed at a higher dose (800 mg five times a day).
Hairy leukoplakia prognosis
Leukoplakia is generally harmless and 10% of patients improve spontaneously, disappearing within a few weeks or months after removing the cause of the irritation.
Hairy leukoplakia patches can be early signs of cancer or AIDS.
Prevention
You should stop smoking or using other tobacco products. Do not drink alcohol. Have rough teeth treated and braces repaired immediately.
