2.1.9 Oral Hairy Leukoplakia

Epstein-Barr virus associated hyperkeratotic changes on the tongue in HIV infection.

Current incidence of cancers of the oral cavity is mainly consisting of squamous cell carcinomas. It varies worldwide from less than three to seven or eight per 100,000 population. It affects mainly middle-aged and elderly people. Prevalence of oral leukoplakia is approximately 0.1% with a huge variation in different parts of the world above the age of 30-40 years. Annual risk of malignant transformation of oral leukoplakia from 2 to 3% or even much higher. individuals who are not immunocompromised. It occurs also in immunocompetent patients having continuously inhaled topica or systemic corticosteroids for the long term.

The Centre for Disease Control and Prevention has classified this condition as a Category-B clinical marker of HIV disease since it has a clear prognostic value in the subsequent development of AIDS.

It is associated with Epstein-Barr virus (EBV), also known as human herpesvirus 4. It occurs most commonly in people infected with HIV, although it can also be seen in people who do not have HIV. Such patients usually have had an organ or bone marrow transplant or some immunocompromised disease or hematological malignancy.

In hairy leukoplakia, the BZLF1 gene is restricted to the cells of the stratum spinosum and stratum granulosum, not to the basal cells.

White, hyperkeratotic, often thread-like deposits on the sides and under surface of the tongue which cannot be wiped away (in contrast to oral candidiasis).

Five Signs. Hyperkeratosis of the superficial layer of the epithelium and Hyperparakeratosis of the superficial layer of the epithelium. Acanthosis of the upper stratum spinosum. Absence of inflammation in the epithelium and minimal to zero inflammation in the lamina propria, and even absent inflammatory mononuclear cells infiltrate. Normal basal cells of the epithelium.

Leukoplakia, lichen planus, candidiasis.

Hairy leukoplakia is a benign condition with a low morbidity rate and a tendency to resolve spontaneously. Treatment options include anti-retroviral drugs. Highly active antiretroviral therapy drugs usually reduce hairy leukoplakia, relapses can occur despite when dosage is reduced.

A topical treatment with low concentration with podophyllin or tretinoin 0.1% can be done.