Oral Hairy Leukoplakia

What Is Oral Hairy Leukoplakia?

A condition that gets triggered by the Epstein-Barr virus (EBV) is called oral hairy leukoplakia (OHL). The term oral hairy leukoplakia was given because of the rough and corrugated surface of the epithelium. White patches could be visible on the corrugated tongue, and these patches can sometimes be seen on the other parts of the mouth. The patches appear hairy and hence the name hairy leukoplakia. Oral hairy leukoplakia is known to occur in people with poor or weak immune responses, and HIV (human immunodeficiency syndrome) is said to often cause this condition. Initially, this lesion was observed exclusively in male homosexuals. Greenspan and coworkers first reported oral hairy leukoplakia in 1984 on the lateral margin of the tongue among young homosexual males.

Further studies indicated their prevalence among other risk groups of AIDS, such as injecting drug users, transfusion recipients, hemophiliacs, and certain immunocompromised HIV seronegative patients. These lesions are shown to be associated with the Epstein-Barr virus, which has been demonstrated by electron microscopy, immunohistochemistry, and in situ hybridization. Sometimes, the healthcare provider may need to take a closer look at the HIV treatment to help boost the immune status. Mostly they might prescribe symptom-relieving medications and, in some patients, antiviral drugs are given. In more severe cases, healthcare professionals may suggest surgical removal of the sore.

What Causes Oral Hairy Leukoplakia?

As the immune system weakens, certain factors may trigger oral hairy leukoplakia. The triggering factors could be the Epstein-Barr virus and human immunodeficiency virus. In addition, it occurs in other people with a suppressed immune system, such as:

1. Organ transplant recipients.

2. Cancer patients.

3. People taking systemic or inhaled steroids.

Oral candidiasis and oral hairy leukoplakia are the diagnostic signs of the successive development of acquired immunodeficiency syndrome. The most important causative factor of oral hairy leukoplakia is the Epstein-Barr virus infection of the tongue epithelium, where there are only a few or no Langerhans cells. It has been proposed that basal epithelial cells on the lateral margin of the tongue typically hold latent Epstein-Barr virus. Significant decrease of Langerhans cells by human immunodeficiency virus in the affected site permits Epstein-Barr virus reactivation with subsequent epithelial hyperplasia. Epithelial cell proliferation and hyperplasia occur due to the delayed cell death caused by the Epstein-Barr virus. It must be noted that the Epstein-Barr virus is associated with several forms of lymphoma in HIV-positive patients.

What Are the Clinical Manifestations of Oral Hairy Leukoplakia?

Oral hairy leukoplakia frequently appears:

1. Bilaterally on the lateral borders of the tongue, but it could occur unilaterally or bilaterally.

2. It occurs less frequently in the areas such as the floor of the mouth, soft palate, buccal mucosa, tonsillar region, and posterior region of the pharynx.

3. It is a painless condition.

4. These lesions do not go away or cannot be wiped off.

5. The appearance ranges from soft white vertical streaks or thickened and furrowed areas.

6. These areas appear as a fuzzy keratotic surface with vertical striations showing a corrugated appearance.

7. The hairy white patches appear as folds and cannot be removed with a tongue cleaner, toothbrush, or other oral tools.

8. There may be discomfort, stinging, and burning sensation.

9. These patches may cause some taste changes.

10. Rarely oral hairy leukoplakia occurs in the oropharynx but is not seen on other mucosal surfaces.

These are the symptoms of oral hairy leukoplakia, which may appear as other medical conditions, so it is better to talk with the doctor or healthcare provider for a definitive diagnosis.

What Are the Histological Manifestations of Oral Hairy Leukoplakia?

1. Lesions show features of epithelial hyperplasia with velvety patches and hyperkeratosis, which produce surface corrugations.

2. Upper prickle cell layer - A unique feature of the epithelium that shows the velvety patch is the presence of varying numbers of lightly stained, swollen balloon cells in the upper prickle cell layer.

3. Superficial epithelial cells - These cells show dense aggregates of nuclear chromatin material marginated along the atomic membrane known as nuclear beading.

4. Ultrastructural studies - Heterochromatin distribution and a ground glass nucleoplasm are seen along the nuclear envelope's inner aspect with an even distribution of Epstein-Barr virus particles throughout.

5. Occasional minor atypical changes such as increased number of mitoses and basal cell hyperchromatism are seen.

6. The presence of candidal hyphae in the overlying superficial epithelial cell layers is not uncommon.

7. Epstein-Barr virus can be confirmed by in situ hybridizations, PCR (polymerase chain reaction), or immunohistochemistry.

What Are the Treatment Options for Oral Hairy Leukoplakia?

Treatment is not required for oral hairy leukoplakia as it is not premalignant and is usually asymptomatic. However, occasional slight discomfort, soreness, and the unsightly appearance of lesions warrant treatment. The treatment options for oral hairy leukoplakia will depend on age, general health, and symptoms. It will also depend on the severity of the condition.

Pharmacological Treatment:

1) As many oral hairy leukoplakia cases reveal candida, topical and systemic antifungal agents are employed. They are:

• Nystatin.

• Clotrimazole.

• Ketoconazole.

• Fluconazole.

2) When recurrence is observed in days to months, then gentian violet, retinoic acid, and podophyllin resin would be suggested.

3) Antiviral agents such as Acyclovir, Desciclovir, and Ganciclovir result in clinical improvement by inhibiting the replication of the Epstein-Barr virus. However, if latent infection or immunosuppression persists, discontinuation of therapy can result in the recurrence of lesions.

4) Antiretroviral therapy helps improve the condition in those with HIV-associated oral hairy leukoplakia.

Surgical Measure:

The symptoms become enhanced on surgical excision, which induces remission.

Conclusion:

Oral hairy leukoplakia is linked to HIV infection. So the patient might experience HIV-related complications like low immunity, which may even lead to death. People with oral hairy leukoplakia often need HIV treatment, and the healthcare provider will have a close eye on them. However, prevention is better than cure, and it starts by having a good immune system. Try to take appropriate steps to have a healthy life. Start practicing safe sex, a healthy diet, regular exercise, and avoid smoking. If you have been prescribed HIV medications, stick to them and have a dental hygiene routine. In addition, reach out to your doctor in case of any doubts and new symptoms.