Hairy leukoplakia
| Hairy leukoplakia | |
|---|---|
| Classification and external resources | |
| Specialty | gastroenterology |
| ICD-10 | K13.3 |
| ICD-9-CM | 528.6 |
| DiseasesDB | 5594 |
| eMedicine | med/938 |
| MeSH | D017733 |
Hairy leukoplakia (also known as oral hairy leukoplakia, OHL, or HIV-associated hairy leukoplakia), is a white patch on the side of the tongue with a corrugated or hairy appearance. It is caused by Epstein-Barr virus (EBV) and occurs usually in persons who are immunocompromised, especially those with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). This white lesion cannot be scraped off. The lesion itself is benign and does not require any treatment, although its appearance may have diagnostic and prognostic implications for the underlying condition.
Depending upon what definition of leukoplakia is used, hairy leukoplakia is sometimes considered a subtype of leukoplakia, or a distinct diagnosis.
In a classification of the oral lesions in HIV disease, OHL is grouped as "lesions strongly associated with HIV infection" (group I). It could also be classed as an opportunistic, viral disease. Hairy leukoplakia occurs on the tongue and has a similar name to hairy tongue, but these are separate conditions with different causes.
There are no symptoms associated with the lesion itself, although many and varied symptoms and signs may be associated with the underlying cause of immunosuppression. The lesion is a white patch, which almost exclusively occurs on the lateral surfaces of the tongue, although rarely it may occur on the buccal mucosa, soft palate, pharynx or esophagus. The lesion may grow to involve the dorsal surface of the tongue. The texture is vertically corrugated ("hairy") or thickly furrowed and shaggy in appearance.
The white appearance is created by hyperkeratosis (overproduction of keratin) and epithelial hyperplasia. The causative organism implicated is Epstein-Barr virus, the same virus that causes infectious mononucleosis (glandular fever). After the primary EBV infection has been overcome, the virus will persist for the rest of the host's life and "hides" from the immune system by latent infection of B lymphocytes. The virus also causes lytic infection in the oropharynx, but is kept in check by a normal, functioning immune system. Uncontrolled lytic infection is manifested as oral hairy leukoplakia in immunocompromised hosts. OHL usually arises where the immunocompromise is secondary to HIV/AIDS. Rarely are other causes of immunocompromise associated with OHL, but it has been reported in people who have received transplants and are taking immunosuppressive medication. OHL may also accompany chronic graft versus host disease. Even more rare are reports of OHL in persons with competent immune systems.
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