Oral hairy leukoplakia is a lesion of the lateral tongue that is typically seen in HIV-positive patients. The lesion usually is white, poorly demarcated, and corrugated ("hairy"). Epstein-Barr virus (EBV) can be demonstrated in the lesions by a number of techniques.





usually in high risk category for HIV-disease


unilateral or bilateral tongue involvement, rarely on buccal mucosa


lack of complete regression after topical or systemic antifungal therapy


hyperkeratosis, band-like or projections


presence of balloon cells


usually absence of inflammatory cell infiltrate (inflammation sometimes present)


Epstein-Barr viral DNA on in-situ hybridization


evidence of herpes-type virus particles on electron microscopy


usually HIV-positive, may be negative


High risk populations:

(1) intravenous drug abusers

(2) homosexual and bisexual men (men who have sex with men)

(3) hemophiliacs exposed to non-recombinant, pooled plasma concentrates untreated for viral inactivation

(4) females who are sex workers or who have sex with men who are intravenous drug abusers or who have sex with other men



• Other leukoplakic lesions may clinically mimic oral hairy leukoplakia.

• Histologic features like hyperkeratosis are nonspecific.

• Morsicatio lingue (tongue biting) may share both clinical and histologic features, but evidence of EBV would be lacking.


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