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Criteria for Diagnosis of Oral Hairy Leukoplakia

Purpose: To evaluate a patient with a white lesion of the tongue for the diagnosis of oral hairy leukoplakia.

Description

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.


 

Parameter

Findings

clinical

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

histolopathology

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

laboratory

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

 

Limitations:

• 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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Specialty

Objective

ICD-10