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hairy leukoplakia
Whitish discoloration of the tongue that does not scrap off easily.
Etiology:
- mucosal epithelial infection with Epstein-Barr virus (EBV)
Epidemiology:
- common in patients with HIV1 infection
- also occurs in patients taking immunosuppressive agents
Clinical manifestations:
1) painless patches of white, linear, frond-like lesions on the buccal mucosa & tongue
- white, corrugated, adherent plaque on the lateral surface of the tongue [2]
2) lesions do not scrap off easily as does thrush (Candida)
3) lesions may wax & wane over time or resolve spontaneously
Laboratory:
1) none generally needed
2) biopsy shows changes typical for EBV
3) scrapings from lesions may show colonization with Candida
Complications:
- not a premalignant lesion
Differential diagnosis:
- squamous cell carcinoma of the mouth
- white, corrugated, adherent plaque on the lateral surface of the tongue may be white exudate concealing ulcerated nodular lesion on the ventral surface of the tongue
- ulcer for >= 2 months with increasing pain (hairy leukoplakia is painless)
- history of heavy alcohol & tobacco use
- oral lichen planus
- white, lacy pattern on dorsal tongue or as shallow red ulcers
- generally due to medications or chronic trauma in elderly
- Behcet disease
- generally manifests in patients in their 20s
- recurrent oral ulcers may last 3 weeks, not 2 months
- secondary syphilis:
- whitish, wart-like lesions (condyloma latum) on mucous membranes
- resolution in 3-6 weeks
Management:
1) may resolve spontaneously
2) resolution with antiviral therapy
a) acyclovir
b) zidovudine (AZT)
Related
Epstein-Barr virus (EBV); human herpesvirus 4 (HHV4)
General
viral infection
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- NEJM Knowledge+ Gastroenterology