From the Guidelines
Oral hairy leukoplakia is a condition that can occur in immunosuppressed patients, including those with chronic kidney disease (CKD) on dialysis, and is often associated with immunosuppressive drug therapy, particularly when blood urea nitrogen (BUN) levels are above 300 mg·mL−1. This condition is caused by the Epstein-Barr virus (EBV) and can be managed with antiviral medications such as acyclovir or valacyclovir, although treatment is often unnecessary as the condition is benign 1. The lesions appear white or gray with a hairy or corrugated texture and cannot be scraped off, distinguishing them from candidiasis.
Key Considerations
- Immunocompromised patients, including those with CKD on dialysis, are at increased risk of developing oral hairy leukoplakia due to impaired immune function 1.
- The condition is often associated with immunosuppressive drug therapy, particularly when BUN levels are above 300 mg·mL−1 1.
- Regular dental check-ups are important for monitoring and managing oral hairy leukoplakia, as well as evaluating for underlying immunosuppression if the cause is unknown.
Management Options
- Antiviral medications such as acyclovir (800 mg five times daily for 2-3 weeks) or valacyclovir (1-2 g three times daily for 2-3 weeks) may be used to treat oral hairy leukoplakia, although treatment is often unnecessary as the condition is benign 1.
- Topical podophyllum resin (25% solution applied carefully to lesions) may also be used as a treatment option.
- For HIV-positive patients, antiretroviral therapy is the most effective long-term management as it improves immune function.
Important Laboratory Tests
- Blood tests, including complete blood count, blood urea, creatinine, and bicarbonate levels, should be performed to evaluate the patient's overall health and immune function 1.
- Coagulation tests, including bleeding time, should be performed to assess the risk of hemorrhage, particularly in patients on dialysis 1.
From the Research
Definition and Cause of Oral Hairy Leukoplakia
- Oral hairy leukoplakia (OHL) is a disease associated with Epstein-Barr virus (EBV) and human immunodeficiency virus (HIV) infections 2, 3, 4.
- The clinical and histologic features of OHL are characteristic and distinctive, but the presence of EBV is required for diagnosis in questionable cases 3.
Treatment of Oral Hairy Leukoplakia
- Acyclovir is the current drug of preference for treating OHL, and it has been shown to lead to partial or complete remission in some patients 5, 3.
- Topical treatment with gentian violet, retinoids, podophyllin, acyclovir, and podophyllin associated with topical antiviral drugs have been used to treat OHL 2.
- Podophyllin with acyclovir cream has been found to be effective in causing regression of lesions with no recurrences 2.
- Valacyclovir has also been used to treat OHL and inhibit productive EBV replication, with some cases showing resolution of HLP and termination of EBV replication 6.
Response to Treatment and Resistance
- The response to treatment with acyclovir or valacyclovir can be partial or complete, but recurrence of OHL is common after discontinuation of treatment 5, 6.
- In some cases, treatment with valacyclovir can fail, and productive EBV replication can persist, possibly due to the evolution of acyclovir-resistant EBV 6.
- The mechanisms of EBV persistence in oral mucosa are not fully understood, but treatment with valacyclovir provides new insight into this area 6.