Oral Hairy Leukoplakia – It’s Causes and Treatment

Every health disease reflects some of its characteristics in the oral cavity. One of such oral conditions is oral hairy leukoplakia.

Oral hairy leukoplakia is commonly represented as a white patch that occurs along the sides of the tongue or the cheek.


Usually, this oral condition is caused by the Epstein Barr virus and is commonly associated with people suffering from HIV.

Oral hairy leukoplakia is relatively a non-serious oral condition. The lesion may resemble an oral thrush, but it cannot be scraped out of the surface.

The prevalence of oral hairy leukoplakia is more among men who have HIV and are chronic smokers. One out every four patients with HIV develop oral hairy leukoplakia.

Treatment of oral hairy leukoplakia depends on the extent of the immune disease. However, symptomatic therapy can help to subside the lesion and its progress.

Let’s continue to read further and learn more about the causes and treatment of oral hairy leukoplakia.

What is oral hairy leukoplakia?

Oral hairy leukoplakia is an HIV associated oral condition which develops as a white patch with a corrugated or hairy appearance on the top and sides of the tongue.

Usually, it occurs in immunocompromised people. The white lesion clinically represents as oral thrush, but it cannot be scraped from the surface of the tongue. (1)

It is potentially a begin condition. The appearance of the lesion is a common diagnostic implication for the underlying health condition.


The main culprit to cause oral hairy leukoplakia is Epstein Barr virus. This virus remains in a dormant stage unless the body gets immunocompromised. Its symptoms are usually seen in the oral cavity only.

Other potential causes of oral hairy leukoplakia may include –

  • A long term habit of smoking and chewing tobacco
  • Presence of HIV/AIDS or any other autoimmune disease that may stimulate the Epstein Barr virus in the body (2)
  • Ill-fitting dentures and bridges also contribute to the formation of oral leukoplakia

What are the clinical signs and symptoms?

The signs of the lesion are more significant than the symptoms.

Typically, oral hairy leukoplakia looks like a white patch which is usually painless with rugged borders and a puckered appearance.

The location is often in the top, sides or underside of the tongue; in some cases, the sides of the cheek may also get involved. (3)

The lesion is non-scrapable and does not produce any discomfort to the patient. However, some symptoms may include –

  • Mild pain
  • Alteration of taste in the mouth
  • Sensitivity to food temperatures

Who is at risk?

Oral hairy leukoplakia can occur at any CD4 count among HIV patients, but most commonly it occurs in patients with less than 200 CD4 count. One out of every four people who have HIV develop this oral condition.

People with weak immune systems can contribute to the formation of oral hairy leukoplakia caused by Epstein Barr virus.

Prevalence of oral hairy leukoplakia is high among men who are chronic smokers or have a habit of chewing tobacco. (4)

How is it diagnosed?

Detection of oral hairy leukoplakia is an easy one. Often a medical history of HIV/AIDS points the diagnosis towards oral hairy leukoplakia.

A dentist can diagnose the condition by just looking at the typical white corrugated appearance of the lesion during a physical examination.

The lesion is then scraped with a tongue depressor or a toothbrush to differentiate it from oral thrush. A biopsy if required, can confirm the diagnosis. (5)

Treatment options

Oral hairy leukoplakia is a benign oral condition and often doesn’t require any specific treatment. Symptomatic treatments may help to reduce pain.

Commonly antiviral medications work well to resolve oral hairy leukoplakia. The course of these medications may vary from 1-2 weeks.

People who do not like the presence of a white patch in their mouth can undergo a multi-pronged approach in the dentist’s office. This may include –

  • A thorough examination of the lesion and confirmation of diagnosis by biopsy
  • Dental lasers or scalpel can easily remove small sized oral hairy leukoplakia. A cryoprobe can also be used to freeze the cells of the lesion
  • Large sized oral hairy leukoplakia may require extensive consultation and evaluation from an oral surgeon before proceeding for a surgical removal
  • A topical antiviral solution often plays a significant role in reducing the symptoms of the lesion. However, it may take up to a few weeks before you notice any results of this therapy
  • Fabrication of well-fitted denture and bridges may also help to reduce the symptoms of the oral condition

How can you prevent it?

Prevention of oral hairy leukoplakia always starts by improving the immune system of the body. Following are some of the preventive techniques that you can use –

  • Stick to the prescribed treatment for HIV
  • Abstinence from alcohol, smoking, and tobacco will contribute to the maintenance of the procedure and reduce reoccurrence of the lesion
  • Maintain a healthy lifestyle by exercising regularly
  • Eat a nutritious, healthy diet rich in vegetables, fruits and antioxidants like beta carotene.
  • Maintain a routine oral health care regime to prevent any added oral problems

Take away message

Oral hairy leukoplakia is a rare condition that commonly occurs as a trigger to Epstein Barr virus. Decreased immunity is a critical factor that initiates this process.

The most common immunocompromised disease that is associated with oral hairy leukoplakia is HIV/AIDS.

It is seen as a white patch with rugged borders that give a hairy appearance. The location of the lesion may vary from the top, sides to the underside of the tongue.


Often the only symptoms of this oral condition are mild pain and alteration of taste in the mouth.

Treatment of oral hairy leukoplakia may depend upon the underlying disease. For aesthetic reasons, small sized lesions can be removed by a scalpel or lasers.

Preventive therapies are best to maintain a healthy body and mouth. Regular dental visits can also help to detect the lesion during a dental examination.


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