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| Fig. 39.3 Oral changes. A, Oral hairy leukoplakia. Vertically oriented white plaques with a corrugated appearance are seen on the lateral edge of the tongue. B, Hyperplastic candidiasis. A white coating that does not scrape off is present on the dorsal surface of the tongue in this HIV-positive patient. |
Oral hairy leukoplakia, which is predictive for development of AIDS, is primarily seen in HIV-infected patients but also has been described rarely in HIV-negative immunosuppressed organ transplant recipients. It is due to Epstein-Barr virus replication within clinical lesions. Oral hairy leukoplakia occurs primarily on the lateral edges of the tongue as parallel, vertically oriented, white plaques, producing a corrugated appearance (Fig. 39-3A). It can infrequently also involve the dorsal and ventral aspects of the tongue, the buccal or labial mucosa, and the soft palate. The plaque in this condition does not rub off with scraping (unlike candidal thrush) and is usually asymptomatic. Histologically, parakeratosis, acanthosis, and ballooning cells (koilocytes) are seen. In situ Epstein-Barr virus DNA hybridization of lesional scrapings or tissue sections shows positive nuclear staining within epithelial cells. Lesions may respond to acyclovir, zidovudine, podophyllin, tretinoin, or excision but do not respond to anticandidal treatment.
Resnick L, Herbst JS, Raab-Traub N: Oral hairy leukoplakia,
J Am Acad Dermatol 22:1278–1282, 1990.
