This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )

1. HAIRY LEUKOPLAKIA
SUBMITTED TO : DEPARTMENT OF ORAL
MEDICINE & RADIOLOGY
Submitted By : VASU KALRA
Roll no :12
Final year ND

2. What is leukoplakia ?
 Leukoplakia (white patch) is the most common potentially malignant
lesion of the oral mucosa
 As many lesion have same clinical features as leucoplakia hence It usage
should be limited clinically .It sometime misleading to directly jump to this before
excluding all the lesions like lichen planus ,morsicatio (chronic cheek bite )
 Histologically leucoplakia represents an area localized in distribution,
hyperkeratotic in nature and white in appearance due to wetting of the
keratotic patch while in contact with saliva
 Diagnosis of leukoplakia generally suggest that
The mucosa is
irritated by either
mechanical,
chemical or
galvanic means, and
The mucosa is
trying to adapt to
the noxious
stimuli by
undergoing
hyperkeratinizatio
n

3. Definable White Lesions
 Hyperplastic candidiasis (candidal leucoplakia). When dealing
with a hyperplastic epithelial lesion in which the presence of
Candida albicans is demonstrated, it is referred to as candida-
associated leukoplakia
 Hairy leukoplakia (Greenspan lesion)- the lesion is not
premalignant in nature. Therefore, the use of the term should be
abandoned. As an alternative, the term Greenspan lesion’ has been
suggested.
 Tobacco-induced white lesions- Smoker’s palate (leukokeratosis
nicotina palati), palatal keratosis in reverse smokers and snuff
dippers lesions are clearly related to tobacco use
 Tobacco-associated leucoplakia -The etiological role of tobacco in
patients who smoke cigarettes, cigars or pipes is less obvious.
Therefore, preference has been given to the term ‘tobacco-
associated leukoplakia’ (leukoplakia in smokers) over the term
‘tobacco-induced white lesions
Hairy leukoplakia
Candidal leukoplakia

4. Hairy leukoplakia
• HAIRY LEUKOPLAKIA IS A WHITE PATCH ON THE SIDE OF
THE TONGUE WITH A CORRUGATED OR HAIRY
APPEARANCE
• THE WHITE LESION, WHICH CANNOT BE SCRAPED OFF, IS
BENIGN AND DOES NOT REQUIRE ANY TREATMENT
• ALTHOUGH ITS APPEARANCE MAY HAVE DIAGNOSTIC
AND PROGNOSTIC IMPLICATIONS FOR THE UNDERLYING
CONDITION.
• IT IS ASSOCIATED WITH EPSTEIN-BARR VIRUS (EBV)(ALSO
KNOWS AS HSV 4)
• IT OCCURS MOST COMMONLY IN PEOPLE INFECTED
WITH HIV

5. Clinical features
 Intraorally, unilateral or bilateral non-painful white lesions are seen mostly on the
lateral margin of the tongue
 The lesion may vary in appearance from a smooth, flat, and small lesion to an
irregular "hairy" or "feathery" lesion with prominent folds or projections
 It may occur as either continuous or discontinuous lesion along the lateral border of
the tongue and is often not symmetrical bilaterally.
 The lesions may vary in size, severity, and surface characteristics.[10] The lesion is
adherent to the surface, and cannot be removed by scraping
 The surrounding tissue does not show any sign of erythematous or edematous
change
 Hairy leukoplakia may also involve other surfaces f the tongue, the buccal mucosa,
and/or the gingiva. Here, it may appear as flat with a smooth surface, thus, lacking
the typical "hairy" appearance of the lesion.

6. Etiology of (ORAL HAIRY LEUKOPLAKIA)
HIV
EBV
(Epstein
-Barr
virus)
Immunocompromize
d
Patient undergoing
any kind of
treatment
Patient on any
type of
corticosteroids or
any other immune
compressants
• it has been observed that
the risk of developing hairy
leukoplakia increases to
almost two times with
every 300-unit decrease in
the CD4 count
Behcet
syndrome

7. Pathophysiology
 The causative agent implicated is Epstein-Barr virus, the same
virus that causes infectious mononucleosis (glandular fever)
 the primary EBV infection has been overcome, the virus will
persist for the rest of the host's life and "hides" from the
immune system by latent infection of B lymphocytes
 The virus also causes lytic infection in the oropharynx, but is
kept in check by a normal, functioning immune system.
 Uncontrolled lytic infection is manifested as oral hairy
leukoplakia in immunocompromised hosts. OHL usually arises
where the immunocompromise is secondary to HIV/AIDS

8. Histopathology
 It is this hyperkeratotic thick layer that may separate from the
underlying cells resulting in projections producing the typical
"hairy" appearance of the lesion. This hyper-keratinized
epithelium may get superficially infected with bacteria and/or
Candida.
 The abnormal persistence of nuclei of the cell in this layer of the
epithelium represents incomplete squamous differentiation.
 The abnormal persistence of nuclei of the cell in this layer of the
epithelium represents incomplete squamous differentiation.
 This abnormal expansion of cells occurs with layers of
koilocyte-like cells or ballooned cells
 Absence of inflammation in the epithelium and minimal to zero inflammation
in the lamina propria and even absent inflammatory mononuclear cells
infiltrate.

9. Treatment
• AS HAIRY LEUKOPLAKIA IS A BENIGN CONDITION HAVING A LOW
MORBIDITY RATE AND A TENDENCY TO RESOLVE SPONTANEOUSLY,
EVERY CASE DOES NOT NEED TO BE SPECIFICALLY TREATED
• TREATMENT IS GIVEN FOR PROVIDING RELIEF FOR
SYMPTOMS CAUSED BY THE CONDITION, OR WHEN THE PATIENT
WISHES TO TREAT THE CONDITION FOR ESTHETIC REASONS
• HIGHLY ACTIVE ANTIRETROVIRAL THERAPY DRUGS USUALLY REDUCE
HAIRY LEUKOPLAKIA, BUT THE CONDITION MAY REOCCUR WHEN THE
DRUG DOSAGE IS REDUCED.
• ORAL TREATMENT WITH ANTIVIRAL MEDICATION SUCH AS ACYCLOVIR
NEEDS TO BE GIVEN IN A HIGH DOSAGE OF ABOUT 4000 MG PER DAY
IN DIVIDED DOSAGES FOR AT LEAST SEVEN DAYS TO ACHIEVE THE
REQUIRED THERAPEUTIC LEVELS.
• TOPICAL TREATMENT CAN BE DONE USING PODOPHYLLIN RESIN.
THE SOLUTION OF THIS RESIN IS USED IN THE CONCENTRATION OF
25%

10. Diagnosis
• THE WHITE LESION CANNOT BE WIPED AWAY,[6] UNLIKE
SOME OTHER COMMON ORAL WHITE LESIONS,
E.G. PSEUDOMEMBRANOUS CANDIDIASIS, AND THIS
MAY AID IN THE DIAGNOSIS.
• DIAGNOSIS OF OHL IS MAINLY CLINICAL, BUT CAN BE
SUPPORTED BY PROOF OF EBV IN THE LESION
• HEN CLINICAL APPEARANCE ALONE IS USED TO
DIAGNOSE OHL, THERE IS A FALSE POSITIVE RATE OF
17% COMPARED TO MORE OBJECTIVE METHODS
• IF TISSUE BIOPSY IS CARRIED OUT,
THE HISTOPATHOLOGIC APPEARANCE IS OF
HYPERPLASTIC AND PARAKERATINIZED EPITHELIUM,
WITH "BALLOON CELLS" (LIGHTLY STAINING CELLS) IN
THE UPPER STRATUM SPINOSUM AND "NUCLEAR
BEADING" IN THE SUPERFICIAL LAYERS

11. T H
A N K
Y O u

12. CONTENT
 Referred to SHAFERS TEXTBOOK OF ORAL PATHOLOGY
 https://www.ncbi.nlm.nih.gov/books/NBK554591/
 https://en.wikipedia.org/wiki/Hairy_leukoplakia#:~:text=Hairy%20leukopla
kia%20is%20a%20white,syndrome%20(HIV%2FAIDS)