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Leukoplakia

Leukoplakia is a common condition (<1%) of the mouth that involves the formation of white leathery spots on the mucous membranes of the tongue and inside of the mouth. It is not a specific disease entity and is diagnosed by exclusion of diseases that may cause similar white lesions like candidiasis or lichen planus. more...

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Leukoplakia is common in adults, mostly in the 50-70 years age group. The cause in most cases is unknown, but many are related to tobacco use and chronic irritation. A small proportion of cases, particularly those involving the floor of the mouth or the undersurface of the tongue is associated with a risk of cancer.

The so-called hairy leukoplakia associated with HIV infection and other diseases of severe immune deficiency does not have risks for cancer.

The treatment of leukoplakia mainly involves avoidance of predisposing factors like smoking, tobacco and betel chewing, alcohol,and removal of chronic irritants like sharp edges of teeth. In suspicious cases, a biopsy is also taken, and surgical excision done if pre-cancerous changes or frank cancer is detected.


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Oral hairy leukoplakia in HIV-infected patients
From American Family Physician, 4/1/89

Oral Hairy Leukoplakia in HIV-Infected Patients One of the early manifestations of human immunodeficiency virus (HIV) infection is oral hairy leukoplakia. These lesions occur primarily on the tongue and often precede the development of the acquired immunodeficiency syndrome. Evidence suggests that oral hairy leukoplakia is of viral origin, and both Epstein-Barr virus and the papillomavirus have been implicated. Oral hairy leukoplakia is not known to resolve spontaneously.

Currently, the only antiviral agent specifically approved for use in the treatment of HIV infection is zidovudine. Kessler and associates report that oral zidovudine therapy may be effective in the treatment of oral hairy leukoplakia. The authors describe two patients who had HIV infection and oral hairy leukoplakia that responded to zidovudine.

Both patients received 200 mg every four hours for a total of six to seven weeks. In one patient, the tongue lesions had partially regressed after four weeks of therapy and had completely resolved after seven weeks of therapy. This patient noted improvement in his physical well-being and appetite. The other patient also received acyclovir therapy for anal herpes. After one week of treatment with zidovudine, he noted partial resolution of the tongue lesions and significant improvement in physical well-being. Complete resolution of the oral hairy leukoplakia occurred after six weeks of zidovudine therapy.

It could not be determined whether resolution of oral hairy leukoplakia was due to a direct antiviral action of zidovudine or to an indirect effect on immune function. Because of its expense and potential bone marrow toxicity, zidovudine should be reserved for those patients who meet the current approved criteria for use of this drug. (Archives of Internal Medicine, November 1988, vol. 148, p. 2496.)

COPYRIGHT 1989 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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