What is Hairy Leukoplakia?
Hairy leukoplakia (HL) is a disease that affects the lining of the mouth and was first identified in 1984. It’s often linked to the Epstein-Barr virus (EBV), a type of herpes virus. This condition is most usually found in people who have human immunodeficiency virus (HIV), but it can also occur in those who don’t have HIV, especially individuals who have received organ or bone marrow transplants or are dealing with immune-weakening diseases or blood cancers.
Interestingly, it’s also been found in people with healthy immune systems. These patients typically have been using corticosteroids, medicines for inflammations in the form of inhalers, creams, or pills for a prolonged period. This long-term use of corticosteroids appears to be a risk factor for developing the disease.
The Centres for Disease Control and Prevention, a national public health institute in the United States, has categorised this condition as a Category-B clinical marker of HIV disease. This is because the presence of this condition can forecast the further progress of Acquired Immune Deficiency Syndrome (AIDS), the most advanced stage of HIV infection.
What Causes Hairy Leukoplakia?
Hairy leukoplakia is often found in people with HIV infection or those with weakened immune systems. It’s observed that the chance of getting hairy leukoplakia goes up almost two times for every 300-unit decrease in the CD4 count. The CD4 count is a key measure of the health of your immune system.
This condition also appears in individuals with other serious immune deficiencies. For example, those undergoing chemotherapy, who’ve had an organ transplant, or who are suffering from leukemia. However, it’s not common in people with healthy immune systems.
Hairy leukoplakia has also been linked to Behcet syndrome and ulcerative colitis, both are diseases that can cause inflammation and sores in your body. For men with HIV, smoking more than a pack of cigarettes a day has shown a positive correlation with the development of hairy leukoplakia. This means that heavy smokers with HIV are more likely to develop this condition.
Risk Factors and Frequency for Hairy Leukoplakia
Hairy leukoplakia is a condition often spotted among HIV-positive men who identify as homosexual, particularly those who smoke. It’s known to occur in roughly half of untreated HIV-positive patients, especially when their CD4 count, a key indicator of immune health, falls below a certain level. It’s noteworthy that the condition doesn’t favor any racial or age group.
- Hairy leukoplakia is common among HIV-positive homosexual men, especially smokers.
- Up to 50% of HIV patients who aren’t receiving treatment can get this condition.
- Hairy leukoplakia is more likely to occur when the CD4 count falls below 0.3 x 10/L.
- This condition doesn’t show a preference for any racial or age group.
Signs and Symptoms of Hairy Leukoplakia
Hairy leukoplakia is a condition that often does not show symptoms, so many people might not even know that they have it. It’s usually noticed as a painless white patch on the side of the tongue. This patch can come and go on its own. Some people might experience mild discomfort, a change in how they perceive the sensation of touch, a change in their sensitivity to the temperature of food, changes in their sense of taste, or feel self-conscious about the way it looks.
During a physical examination, a healthcare provider might notice white patches on one or both sides of the tongue. These patches might have a variety of appearances – they could be smooth, flat, and small, or irregular and rough with folds or projections that give them a “hairy” or “feathery” look. The patches can line the side of the tongue in a continuous or broken pattern and might not be symmetrical on both sides of the tongue. The patches can stick to the surface of the tongue and cannot be scraped away. There is usually no redness or swelling in the surrounding areas. In some cases, hairy leukoplakia might also affect other sections of the tongue, the inside of the cheeks, or the gums. If it does, it would likely appear as a flat, smooth patch without the typical “hairy” appearance.
Testing for Hairy Leukoplakia
If a doctor suspects you might have a condition called hairy leukoplakia, they’ll likely first decide based on what they see during check-ups. Nevertheless, to confirm this diagnosis, they’ll need to take a closer look at your skin cells under a microscope and check for signs of a virus called Epstein-Barr. This virus’s DNA, RNA, or protein must be found within the skin cells to make a sure diagnosis.
There are numerous commercially available kits that physicians can utilize to uncover this Epstein-Bar virus. They can use methods such as polymerase chain reaction (a way to make millions of copies of specific DNA sequences), electron microscopy (a super-strong microscope), immunohistochemistry (a special staining process that visualizes proteins in cells of a tissue), and in situ hybridization (a technique that uses a labeled complementary DNA, RNA, or modified nucleic acids strand to locate a specific DNA or RNA sequence in a portion of tissue).
Among all these techniques, in situ hybridization is considered a “gold standard,” meaning it’s the most reliable method.
If there are certain worrying signs, such as a weird look to the lesion or an open sore that suggests cancer, the doctor could do a biopsy. A biopsy involves taking a small sample of your tissue to study it and rule out or confirm other issues.
Treatment Options for Hairy Leukoplakia
Hairy leukoplakia is a harmless condition that doesn’t always need to be treated. It usually clears up by itself and has a low risk of causing other health problems. However, treatment might be needed if the condition is causing discomfort or if a patient chooses to have it treated for appearance reasons. In such cases, anti-HIV drugs can be used.
Antiviral drugs can often clear up this condition within a week or two. Medications like acyclovir, valacyclovir and famciclovir can be prescribed. While these drugs can stop the virus from making copies of itself in your body, they can’t completely eliminate the virus. Because of this, hairy leukoplakia may come back after you stop taking the medication.
Topical treatments, which are medicines you apply to your skin, can also be used. One option is a solution containing podophyllin resin, which can resolve the condition after several applications. However, just like with antiviral drugs, the condition can reoccur after the treatment is stopped. This treatment can also cause temporary pain and discomfort where it’s applied, and it can affect your sense of taste.
A cream containing retinoic acid, a form of vitamin A, can be used as a topical treatment. This is usually applied two to three times a day until the patches have disappeared. However, like other treatments, retinoic acid doesn’t cure the condition and it might come back several weeks after treatment.
Cryotherapy, a treatment using extreme cold, can also be used to resolve hairy leukoplakia, but it’s not commonly employed for this condition.
What else can Hairy Leukoplakia be?
When a patient presents with hairy leukoplakia, doctors need to consider several other similar conditions before reaching a definite diagnosis. These can include:
- Candidiasis
- Oral leukoplakia
- White sponge nevus
- Oral frictional keratosis
- Smoker’s keratosis
- Proliferative verrucous leukoplakia
- Lichen planus
- Lichenoid reactions
- Condyloma acuminatum
What to expect with Hairy Leukoplakia
Most patients diagnosed with hairy leukoplakia, a specific mouth condition, often have a significantly weakened immune system. This condition typically appears after the person has been infected with HIV, before the disease progresses to AIDS. The number of key immune cells, known as CD4 cells, can range from 235-468 units in a tiny drop of blood when this condition is first spotted.
Research has shown that patients with AIDS who also have hairy leukoplakia tend to live shorter lives than those who don’t have this oral issue. Also, if these patients get infected with the hepatitis B virus as well, their health may deteriorate even faster, potentially causing AIDS to progress sooner than expected.
Possible Complications When Diagnosed with Hairy Leukoplakia
Hairy leukoplakia, a condition in the mouth, can sometimes be complicated by an additional infection of candida yeast. This secondary infection can lead to a burning sensation in the tongue, also known as glossopyrosis. Another uncommon complication is that one’s sense of taste can be affected. If topical retinoids, which are common treatments for skin conditions, are used for an extended period, they might also cause a burning sensation.
Common Side Effects:
- Hairy leukoplakia complicated by a candida yeast infection
- Glossopyrosis or a burning sensation in the tongue
- An altered sense of taste
- Topical retinoids, when used for a long period, can cause a burning sensation
Preventing Hairy Leukoplakia
Having issues in the mouth can really affect a person’s quality of life. Problems such as difficulties in talking, eating and swallowing, or even experiencing severe pain can often arise. These problems could lead to even more health issues due to poor nourishment. That’s why it’s crucial to understand about HIV-related mouth problems and maintain good oral health.
Preventing a condition called hairy leukoplakia, which often affects people with HIV, starts with keeping your immune system healthy. Living a healthy lifestyle and sticking to the HIV treatment plan provided by the doctor is key. Observing good dental hygiene is also crucial. In addition, it’s important to know that if you smoke and have HIV, it puts you at a higher risk of developing this oral problem compared to non-smokers. Public awareness should be raised about this risk factor.