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Hairy leukoplakia is a viral infection of the tongue that manifests as rough, flaky, white lesions that look like they are sprouting hairs. The condition is most commonly seen in HIV-positive individuals, and it is often one of the first signs that a person is infected. Lesions are usually painless and do not cause uncomfortable symptoms, but medical evaluation is still important to determine the underlying cause and receive the proper treatment.
Medical research has indicated that hairy leukoplakia is caused by the Epstein-Barr virus, a common viral agent found in the mouth and other mucous membranes. Nearly everyone in the world carries the virus, but it remains dormant and completely harmless in healthy individuals. When the immune system is weakened by HIV, AIDS, immunosuppressive drugs, or frequent blood transfusions, the Epstein-Barr virus can become activated and trigger hairy leukoplakia development.
The first sign of hairy leukoplakia is usually a thin off-white film on the sides of the tongue. Over several days or weeks, small flat lesions tend to develop on different sections of the tongue. The lesions develop a hairy appearance when they start to flake and develop raised ridges. The outer surface of the flakes may scrape off when brushing or rinsing, exposing the darker interior of a lesion. Pain is uncommon with hairy leukoplakia, but lesions that break open and become infected with bacteria can cause tenderness and inflammation.
A doctor can confirm hairy leukoplakia by collecting and analyzing a small tissue sample. In a medical lab, a clinical pathologist inspects the tissue under a microscope to rule out other possible causes of tongue discoloration, such as cancer and bacterial infection. Patients who do not know whether or not they are HIV-positive typically receive blood tests.
Hairy leukoplakia may not require medical treatment if it does not cause physical symptoms. If lesions are large or painful, a doctor may prescribe an oral or topical antiviral medication to shrink them and help prevent new ones from developing. Brushing regularly and avoiding tobacco products and spicy foods helps reduce the chances of a recurring bacterial infection in the mouth.
In most cases, doctors are more concerned about the underlying causes of hairy leukoplakia than the lesions themselves. Treatment regimens for HIV or another immunosuppressive condition are initiated immediately after they are detected. Patients may need to take daily oral drugs or receive regular shots for the rest of their lives to help manage symptoms and slow the progression of serious diseases.