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Almazyad A, Alabdulaaly L, Noonan V, Woo SB. Oral hairy leukoplakia: a series of 45 cases in immunocompetent patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:210-216. [PMID: 34030995 DOI: 10.1016/j.oooo.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/07/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Oral hairy leukoplakia (OHL) is a benign Epstein-Barr virus infection typically presenting as a white lesion on the lateral border of the tongue. Historically, OHL was described in patients who are severely immunocompromised, such as those with HIV/AIDS and organ transplant patients. OHL is increasingly seen in patients who are not severely immunocompromised. This study reviews 45 cases of OHL in a single institution and characterizes the clinical features of these relatively immunocompetent patients. STUDY DESIGN Retrospective study. RESULTS There were 45 cases with 23 male patients (51.1%) and a median age of 64 (range, 24-100 years). The lateral/ventral tongue was the affected site in 41 cases (91.1%), and 5 cases presented bilaterally. A review of the medical history and medications showed the most common conditions were hypertension (53.3%), hyperlipidemia (42.2%), and chronic respiratory conditions (33.3%); 8 patients (17.8%) had diabetes mellitus, and 1 had rheumatoid arthritis. Eleven cases (24.4%) reported no underlying medical conditions or history of medications. The most frequently reported medications included antihypertensive drugs (21.0%), steroid inhalers (14.6%), and cholesterol-lowering drugs (11.0%). CONCLUSIONS OHL is not exclusively seen in profoundly immunocompromised patients. Localized immunosuppression (from steroid inhalers) and immunosenescence (aging) are possible contributing factors.
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Affiliation(s)
- Asma Almazyad
- Maxillofacial Surgery and Diagnostic Sciences Department, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
| | - Lama Alabdulaaly
- Maxillofacial Surgery and Diagnostic Sciences Department, King Saud bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Vikki Noonan
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA; Center of Oral Pathology, StrataDx, Lexington, MA, USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Center of Oral Pathology, StrataDx, Lexington, MA, USA; Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
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Alramadhan SA, Bhattacharyya I, Cohen DM, Islam MN. Oral Hairy Leukoplakia in Immunocompetent Patients Revisited with Literature Review. Head Neck Pathol 2021; 15:989-993. [PMID: 33428065 PMCID: PMC8384929 DOI: 10.1007/s12105-021-01287-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
Oral hairy leukoplakia (OHL) is an Epstein-Barr virus (EBV) related lesion seen in severely immunocompromised patients especially, those with concomitant human immunodeficiency virus (HIV) infection. It has been rarely reported in immunocompetent patients. OHL most often presents on the lateral border of the tongue as an asymptomatic, white, and corrugated plaque that does not rub off. With Institutional Review Board (IRB) approval, the University of Florida Oral & Maxillofacial Pathology Biopsy Service archives spanning 1994-2020 were queried. All cases of OHL affecting immunocompetent patients were identified. Data related to age, gender, clinical presentation, results of Epstein-Barr virus in situ hybridization (EBER-ISH), and periodic acid-Schiff (PAS)-fungus stains were recorded. Medical history and histology of all cases were reviewed for confirmation of diagnosis. A total of 11 cases were identified, the majority of which were males (63.6%) with a mean age of 62 years. All patients were Caucasian. Lesions entirely were located on the lateral borders of the tongue. OHL should not be considered pathognomonic for HIV infection and should be included in the differential diagnoses of keratotic lesions affecting the lateral border of tongue even in immunocompetent elderly patients. The etiology of OHL in this group of patients is not clearly understood.
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Affiliation(s)
- Saja A. Alramadhan
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
| | - Indraneel Bhattacharyya
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
| | - Donald M. Cohen
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
| | - Mohammed N. Islam
- grid.15276.370000 0004 1936 8091Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
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Mueller SM, Stoeckle M, Goldust M. Treatment options for oral hairy leucoplakia: A case report. Dermatol Ther 2020; 33:e13425. [DOI: 10.1111/dth.13425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/23/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Simon M. Mueller
- Department of Dermatology University Hospital Basel Basel Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Basel Basel Switzerland
| | - Mohamad Goldust
- Department of Dermatology University Hospital Basel Basel Switzerland
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Shanahan D, Cowie R, Rogers H, Staines K. Oral hairy leukoplakia in healthy immunocompetent patients: a small case series. Oral Maxillofac Surg 2018; 22:335-339. [PMID: 30079439 DOI: 10.1007/s10006-018-0709-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/02/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral hairy leukoplakia (OHL) is caused by the Epstein-Barr virus (EBV) and usually presents in patients with human immunodeficiency virus (HIV) infection and systemic immunosuppression. It is rarely seen in patients who are immunocompetent. It is clinically characterised as an asymptomatic, soft, white and corrugated lesion that cannot be scraped from the surface it adheres to. METHODS Immunocompetent patients with OHL attending Bristol Dental Hospital within the last 6 months were identified. EBV infection was demonstrated using EBV in situ hybridization. Clinical features and medical history were determined by reviewing medical records. CASE REPORT Four cases of OHL in immunocompetent individuals were identified. All lesions were located on the lateral borders of the tongue. DISCUSSION OHL should be considered as a differential diagnosis for white patches on the lateral borders of the tongue in apparently healthy immunocompetent patients, even when they do not have a typical corrugated appearance. OHL should no longer be regarded as pathognomonic for HIV infection or systemic immunosuppression.
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Affiliation(s)
- Daire Shanahan
- Department of Oral Medicine, The University of Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, England.
| | - Rachel Cowie
- Department of Oral Medicine, The University of Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, England
| | - Helen Rogers
- Department of Oral Medicine, The University of Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, England
| | - Konrad Staines
- Department of Oral Medicine, The University of Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, England
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Oral hairy leukoplakia in the buccal mucosa of a healthy, HIV-negative patient. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.412354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vigarios E, Fricain JC, Projetti F, Boulanger M, Sibaud V. [Oral hairy leukoplakia induced by topical steroids]. Ann Dermatol Venereol 2015; 142:572-6. [PMID: 26362131 DOI: 10.1016/j.annder.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/02/2015] [Accepted: 08/05/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral hairy leukoplakia (OHL) is an EBV-associated condition of the oral mucosa, which is often painless. It is found predominantly in HIV-positive patients and is considered a clinical indicator of immunosuppression. OHL has rarely been described in HIV-negative patients, being found most often in association with iatrogenic immunosuppression. OHL induced by topical steroids remains extremely rare. PATIENTS AND METHODS An 81-year-old HIV-negative woman, treated for 3 months with topical steroids for oral lichen planus, developed an asymptomatic white, corrugated, non-removable plaque with vertical folds on the lateral edge of the tongue. Associated oral candidiasis was noted. Based upon histological findings and in situ hybridisation showing numerous EBV-infected epithelial cells, a diagnosis of oral hairy leucoplakia was made. DISCUSSION AND CONCLUSION To our knowledge, we report herein only the second recorded case of OHL induced strictly by topical steroids. Self-medication and poor adherence to dosage recommendations were noted in the patient's medical history. Physicians must be aware of the rare but nevertheless possible adverse events associated with topical steroid use, particularly when such medication is prescribed over a long period for inflammatory diseases of the oral mucosa.
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Affiliation(s)
- E Vigarios
- Médecine bucco-dentaire, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France.
| | - J-C Fricain
- Chirurgie orale, consultation pluridisciplinaire de pathologies de la muqueuse buccale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; UFR d'odontologie, 16-20, cours de la Marne, 33082 Bordeaux cedex, France
| | - F Projetti
- Anatomie et cytologie pathologiques, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - M Boulanger
- UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France; Chirurgie orale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - V Sibaud
- Dermatologie, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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Chambers AE, Conn B, Pemberton M, Robinson M, Banks R, Sloan P. Twenty-first-century oral hairy leukoplakia--a non-HIV-associated entity. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:326-32. [PMID: 25600979 DOI: 10.1016/j.oooo.2014.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/10/2014] [Accepted: 11/19/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study presents the clinicopathologic features of a series (N = 35) of patients with non-human immunodeficiency virus (HIV)-associated oral hairy leukoplakia (OHL). METHODS Patients with non-HIV-associated OHL were identified from three centers. Epstein-Barr virus infection was demonstrated by using EBV early ribonucleic acid in situ hybridization. The presence of Candida co-infection was evaluated by diastase periodic acid-Schiff staining. The clinical features were determined by review of the medical records. RESULTS Twenty-eight patients had intercurrent respiratory problems requiring long-term steroid inhaler use, four suffered from autoimmune diseases requiring immunosuppressant therapy, and four had diabetes. The majority of lesions were located on the tongue, and 24 showed evidence of Candida co-infection. CONCLUSIONS In the twenty-first century, the presence of OHL should not be regarded as pathognomic for HIV infection or significant systemic immunosuppression. Local and systemic immunosuppression, in the form of steroid inhaler use, is a risk factor for the development of OHL.
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Affiliation(s)
- Anne Elizabeth Chambers
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of Cellular Pathology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK.
| | - Brenden Conn
- Royal Infirmary of Edinburgh, Department of Pathology, Royal Infirmary Edinburgh, Scotland
| | - Michael Pemberton
- University Dental Hospital of Manchester, Department of Oral Medicine, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, UK
| | - Max Robinson
- Newcastle University, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Rob Banks
- Sunderland Royal Hospital, Department of Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland, Tyne and Wear, UK
| | - Philip Sloan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of Cellular Pathology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK
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