Hairy Leukoplakia

Patients infected with HIV, particularly homosexual males, may develop characteristic intraoral white lesions [149]. The lateral margins and underlying ventrum of the tongue are the most common sites. The lesion was called hairy leukoplakia, but typically it forms painless, vertical, white corrugations that may or may not have a rough or "hairy" surface. Some lesions are flat white plaques. Other sites may also be involved, especially the post-commissural buccal mucosa.

Microscopy shows acanthosis and parakeratosis, usually with verruciform, hair-like surface projections [168]. Invasion of the surface epithelium by candidal hy-phae is common. Immediately below the parakeratotic layer there is a zone of vacuolated and enlarged epithelial cells with intense basophilic, pyknotic nuclei and perinuclear clearing (koilocytes). Epstein-Barr capsid viral antigen and viral particles can be demonstrated in the koilocytic nuclei [172]. There is usually little or no inflammatory infiltration of the epithelium or underlying corium. Similar lesions have occasionally been reported in patients receiving immunosuppressant drugs following organ transplantation. The early cases of hairy leu-koplakia associated with HIV infection showed a very high rate of progression to full-blown AIDS. Lesions can resolve spontaneously and usually respond well to antiviral or anti-retroviral drug treatment; they appear to have no premalignant potential.

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