Clinical Guide > Oral Health > OHL

Oral Hairy Leukoplakia

January 2011

Chapter Contents


Oral hairy leukoplakia (OHL) is an oral infection caused by Epstein-Barr virus (EBV). It appears as white corrugated lesions (sometimes "hairy" in appearance) primarily on the lateral aspects of the tongue. This infection may spread across the entire dorsal surface onto the ventral surface of the tongue, and occasionally may be found on buccal mucosa. It is common in people with HIV infection, particularly in those with advanced immunosuppression (CD4 count <200 cells/µL).

S: Subjective

The patient notices new, white lesions on the tongue that cannot be wiped off or removed by scraping or brushing. The OHL lesions usually are asymptomatic, but occasionally may cause alteration in taste, discomfort, or other symptoms.

O: Objective

Perform a focused examination of the oropharynx. OHL appears as unilateral or bilateral white plaques or papillary lesions on the lateral, dorsal, or ventral surfaces of the tongue or on buccal mucosa. The lesions may vary in appearance from smooth, flat, small lesions to irregular, "hairy" or "verrucous" lesions with prominent vertical folds or projections.

A: Assessment

A partial differential diagnosis for OHL includes:

P: Plan

Diagnostic Evaluation

A presumptive diagnosis of OHL usually is made on the basis of the clinical appearance of the lesions. OHL often is confused with candidiasis; the diagnosis of OHL should be considered for lesions that do not wipe away, as would be the case for pseudomembranous candidiasis. Definitive diagnosis of OHL requires biopsy and demonstration of EBV.


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