Oral hairy leukoplakia: a series of 45 cases in immunocompetent patients

Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Aug;132(2):210-216. doi: 10.1016/j.oooo.2021.03.015. Epub 2021 Mar 29.


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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Epstein-Barr Virus Infections*
  • Female
  • Herpesvirus 4, Human
  • Humans
  • Leukoplakia, Hairy
  • Leukoplakia, Oral
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tongue Diseases*
  • Young Adult