Leukoplakia

Alternative names 
Hairy leukoplakia; Smoker’s keratosis

Definition
Leukoplakia is a precancerous lesion that develops on the tongue or the inside of the cheek as a response to chronic irritation. Occasionally, leukoplakia patches develop on the female external genitalia.

Causes, incidence, and risk factors
Leukoplakia is primarily a disorder of the mucous membranes of the mouth, caused by irritation. Lesions usually develop on the tongue, but they may also appear on the insides of the cheek.

Irritation may result from rough teeth or rough places on dentures, fillings, and crowns. It may also result from smoking or other tobacco use (smoker’s keratosis). Pipe smoking involves a high risk for development of leukoplakia, as does holding chewing tobacco or snuff in the mouth for a prolonged period of time.

Leukoplakia patches may develop on the female external genital area, but the cause is unknown.

Like other mouth ulcers, leukoplakia may become a cancerous lesion.

The disorder is most common in the elderly.

“Hairy” leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in HIV-positive individuals. It consists of fuzzy white patches on the tongue, and less frequently, elsewhere in the mouth. It may resemble thrush, a type of candida infection that, in adults, is also associated with HIV and AIDS. Hairy leukoplakia may be one of the first signs of infection with HIV.

Symptoms

The primary symptom of leukoplakia is a skin lesion with the following characteristics:

     
  • Location       o Usually on the tongue       o May be on the inside of the cheeks       o In females, occasionally on the genitals  
  • Color       o Usually white or gray       o May be red (called erythroplakia)  
  • Texture       o Thick       o Slightly raised       o Hardened surface

The symptoms of hairy leukoplakia are painless, fuzzy, white patches on the tongue.

Signs and tests

The typical white patch of leukoplakia develops slowly, over weeks to months. The lesion may eventually become rough in texture, and may become sensitive to touch, heat, spicy foods, or other irritation.

A biopsy of the lesion confirms the diagnosis. An examination of the biopsy specimen may find changes that indicate oral cancer.

Treatment

The goal of treatment is to eliminate the lesion. Removal of the source of irritation is important and may lead to disappearance of the lesion.

     
  • Dental causes such as rough teeth, irregular denture surface, or fillings should be treated as soon as possible.  
  • Smoking or other tobacco use should be stopped.

Surgical removal of the lesion may be necessary. The lesion is usually removed in your health care provider’s office with the use of local anesthesia.

Some research has shown that vitamin A or vitamin E may shrink lesions, but this should only be administered with close supervision by a health care provider.

Treatment of leukoplakia on the vulva is the same as treatment of oral lesions.

Expectations (prognosis)
Leukoplakia is usually harmless, and lesions usually clear in a few weeks or months after the source of irritation is removed. Approximately 3% of leukoplakia lesions develop cancerous changes.

Hairy leukoplakia is often a sign of HIV infection and an increased likelihood of developing AIDS.

Complications

     
  • Chronic discomfort  
  • Infection of the lesion  
  • Oral cancer

Calling your health care provider
Call for an appointment with your health care provider if you have any lesions resembling leukoplakia or hairy leukoplakia.

Prevention
Minimize or stop smoking or other tobacco use. Have rough teeth treated and dental appliances repaired promptly.

Safer sexual practices minimize the risk of contracting sexually-transmitted diseases, including HIV.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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