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Hairy leukoplakia is a condition that is characterised by irregular white patches on the side of the tongue and occasionally elsewhere on the tongue or in the mouth. It is a form of leukoplakia, which refers to white patches on the mucous membranes of the mouth often arising in response to chronic irritation. Hairy leukoplakia occurs primarily in HIV-positive individuals.


When associated with HIV or AIDS, hairy leukoplakia may be one of the first signs of infection with HIV. It was originally thought that this condition only ever occurred in people with HIV but there have since been cases in other people with suppressed immune systems such as organ transplant recipients and chemotherapy patients. It is often the first sign that the immune system is weakening and that the person may be at increased risk of a more serious infection waiting to manifest.

Symptoms and signs of hairy leukoplakia include:

- Irregular non-painful white patches on the sides of the tongue and less frequently elsewhere on the tongue or in the mouth

- Patches look corrugated or folded in appearance with tiny fuzzy hair-like protrusions running along the folds

- Patches look similar to Candida infection (oral thrush), except hairy leukoplakia lesions cannot be moved or dislodged


Hairy leukoplakia is associated with Epstein-Barr virus (EBV), the cause of glandular fever, as EBV receptors have been found in surrounding normal mucosal surfaces. It is unclear whether hairy leukoplakia develops after superinfection with EBV or activation of a latent infection due to a weakening of the immune system.

Hairy leukoplakia has also been found in patients with Behcet syndrome and ulcerative colitis. In addition, men who are HIV positive who are smokers of more than a pack of cigarettes a day are at much greater risk of developing the condition. The risk of developing hairy leukoplakia doubles with each 300-unit decrease in CD4 count.


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