Hairy leukoplakia (HL) occurs almost exclusively in the
immunosuppressed individual, typically in HIV-positive
patients. The aetiologic agent is the Epstein–Barr virus.
Examination will reveal whitish lesions generally, but not
exclusively, on the lateral borders of the tongue, with
prominent projections, giving a hairy appearance.
Bilateral lesions are common. HL is not to be confused with
‘hairy tongue’, which is caused by hypertrophy of the
filiform papillae on the tongue. The lesions are
generally asymptomatic unless there is concomitant
candidal superinfection. HL in HIV is a poor prognostic
If the lesion is asymptomatic, there is no need to treat it
actively as many resolve spontaneously if the underlying
local or systemic immunosuppression is corrected. They
usually settle with antiretroviral treatment.
Treatment options for aggressive lesions include systemic antivirals,
topical podophyllin or retinoic acid, and ablation with laser