Author: Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.
Oral hairy leukoplakia is caused by Epstein-Barr virus (EBV) infection of the oral mucosa. It most often occurs in association with HIV infection. It has been less frequently described in immunosuppressed patients, especially following organ transplantation, and is rare in immune competent individuals.
Histology of oral hairy leukoplakia
In oral hairy leukoplakia, the mucosa displays mild papillary acanthosis (figure 1). Hyperkeratosis and marked parakeratosis of the superficial epithelial layer is a prominent feature (figure 2). Superficial infections of the hyperkeratinized epithelium with bacteria or Candida may also be seen. The acanthosis is caused by ballooning koilocyte-like cells. (Figures 1, 3). The nuclei of these have a homogenous ground-glass appearance and may contain intranuclear inclusions.