hairy leukoplakia

WordNet

1. filamentous hairlike growth on a plant; "peach fuzz" (同)fuzz, tomentum
2. a filamentous projection or process on an organism
3. any of the cylindrical filaments characteristically growing from the epidermis of a mammal; "there is a hair in my soup" (同)pilus
4. a covering for the body (or parts of it) consisting of a dense growth of threadlike structures (as on the human head); helps to prevent heat loss; "he combed his hair"; "each hair consists of layers of dead keratinized cells"
5. hazardous and frightening; "hairy moments in the mountains"
6. having or covered with hair; "Jacob was a hairy man"; "a hairy caterpillar" (同)haired, hirsute

PrepTutorEJDIC

1. 〈C〉(人間・動物の1本の)『毛』;(植物・昆虫などの)毛 / 〈U〉《集合的に》『髪の毛』,毛,毛髪;(動物の)体毛 / 《a~》1本の毛ほどの量(距離,程度),ごくわずか
2. 毛深い,毛だらけの・粗い,ざらざらした・《俗》 ぞっとするほど危険な; 困難な，難しい

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/31 22:46:34」(JST)

wiki en

[Wiki en表示]

Not to be confused with Hairy tongue.

Hairy leukoplakia
Classification and external resources
Specialty	gastroenterology
ICD-10	K13.3
ICD-9-CM	528.6
DiseasesDB	5594
eMedicine	med/938
MeSH	D017733

Hairy leukoplakia (also known as oral hairy leukoplakia, OHL, or HIV-associated hairy leukoplakia), is a white patch on the side of the tongue with a corrugated or hairy appearance. It is caused by Epstein-Barr virus (EBV) and occurs usually in persons who are immunocompromised, especially those with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). This white lesion cannot be scraped off. The lesion itself is benign and does not require any treatment, although its appearance may have diagnostic and prognostic implications for the underlying condition.

Depending upon what definition of leukoplakia is used, hairy leukoplakia is sometimes considered a subtype of leukoplakia, or a distinct diagnosis.

Classification

In a classification of the oral lesions in HIV disease, OHL is grouped as "lesions strongly associated with HIV infection" (group I). It could also be classed as an opportunistic, viral disease. Hairy leukoplakia occurs on the tongue and has a similar name to hairy tongue, but these are separate conditions with different causes.

Signs and symptoms

There are no symptoms associated with the lesion itself, although many and varied symptoms and signs may be associated with the underlying cause of immunosuppression. The lesion is a white patch, which almost exclusively occurs on the lateral surfaces of the tongue, although rarely it may occur on the buccal mucosa, soft palate, pharynx or esophagus. The lesion may grow to involve the dorsal surface of the tongue. The texture is vertically corrugated ("hairy") or thickly furrowed and shaggy in appearance.

Causes

The white appearance is created by hyperkeratosis (overproduction of keratin) and epithelial hyperplasia. The causative organism implicated is Epstein-Barr virus, the same virus that causes infectious mononucleosis (glandular fever). After the primary EBV infection has been overcome, the virus will persist for the rest of the host's life and "hides" from the immune system by latent infection of B lymphocytes. The virus also causes lytic infection in the oropharynx, but is kept in check by a normal, functioning immune system. Uncontrolled lytic infection is manifested as oral hairy leukoplakia in immunocompromised hosts. OHL usually arises where the immunocompromise is secondary to HIV/AIDS. Rarely are other causes of immunocompromise associated with OHL, but it has been reported in people who have received transplants and are taking immunosuppressive medication. OHL may also accompany chronic graft versus host disease. Even more rare are reports of OHL in persons with competent immune systems.

Diagnosis

The white lesion cannot be wiped away, unlike some other common oral white lesions, e.g. pseudomembranous candidiasis, and this may aid in the diagnosis. Diagnosis of OHL is mainly clinical, but can be supported by proof of EBV in the lesion (achieved by in situ hybridization, polymerase chain reaction, immunohistochemistry, Southern blotting, or electron microscopy) and HIV serotesting. When clinical appearance alone is used to diagnose OHL, there is a false positive rate of 17% compared to more objective methods. The appearance of OHL in a person who is known to be infected with HIV does not usually require further diagnostic tests as the association is well known. OHL in persons with no known cause of immunocompromise usually triggers investigations to look for an underlying cause. If tissue biopsy is carried out, the histopathologic appearance is of hyperlastic and parakeratinized epithelium, with "balloon cells" (lightly staining cells) in the upper stratum spinosum and "nuclear beading" in the superficial layers (scattered cells with peripheral margination of chromatin and clear nuclei, created by displacement of chromatin to the peripheral nucleus by EBV replication). Candida usually is seen growing in the parakeratin layer, but there are no normal inflammatory reactions to this in the tissues. There is no dysplasia (OHL is not a premalignant lesion).

Treatment

Treatment is not necessary since the lesion is benign, however the person may have esthetic concerns about the appearance. The condition often resolves rapidly with high dose acyclovir or desiclovir but recurs once this therapy is stopped, or as the underlying immunocompromise worsens. Topical use of podophyllum resin or retinoids has also been reported to produce temporary remission. Antiretroviral drugs such as zidovudine may be effective in producing a significant regression of OHL. Recurrence of the lesion may also signify that highly active antiretroviral therapy (HAART) is becoming ineffective.

Prognosis

The oral lesion itself is benign and self-limiting, however this may not necessarily be the case for the underlying cause of immunocompromise. For instance, OHL with HIV/AIDS is a predictor of bad prognosis, (i.e. severe immunosuppression and advanced disease).

Epidemiology

Hairy leukoplakia is one of the most common oral manifestations of HIV/AIDS, along with oral candidiasis. It is the most common HIV/AIDS related condition caused by EBV, although EBV associated lymphomas may also occur. OHL mainly occurs in adult males, less commonly in adult females and rarely in children. The incidence rises as the CD4 count falls, and the appearance of OHL may signifiy progression of HIV to AIDS. A study from 2001 reported a significant decrease in the incidence of some oral manifestations of AIDS (including OHL and necrotizing ulcerative periodontitis), which was attributed to the use of HAART, whilst the incidence other HIV associated oral lesions did not alter significantly.

History

Oral hairy leukoplakia was first described by Greenspan et al in 1984, a few years after the start of the AIDS epidemic. A link with OHL was not initially reported as scientific understanding of HIV/AIDS was just beginning to unfold during this time. Later, it was thought to occur only in HIV-infected, homosexual males, however this is now known not always to be the case.

Research directions

It has been suggested that OHL be renamed according to its causative factor as “EBV leucoplakia”.

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 口腔病変 oral lesions
• 2. エプスタインバーウイルス（EBウイルス）感染の臨床的特徴および治療 clinical manifestations and treatment of epstein barr virus infection
• 3. 先天性角化異常症とその他の短縮テロメア症候群 dyskeratosis congenita and other short telomere syndromes
• 4. 青年および成人におけるHIV感染の自然経過および臨床的特徴 the natural history and clinical features of hiv infection in adults and adolescents
• 5. 口腔扁平苔癬：病因、臨床的特徴、および診断 oral lichen planus pathogenesis clinical features and diagnosis

English Journal

• Periodontal disease in HIV/AIDS.

• Ryder MI, Nittayananta W, Coogan M, Greenspan D, Greenspan JS.AbstractSince the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined somewhat and has remained relatively constant. Nevertheless, because of the large numbers of existing and new cases of HIV infection, the dental practitioner and other healthcare practitioners will still be required to treat oral and periodontal conditions unique to HIV/AIDS as well as conventional periodontal diseases in HIV-infected adults and children. The oral and periodontal conditions most closely associated with HIV infection include oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, salivary gland diseases, oral warts, other oral viral infections, linear gingival erythema and necrotizing gingival and periodontal diseases. While the incidence and prevalence of these oral lesions and conditions appear to be declining, in part because of antiretroviral therapy, dental and healthcare practitioners will need to continue to diagnose and treat the more conventional periodontal diseases in these HIV-infected populations. Finding low-cost and easily accessible and acceptable diagnostic and treatment approaches for both the microbiological and the inflammatory aspects of periodontal diseases in these populations are of particular importance, as the systemic spread of the local microbiota and inflammatory products of periodontal diseases may have adverse effects on both the progression of HIV infection and the effectiveness of antiretroviral therapy approaches. Developing and assessing low-cost and accessible diagnostic and treatment approaches to periodontal diseases, particularly in developing countries, will require an internationally coordinated effort to design and conduct standardized clinical trials.
• Periodontology 2000.Periodontol 2000.2012 Oct;60(1):78-97. doi: 10.1111/j.1600-0757.2012.00445.x.
• Since the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined some
• PMID 22909108

• Oral lesions associated with HIV/AIDS in HIV-seropositive patients attending a counselling and treatment centre in Dar es Salaam.

• Mwangosi IE, Tillya J.SourceInstitute of Allied Health Sciences, Muhimbili National Hospital, Dar es Salaam, Tanzania. ieatmwangosi@yahoo.com
• International dental journal.Int Dent J.2012 Aug;62(4):197-202. doi: 10.1111/j.1875-595X.2011.00108.x. Epub 2012 Jun 14.
• OBJECTIVE:  To assess the prevalences and patterns of oral lesions occurring in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS).METHODS:  A cross-sectional study was conducted among 200 people living with HIV/AIDS (PlwHA) who regularly attended a counselling and
• PMID 23017001

Japanese Journal

• EBV-Associated Diseases in Humans and their Animal in vivo Models: Part II

• Hayashi Kazuhiko
• Yonago Acta medica 48(2), 41-56, 2005-06
• … The range of EBV-associated diseases has recently expanded to include Hodgkin's lymphoma, T-cell lymphoma, pyothorax-associated or methotrexate-associated B-cell lymphoma, primary effusion lymphoma and lymphoepithelioma-like carcinoma of the stomach, thymus and salivary gland, lymphoproliferative disorders (LPDs) or leiomyosarcomas from immunocompromized host, oral hairy leukoplakia and EBV-associated hemophagocytic syndrome. …
• NAID 110001240420

• EBV-Associated Diseases in Humans and their Animal in vivo Models: Part I

• Hayashi Kazuhiko
• Yonago Acta medica 48(1), 1-6, 2005-03
• … The range of EBV-associated diseases has recently expanded to include Hodgkin's lymphoma, T-cell lymphoma, pyothorax-associated or methotrexate-associated B-cell lymphoma, primary effusion lymphoma and lymphoepithelioma-like carcinoma of the stomach, thymus and salivary gland, lymphoproliferative disorders (LPDs) or leiomyosarcomas from immunocompromized host, oral hairy leukoplakia and EBV-associated hemophagocytic syndrome. …
• NAID 110001189619

Related Links

• Hairy leukoplakia - Wikipedia, the free encyclopedia

Hairy leukoplakia (also known as oral hairy leukoplakia, :385 OHL, or HIV- associated hairy leukoplakia), is a white patch on the side of the tongue with a corrugated or hairy appearance. It is caused by Epstein-Barr virus (EBV) and occurs ...

• Hairy Leukoplakia - Medscape Reference

13 Jan 2012 ... Hairy Leukoplakia. Oral hairy leukoplakia (OHL) is a disease of the mucosa first described in 1984.

Related Pictures

---

★リンクテーブル★

リンク元	「舌」「毛状白板症」「毛様白斑症」「毛様白板症」
関連記事	「hairy」

「舌」

　　[★]

英

tongue

関

味覚

舌の神経支配

• N.58

　　　　　　　　　舌体　　　　　　　｜［有郭乳頭］　　舌根
　　　　　　　　　前2/3 　　　　　　｜　▼［分界稜］　後1/3
　　　　　　　　　　　　　　　　　　｜　　　▼
感覚神経（特殊）　顔面神経（CN VII）｜　　　　　　　　舌咽神経（CN IX ）、最後方は迷走神経(CN X)
感覚神経（一般）　三叉神経（CN V  ）｜　　　　　　　　舌咽神経（CN IX ）、最後方は迷走神経(CN X)
運動神経　　　　　舌下神経（CN XII）｜　　　　　　　　舌下神経（CN XII）
発生学的起源　　　第一鰓弓　　　　　　　　　　　　　　第二・三・鰓弓＋四鰓弓の一部

機能

• 味覚
• 咀嚼

臨床関連

BAT. 279 IMD.74

• 舌の異常

• 巨大舌 large tongue
• 地図状舌 geographic tongue
• 毛舌 hairy tongue
• 溝状舌 fissured tongue
• smooth tongue atrophic glossitis
• candidiasis
• hairy leukoplakia
• varicose vein　→　臨床的意義はない
• aphthous uncer canker sore
• mucous patch of synphilis
• leukoplakia
• Tori mandibulares
• carcinoma, floor of the mouth
• 乾燥　→　脱水

参考

• 1.

http://www.linkclub.or.jp/~entkasai/zetu-1.html

「毛状白板症」

　　[★]

英

hairy leukoplakia

関

毛様白板症、口腔毛状白板症、毛様白斑症

「毛様白斑症」

　　[★]

英

hairy leukoplakia

関

毛状白板症、毛様白板症

「毛様白板症」

　　[★]

英

hairy leukoplakia

関

毛状白板症、毛様白斑症

「hairy」

　　[★]

• 毛髪状の、毛様