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Oral leukoplakia is a precancerous condition that causes white or gray patches inside the mouth or on the tongue that can be thick and develop slowly over time. The patches are a hyperplasia of the squamous epithelium and can lead to premalignant lesions. It is generally thought of as a benign reactive process however, it is important to be aware that various studies have showed that up to 20 percent of lesions become malignant in the span of 10 years. This disorder is most common in the elderly population.

Leukoplakia usually happens when something irritates the inside of the mouth. Irritation in the mouth may be caused by rough teeth, rough places on dentures, fillings and crowns, smoking, tobacco use, and holding chewing tobacco in your mouth for a long period of time. Sores usually develop on the tongue, but they may also appear on the insides of the cheek, or on the outer female genitals. An association does exist between leukoplakia and human papillomavirus (HPV).

To confirm the diagnosis, a biopsy of the lesion is needed and sent to the lab for analysis. If oral cancer is found, surgical measures to remove the lesion are necessary. Less invasive treatments involve removing the source of irritation and treating dental causes such as rough teeth, irregular denture surface, or fillings as soon as possible. Patients should be advised to stop smoking, using other tobacco products and drinking alcohol immediately.

A type of leukoplakia called hairy leukoplakia primarily affects people whose immune systems are weak, especially in those patients with HIV/AIDS. The most common symptoms of hairy leukoplakia are painless, fuzzy white patches on the side of the tongue. The sores are white or gray and sometimes red which more often lead to cancer. They are thick and slightly raised with a hard surface that can't be easily scraped off unlike oral thrush. They may become sensitive to touch, heat, spicy foods, or other irritation. It results from infection with the Epstein-Barr virus (EBV). Once you are infected with EBV, the virus remains in your body for life. Normally, the virus is dormant, but if your immune system is weakened, either from disease or certain medications, the virus can become reactivated leading to conditions such as hairy leukoplakia. There has been no association to cancer risk in patients with hairy leukoplakia.

Treatment involves systemic and topical medication. Antiviral drugs such as valacyclovir (Valtrex) and famciclovir (Famvir) prevent the Epstein-Barr virus from replicating. Podophyllum resin solution and topical tretinoin can improve the appearance of the white patches.

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