Leukoplakia

Leukoplakia affects the mucous membranes of the mouth. The exact cause is not known. It may be due to irritation such as:

• Rough teeth
• Rough places on dentures, fillings, and crowns
• Smoking or other tobacco use (smoker's keratosis), especially pipes
• Holding chewing tobacco or snuff in the mouth for a long period of time
• Drinking a lot of alcohol

The disorder is more common in older adults.

A type of leukoplakia of the mouth, called oral hairy leukoplakia, is caused by the Epstein-Barr virus. It is seen mostly in people with HIV/AIDS. It may be one of the first signs of HIV infection. Oral hairy leukoplakia can also appear in other people whose immune system is not working well, such as after a bone marrow transplant.

Patches in the mouth usually develop on the tongue (sides of the tongue with oral hairy leukoplakia) and on the insides of the cheeks.

Leukoplakia patches are:

• Most often white or gray
• Uneven in shape
• Fuzzy (oral hairy leukoplakia)
• Slightly raised, with a hard surface
• Unable to be scraped off
• Painful when the mouth patches come into contact with acidic or spicy food

A biopsy of the lesion confirms the diagnosis. Examination of the biopsy may find changes that indicate oral cancer.

The goal of treatment is to get rid of the leukoplakia patch. Removing the source of irritation may cause the patch to disappear.

• Treat dental causes such as rough teeth, irregular denture surface, or fillings as soon as possible.
• Stop smoking or using other tobacco products.
• Do not drink alcohol.

If removing the source of the irritation does not work, your health care provider may suggest applying medicine to the patch or using surgery to remove it.

For oral hairy leukoplakia, taking antiviral medicine usually causes the patch to disappear. Your provider may also suggest applying medicine to the patch.

Leukoplakia is usually harmless. Patches in the mouth often clear up in a few weeks or months after the source of irritation is removed.

In some cases, the patches may be an early sign of cancer.

Contact your provider for an appointment if you have any patches that look like leukoplakia or hairy leukoplakia.

Stop smoking and do not use other tobacco products. Do not drink alcohol, or reduce the number of drinks you have that contain alcohol. Have rough teeth treated and dental appliances repaired.

Hairy leukoplakia; Smoker's keratosis

Dinulos JGH. Premalignant and malignant nonmelanoma skin tumors. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 21.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Disorders of the mucous membranes. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 34.

Sciubba JJ. Oral mucosal lesions. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 87.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.