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Disease: Leukoplakia Leukoplakia
Category: Mouth and teeth diseases
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Disease Definition:

The condition in which thickened, white patches form on the gums, the inside of the cheeks, the bottom of the mouth and sometimes on the tongue is called leukoplakia. These patches can't be scraped off easily.


Even though tobacco, either smoked or chewed, is considered to be the main culprit, however, the exact cause of this condition is still not known.


Though sometimes leukoplakia could be serious, but it's usually not dangerous. Most leukoplakia patches are benign, however, there's a small percentage that show early signs of cancer, and many cancers of the mouth occur next to areas of leukoplakia. Because of this, if someone has unusual and persistent changes in their mouth, they should see a doctor.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


There are several ways in which leukoplakia could appear. Usually, changes occur on the gums, the insides of the cheeks, the bottom of the mouth and sometimes on the tongue, these may appear as:


  • Thickened or hardened areas
  • White or grayish patches that can't be wiped away
  • Irregular or flat texture


In some cases, a person could also have raised red lesions called erythroplakia, which are more likely to show precancerous changes.


Hairy leukoplakia is one type of leukoplakia, which affects people who have HIV/AIDS, or people whose immune systems have been weakened by disease or medications. If someone has hairy leukoplakia, fuzzy and white patches will appear resembling folds or ridges on the sides of the tongue. Hairy leukoplakia is often mistaken for oral thrush, an infection that is characterized by creamy white patches on the area that extends from the back of the throat to the top of the esophagus (pharynx) and the inside of the cheeks. In people with HIV/AIDS, oral thrush is quite common.


In some cases, mouth sores could be harmless, despite the fact that they could be annoying or painful. However, in other cases, a more serious condition may be indicated by mouth problems. Because of this, if someone has any of the conditions mentioned below, they should see a dentist:


  • Lumps or white, red or dark patches in the mouth
  • Persistent changes in the tissues of the mouth
  • White plaques or sores in the mouth that don't heal on their own within 7 to 10 days.


What exactly causes leukoplakia is still not clear. Tobacco, long-term alcohol use and other chronic irritants are some of the possible causes that have been linked to leukoplakia. In the past, mechanical irritants, such as rough fillings or dentures were thought to cause leukoplakia, but not anymore.


It seems that most cases of leukoplakia are caused by smoking. Chewing tobacco and snuff also cause this condition. About three out of four regular users of "smokeless tobacco" products will eventually develop this condition where they hold the tobacco against their cheeks.



Infection with the Epstein-Barr virus (EBV) causes hairy leukoplakia, which is also called oral hairy leukoplakia. After people become infected with EBV, the virus will remain in their body for the rest of their lives. Normally, the virus is inactive, however, it could become reactivated and lead to conditions such as hairy leukoplakia in case their immune system has been weakened, either from certain medications or diseases.


People that are more susceptible to developing hairy leukoplakia are those with HIV/AIDS. Anti-retroviral drugs have reduced the number of cases, however, hairy leukoplakia could be one of the first signs of HIV infection, and it affects as many as one-fourth of HIV-positive people. The appearance of oral hairy leukoplakia could be an indication that anti-retroviral therapy is not working.


Someone’s risk of developing oral cancer as well as leukoplakia will be increased in case they use tobacco, and this risk will be even greater if they drink alcohol together with smoking.



Permanent damage usually isn't caused by leukoplakia to tissues in the mouth. However, one potentially serious complication of leukoplakia is oral cancer. Usually, oral cancers form in the vicinity of leukoplakia patches. These patches could also show cancerous changes. The risk of oral cancer will still be elevated even if the leukoplakia patches are removed.


Even though hairy leukoplakia may indicate the presence of HIV infection or AIDS, but usually it's not painful and it doesn't lead to cancer.


Stopping smoking or alcohol consumption usually clears the condition for most people. However, if this doesn't work, or if the lesions show early signs of cancer, a person may be recommended removing the leukoplakic patches using a laser, a scalpel, or a cryoprobe, which is an extremely cold probe that freezes and destroys cancer cells. Because recurrences happen frequently, follow-up is quite necessary after removal.


Retinoids are derivatives of vitamin A that are used to treat severe acne and other skin conditions. Retinoids appear to be effective against leukoplakia, however, they could cause some side effects even when used topically. The leukemia patches could also be completely or partially reduced by the use of beta carotene, which is an antioxidant that is converted to vitamin A in the body.



The doctor or dentist may take a wait-and-watch approach because not all cases of hairy leukoplakia require treatment. However, if someone needs treatment, some of the available options may be:

Topical medications:

When these medications are applied topically, they may improve the appearance of leukoplakic patches, however, they may return once the medication is stopped. Some examples include podophyllum resin solution and tretinoin (retinoic acid).

Systemic medications:

These include valacyclovir and famciclovir, which are antiviral drugs that prevent the Epstein-Barr virus from replicating, but they don't eliminate the virus from the body. Treatment with antivirals could clear leukoplakic patches, however, once the therapy stops, symptoms tend to return.


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