clobetasol and Leukoplakia--Hairy

Oral hairy leukoplakia (OHL) is an EBV-associated condition of the oral mucosa, which is often painless. It is found predominantly in HIV-positive patients and is considered a clinical indicator of immunosuppression. OHL has rarely been described in HIV-negative patients, being found most often in association with iatrogenic immunosuppression. OHL induced by topical steroids remains extremely rare.. An 81-year-old HIV-negative woman, treated for 3 months with topical steroids for oral lichen planus, developed an asymptomatic white, corrugated, non-removable plaque with vertical folds on the lateral edge of the tongue. Associated oral candidiasis was noted. Based upon histological findings and in situ hybridisation showing numerous EBV-infected epithelial cells, a diagnosis of oral hairy leucoplakia was made.. To our knowledge, we report herein only the second recorded case of OHL induced strictly by topical steroids. Self-medication and poor adherence to dosage recommendations were noted in the patient's medical history. Physicians must be aware of the rare but nevertheless possible adverse events associated with topical steroid use, particularly when such medication is prescribed over a long period for inflammatory diseases of the oral mucosa.

Topics: Administration, Topical; Aged, 80 and over; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Betamethasone Valerate; Candidiasis, Oral; Clobetasol; Epithelial Cells; Female; Herpesvirus 4, Human; HIV Seronegativity; Humans; Leukoplakia, Hairy; Lichen Planus, Oral; Self Medication; Tongue

Oral hairy leukoplakia (OHL) presents as a white, plaque-like lesion typically occurring on the lateral border of the tongue. This condition is caused by the Epstein-Barr virus, a human herpesvirus that often establishes lifelong, asymptomatic latent infection. OHL, initially described in immunocompromised men infected with the human immunodeficiency virus (HIV), has also been described in other severely immunocompromised patients. Only rarely has OHL been reported in less profoundly immunocompromised patients primarily in the setting of corticosteroid therapy. Here we report on two additional cases of OHL attributable to immunosuppressive medications.

Topics: Aged; Anti-Infective Agents; Anti-Inflammatory Agents; Antifungal Agents; Arthritis, Rheumatoid; Clobetasol; Dapsone; Dermatologic Agents; Dexamethasone; Diabetes Mellitus, Type 2; Epstein-Barr Virus Infections; Female; Fluconazole; Humans; Immunocompromised Host; Leukoplakia, Hairy; Lichen Planus; Methotrexate; Nystatin; Prednisone; Zinc Oxide