Regression of oral hairy leukoplakia after orally administered acyclovir therapy
L. Resnick, J. S. Herbst, D. V. Ablashi, S. Atherton, B. Frank, L. Rosen and S. N. Horwitz
Department of Dermatology, Mount Sinai Medical Center, Miami Beach, FL 33140.
To define the role of Epstein-Barr virus (EBV) in the pathogenesis of oral
hairy leukoplakia, 13 human immunodeficiency virus-seropositive men with
clinical and histologic evidence of oral hairy leukoplakia were enrolled in
an open-label trial of orally administered acyclovir therapy (3.2 g/d for
20 days). Of six patients who received therapy, five exhibited clinical
regression. Once therapy was discontinued, recurrences occurred in all
responders. Among seven patients who refused therapy, no spontaneous
remissions occurred. Before therapy, EBV replication within the leukoplakia
was demonstrated by immunofluorescence tissue staining or electron
microscopy in five patients who were studied. Human papillomavirus was not
detected by immunocytochemistry or electron microscopy from tissue
specimens of six patients. After therapy, biopsy specimens from two
patients with complete responses revealed a normalization of histologic
abnormalities and an inability to detect EBV in previously involved mucosa
by immunofluorescence or in situ DNA hybridization assays. It was concluded
that EBV replication within the epithelial cells of the tongue is necessary
for the development of oral hairy leukoplakia.
