Oral Hairy Leukoplakia — ORE Part 1 MCQ
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Correct answer: A — Assess and address underlying immunosuppression
The correct answer is A. Oral hairy leukoplakia (OHL) is an EBV-associated, usually asymptomatic, non-scrapable corrugated white lesion, classically linked to HIV infection or other immunosuppression. In an asymptomatic patient, the priority is assessment of the cause of immunosuppression and appropriate medical management; in HIV, immune restoration with antiretroviral therapy is associated with reduced OHL prevalence. Excision is not first-line for this benign lesion. Topical corticosteroids do not treat EBV-associated OHL and may worsen opportunistic infection. Antifungal treatment is appropriate only if candidosis is also diagnosed; it does not treat OHL itself. Radiotherapy has no role. Lesion-directed measures may occasionally be considered for troublesome symptoms or cosmetic concern, but this is not the scenario described.
Reference: Moura MD, et al. Impact of highly active antiretroviral therapy on the prevalence of oral lesions in HIV-positive patients: a systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery, 2017. https://pubmed.ncbi.nlm.nih.gov/30079439/