Can Hairy Leukoplakia Be Scraped Off?

Can Hairy Leukoplakia Be Scraped Off?

No, hairy leukoplakia cannot be scraped off. Hairy leukoplakia results from a benign hyperplasia of the epithelial layer of the tongue while the oral candidiasis is a type of fungal infection. Thus, although the white patches are seen in both the conditions, but the reason of the white patches are different. In hairy leukoplakia, the white patches are caused by hyperkeratosis (increased production of keratin) and hyperplasia (increase in the number of epithelial cells) while oral candidiasis have the white patches due colonization of fungus, and the dead cells getting trapped between the tongue’s nodules. This is the reason why the patches of candidiasis are scraped off while those due to leukoplakia are not wiped off.

Oral hairy leukoplakia (leucos-white and Plax- flat surface or plate) are the white patches usually occurring on the lateral surface of the tongue. These are caused due to

Epstein – Barr virus. It occurs usually in the HIV-infected patients and the patients generally having compromised immune system. Very rarely, it is found in otherwise healthy person. Oral hairy leukoplakia is a benign lesion and has no known potential to develop into cancer. It is self-limiting and generally does not require treatment.

Can Hairy Leukoplakia Be Scraped Off?


There are no characteristic symptoms of oral hairy leukoplakia and is generally diagnosed by cancelling the other possible causes. The General Symptoms Of Oral Hairy Leukoplakia Are As Follows:

  • Adherent and slightly elevated white patches,
  • Irregular surface with folds and projection, and
  • Corrugated or hairy appearance
  • Usually asymptomatic

White patches are also the symptoms of various oral diseases which are also common in people with compromised immune system.

Causes of Oral Hairy Leukoplakia

Oral hairy leukoplakia is caused by Epstein-Barr virus. Once the virus enters in the body, it remains permanent and dormant. As soon as the immune system of the body is compromised, the virus becomes active. Oral hairy leukoplakia is commonly seen in patients with HIV/AIDS and the people with compromised immune system. In some cases, it may be the first sign of HIV/AIDS.

Risks Associated with Oral Hairy Leukoplakia

Oral hairy leukoplakia does not have the potential to turn in to cancer, but it certainly indicates about the status of the patient’s health. The patients with oral hairy leukoplakia have either AIDS/HIV or have compromised immune system. In very rare cases, healthy people suffer from oral hairy leukoplakia.

Diagnosis of Oral Hairy Leukoplakia

The diagnosis of oral hairy leukoplakia is done through differential diagnosis. The diagnosis of oral hairy leukoplakia is conducted in two stages: Provisional diagnosis and Definitive diagnosis. The provisional diagnosis is done on the basis of clinical features as well the scrape test. In scrape test, the patch is scraped off by the toothbrush or tongue depressor. If the patch is scraped off, it is not oral hairy leukoplakia. But when the clinical features are ambiguous, histological examination can be done. The definitive diagnosis of oral hairy leukoplakia is by examining the present of EBV in the sample. If the patient has certain medical conditions which does not allow for an incisional biopsy, then exfoliative cytology is recommended.

Treatment for Oral Hairy Leukoplakia

Since oral hairy leukoplakia is benign, does not have the potential to turn into cancer and is asymptomatic, the treatment is not required. However, there are cases where the patient is uncomfortable about the presence of leukoplakia or if the patches are creating alteration in the taste. In such cases, various treatment options are recommended ranging from topical to systemic to surgical excision. In topical therapy, retinoids and podophyllum may provide temporary remission. The use of anti-viral drugs such as zidovudine, ganciclovir and acyclovir can result in disappearance of the patches, but they may recur after the discontinuation of the drug therapy.


Hairy leukoplakia is the condition characterized by white, non-painful patches on the tongue with a hairy appearance. The white patches are also the characteristic feature of candidiasis creating confusion between the diseases. This confusion can generally be cleared by conducting a scrape off test in which the white patches of the leukoplakia are not scraped off due to the reason that they are caused by hyperkeratosis and epithelium hyperplasia. Confirmation of hairy leukoplakia is conducted when the clinical features are ambiguous. Nevertheless, the scrape off test is important method which efficiently diagnoses the disease without making patients to undergo other complex methods of diagnosis.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 26, 2019

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