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Leukoplakia of tongue — Clinical Guidelines

Overview

Leukoplakia of the tongue is a precancerous condition characterized by white patches that cannot be scraped off, often associated with chronic irritation or potentially as an indicator of underlying immunosuppression, particularly in HIV-positive individuals 24.

Diagnosis

Clinical examination revealing persistent white patches on the tongue that cannot be removed by scraping 24.

Biopsy for histopathological confirmation to rule out malignancy 24.

Consider HIV status assessment in patients with leukoplakia, especially if other signs of immunosuppression are present 24.

Management

Regular monitoring and follow-up to detect any changes indicative of malignant transformation 24.

Address underlying causes, such as cessation of irritants or improvement of oral hygiene 24.

No specific pharmacological treatment mentioned for leukoplakia; focus on supportive care and symptom management 24.

Special Populations

HIV-Positive Patients: Increased vigilance due to higher risk of malignant transformation; integrate palliative care principles for symptom management 6 24.

Elderly: Consider comorbidities and polypharmacy impacts on overall health and treatment tolerance 8.

Key Recommendations

Perform regular oral examinations and biopsies for patients with leukoplakia, especially in immunocompromised states like HIV, to monitor for malignant changes (Evidence: Expert opinion 24).

Integrate palliative care early in the management of HIV-positive patients with leukoplakia to address pain and quality of life issues (Evidence: Expert opinion 6).

Address and eliminate potential irritants and maintain good oral hygiene practices to manage symptoms and prevent progression (Evidence: Expert opinion 24).

References

1 Portilla-Tamarit I, Rubio-Aparicio M, Fuster-RuizdeApodaca MJ, Portilla-Tamarit J, Reus S, Portilla J. Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis. AIDS and behavior 2024. link 2 Silva JSD, Ernandes BC, Fernandes CLL, Correia AS, Ponce CC, Sztajnbok J et al.. Septic shock, hyperferritinemic syndrome, and multiple organ dysfunction without respiratory failure in a patient with disseminated histoplasmosis and advanced HIV disease. Revista do Instituto de Medicina Tropical de Sao Paulo 2023. link 3 Tsabedze N, Vachiat A, Zachariah D, Manga P. A New Face of Cardiac Emergencies: Human Immunodeficiency Virus-Related Cardiac Disease. Cardiology clinics 2018. link 4 Bruce RD, Merlin J, Lum PJ, Ahmed E, Alexander C, Corbett AH et al.. 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2017. link 5 Fontes AS, Gonçalves JF. Pain treatment in patients infected with human immunodeficiency virus in later stages: pharmacological aspects. The American journal of hospice & palliative care 2014. link 6 Simms V, Higginson IJ, Harding R. Integration of palliative care throughout HIV disease. The Lancet. Infectious diseases 2012. link70085-3) 7 Farrant L, Gwyther L, Dinat N, Mmoledi K, Hatta N, Harding R. The prevalence and burden of pain and other symptoms among South Africans attending highly active antiretroviral therapy (HAART) clinics. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2012. link 8 Emlet CA, Shippy RA. HIV/AIDS treatments. Journal of gerontological social work 2008. link 9 Gray G, Berger P. Pain in women with HIV/AIDS. Pain 2007. link 10 Stevenson M. Developments in basic science research. Topics in HIV medicine : a publication of the International AIDS Society, USA 2006. link 11 Krist AH. Obstetric care in patients with HIV disease. American family physician 2001. link 12 Calabrese LH. Changing patterns of morbidity and mortality in HIV disease. Cleveland Clinic journal of medicine 2001. link 13 James JS. Selenium: African studies reported at Durban. AIDS treatment news 2000. link 14 Paice JA, Shott S, Oldenburg FP, Zeller J, Swanson B. Efficacy of a vibratory stimulus for the relief of HIV-associated neuropathic pain. Pain 2000. link00217-1) 15 Andersson MI, Willcox PA. Tuberculous tenosynovitis and carpal tunnel syndrome as a presentation of HIV disease. The Journal of infection 1999. link90058-0) 16 Daneault S, Labadie JF. Terminal HIV disease and extreme poverty: a review of 307 home care files. Journal of palliative care 1999. link 17 Effros RB, Pawelec G. Replicative senescence of T cells: does the Hayflick Limit lead to immune exhaustion?. Immunology today 1997. link01079-7) 18 Gibbs LM, Ellershaw JE, Williams MD. Caring for patients with HIV disease: the experience of a generic hospice. AIDS care 1997. link 19 Bacon P. Nutritional care of the patient with HIV/AIDS. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 1996. link 20 Wilson R. Epidemiology of AIDS. Optometry and vision science : official publication of the American Academy of Optometry 1995. link 21 McGrew CA, Dick RW, Schniedwind K, Gikas P. Survey of NCAA institutions concerning HIV/AIDS policies and universal precautions. Medicine and science in sports and exercise 1993. link 22 O'Neill WM, Sherrard JS. Pain in human immunodeficiency virus disease: a review. Pain 1993. link90093-5) 23 Martin JP. Issues in the current treatment of hospice patients with HIV disease. The Hospice journal 1991. link 24 . HIV disease, from discovery to management: the major role of the dermatologist. Journal of the American Academy of Dermatology 1990. link70178-k)

Leukoplakia of tongue