Retrospective findings of the clinical benefits i of podophyllum resin 25% sol on hairy leukoplakia Clinical results in nine patients F. Lozada-Nur,a DDS, MS, and Catalina Xi0 Paula, Brazil DEPARTMENT FRANCISCO,

OF STOMATOLOGY, AND

NATIONAL

SCHOOL AND

STATE

Costa,b DDS, San Francisco,

OF DENTISTRY, CANCER

PROGRAM,

UNIVERSITY S50 PAULO,

Calif. and

OF CALIFORNIA

SAN

BRAZIL

Hairy leukoplakia was first described as an oral marker of human immunodeficiency virus infection in 1984. The clinical significance of this lesion in an otherwise healthy, high-risk symptom-free person is that it can be an early manifestation of human immunodeficiency virus infection. Because of its benign nature and the lack of clinical evidence that treatment of the lesion improves the prognosis of human immunodeficiency virus-infected patients, systemic therapy with antiviral drugs does not seem warranted at this time. Topical retinoids (Retin-A sol) and systemic antivirals such as acyclovir have been previously tried; however, lesions tend to recur a few days after treatment is discontinued. Nine patients with oral hairy leukoplakia seen at the Oral Medicine Clinic, University of California San Francisco were offered treatment with podophyllum resin 25% sol. All patients had a complete remission of their condition within 1 week (5 patients) or after the second application a week later (4 patients). Side effects were transient and reversible. These remissions of oral hairy leukoplakia lasted from 2 to 28 weeks, wlhich suggests that podophyllum may be a relatively safe and cost-effective treatment of this otherwise symptom-free lesion. (ORAL Sum

ORAL MED ORAL PATHOL

1992;73:555-8)

H

airy leukopl,akia (HL) was first described as an oral marker of human immunodeficiency virus (HIV) infection in 1984.’ The clinical significance of this lesion in an otherwise healthy, high-risk symptom-free person is that it can be an early manifestation of HIV infection.2 In the last 2 years, HL has been reported among other groups of patiernts who are not at high risk, immunosuppressive, and HIV negative.33 4 The EpsteinBarr virus and the human papillomavirus (HPV) have been identified in HL lesions, but their role is not yet clear.le5 HL is an symptom-free lesion that occurs

“Clinical Professor, Department of Stomatology, School of Dentistry, Division of Oral Medicine, University of California, San Francisco. bNIH Visiting Scholar, Department of Stomatology, School of Dentistry, Division of Oral Medicine, University of California, San Francisco, and National and State Cancer Program, SBo Paulo. 7/13/35647

primarily on the lateral borders of the tongue but can also appear on the buccal and labial mucosa. Because of its ‘benign nature and the lack of clinical evidence that treatment of the lesion improves the prognosis of HIV-infected patients, systemic therapy with antiviral drugs does not seem warranted at this time. However, some patients request treatment for esthetic reasons, particularly when the lesions are extensive. In fact, most patients experience an improved sense of well-being once the lesion is treated. Thus there is a need for some type of nontoxic topical therapy. Topical retinoids (Retin A-sol) have been shown to help patients with flat, thin HL6; however, lesions tend to recur a few days (8 to 12) after treatment is discontinued, the drug is expensive, and patients complain of burning in the treated area when it is used for a prolonged period. Systemic antivirals such as Acyclovir7 do not seem justified at this time for this patient population for several reasons.8 A high risk exists among HIV patients to develop a tolerance to 555

Lozada-Nur

556

and Costa

ORAL

%JRG

ORAL

k&ii)

ORAL

PATHOL

May 1992

Table I. Clinical findings in nine homosexual males No. of patients

Age range hi

9

KS

27-58

~

PC?

Candida

2

I

3

2

3

KS = Kaposi’s sarcoma; PCP = Pneumocystis carinii pneumonia; RAU = recurrent aphthous ulcer; HSV = herpes simplexvirus disease.

5

(genital herpes); VD = venereal

Table II. Medical history in nine patients with OHL Treatment for AIDS No. of patients

Diagnoses as : HIV+ (months)

9

! 1 Asymptomatic

12-60

Other includes antifungals

ARC

AIDS

AZT

Septra

1

6

I

1

2

(8), antivirals

(3), antibiotics

Other

Aerosols pentamidine 2

Treatments oaf 1

(2).

Table Ill. Treatment responseto topical podophyllum 25% in patients with OHL

I

First application CR 5

Second application (1 week later)

:

PR

NR

4*

0

7

Time to respond

Remission time lwkl

CR

PR

NR

days (5 patients)? days (4 patients)

2-28

4

0

0

Time to respond