As mentioned above, microscopic examination of scrapings will be negative for hyphae and therefore exclude the diagnosis of candidiasis in lesions of hairy leukoplakia. Involvement of the inferolateral surface of the tongue is also characteristic of OHL and aids in distinguishing it from other processes. Electron microscopy and DNA probe analysis may also be useful in identifying virally infected cells. Immunoperoxidase stains for CMV, HSV, and zoster virus are commercially available and can increase the speed and the sensitivity of detection of these agents. Return to Page Contents Treatment Herpesvirus infections are treated with acyclovir at doses ranging from 200 to 1000 mg orally every four hours while awake.
Resistant cases require treatment with intravenous foscarnet sodium or vidarabine.
On occasion, patients with seemingly resistant zoster or simplex may be suffering from atrophic gastritis preventing absorption of acyclovir, so that a change to intravenous administration may be effective. Other helpful measures may include local care with cool compresses or sitz baths, topical anesthetics such as 2-5 percent lidocaine gel or ointment, and pramoxine ointment or lotion. Herpes zoster may be associated with acute pain that may respond to treatment with narcotics or even nonsteroidal anti-inflammatory drugs. A more serious complication is post-herpetic neuralgia, which results from neural inflammation and infection with fibrosis around nerves, leading to secondary neural compromise. Treatment consists of targeting the underlying viral infection with high doses of acyclovir as well as attempting to block the chronic pain that is produced following resolution.