Leukoplakia: Symptoms, Causes and Treatment

What is Leukoplakia?

Leukoplakia is a potentially malignant disorder affecting the mouth. It causes a white patch or plaque to form on the gums, tongue, or oral mucosa. It may resemble oral thrush, a yeast infection of the oral cavity.

However, unlike oral thrush or lichen planus, which also cause oral mucosal lesions, leukoplakia can turn into mouth cancer. Around 3 to 17.5% of people with leukoplakia develop squamous cell carcinoma, the most common type of oral cancer, within 15 years.¹

There are different types of leukoplakia:

• Homogenous — oral white lesions with uniform, smooth, wrinkled, or ridged surfaces.
• Non-homogenous — white or white and red patches with a non-uniform appearance and irregular surface texture.
• Proliferative verrucous leukoplakia (PVL) — an uncommon subtype of non-homogenous leukoplakia causing extensive raised white plaques with a wart-like surface. People with PVL have an increased risk of developing oral cancer.
• Hairy leukoplakia — white, hairy lesions with a fuzzy appearance. It’s common in people with a weakened immune system due to Epstein-Barr virus (EBV) or HIV infection.

Symptoms of Leukoplakia 

Leukoplakia patches are usually painless, and you cannot wipe them away. They may appear:

• White, grayish, slightly yellow, or with red discoloration
• Hardened or thickened in places
• Uniform or irregular
• Flat or raised

Doctors associate raised and speckled leukoplakia with an increased risk of malignant transformation, meaning the development of oral cancer.

What Causes Leukoplakia?

The cause of leukoplakia is unknown, but it's thought to be related to chronic irritation or inflammation of the mucous membranes.

Chewing and smoking tobacco are significant risk factors for developing leukoplakia, as are snuff (finely ground tobacco leaves that’s inhaled through the nose) and other forms of smokeless tobacco.²

In some parts of the world, chewing betel is a common practice that can increase the risk of leukoplakia. It can also happen because of wearing ill-fitting dentures or having broken or sharp teeth that rub against the cheeks or tongue.

Other risk factors include: 

• Alcohol consumption
• Fungal infections such as candidiasis
• Bacterial infections
• Sexually transmitted lesions like syphilis
• Combined micronutrient deficiency
• Hormonal disturbances
• Ultraviolet exposure

Age seems to play a role as fewer than 1% of leukoplakia cases occur in people under 30, and most cases occur in men between 50 and 70.¹

Although there seems to be a link between human papillomavirus (HPV) and oral leukoplakia, it’s not fully understood. However, some research shows a strong association between HPV infection and leukoplakia.³

If the doctor cannot find the cause for leukoplakia, they term it idiopathic leukoplakia. This type of leukoplakia is rare and usually forms on the tongue. It has an increased risk of malignant transformation compared to the tobacco-associated form.

How is Leukoplakia Diagnosed? 

Doctors diagnose leukoplakia by:

• Examining your mouth
• Attempting to remove the white patches
• Taking a medical history
• Considering any risk factors
• Eliminating any other possible causes

If it cannot be characterized clinically or histologically as any other condition, your doctor may diagnose leukoplakia. They may then recommend further testing to rule out oral cancer and request the following biopsies:

• Oral brush biopsy — your doctor removes cells from the leukoplakia patches using a small, spinning brush. A laboratory then examines the sample for cancerous cells. Because the procedure is non-invasive, it won't hurt, but it may not provide a final diagnosis.
• Excisional biopsy — a doctor or surgeon removes a small tissue sample from a leukoplakia patch and sends it away for laboratory analysis. These biopsies are slightly more uncomfortable but are more comprehensive and usually provide a definitive diagnosis.

If the biopsies show there are precancerous or cancerous changes, you may need further tests. But if the doctor removed the entire leukoplakia patch during a biopsy, you may not require additional treatment.

A hairy leukoplakia diagnosis may mean you have underlying health causes, so your doctor may also evaluate you for conditions that could weaken your immune system.⁴

How is Leukoplakia Treated?

Treatment aims to prevent leukoplakia patches from becoming cancerous and is most successful when started early and the patch is small. It may involve lifestyle changes or surgery.

Lifestyle Changes

It's essential to remove all contributing factors, meaning you shouldn’t use tobacco products or drink alcohol. In addition, any dental causes such as rough teeth, fillings, or dentures should be addressed as soon as possible.

Your doctor may also suggest the following:

• Maintaining a healthy diet consisting of lots of fruit and vegetables
• Taking supplements such as vitamin A, retinoids, beta-carotene, or lycopene
• Using a mouthwash containing the medication ketorolac⁵

Surgical Management

If the above treatments are ineffective, or the plaques show early signs of cancer, your doctor may suggest surgical options, including:

• Surgery — although the surgeon can remove the lesions, there's still a 10% to 20% chance that they'll recur and a 3% to 12% chance of developing cancer in the treated areas.¹
• Lasers — a surgeon can remove the lesions by using a high-energy laser.
• Electrocauterization — an alternative to laser removal. It involves using electrically heated instruments to remove oral leukoplakia patches.
• Cryotherapy — this involves targeting the lesions with liquid nitrogen to freeze and remove them.
• Photodynamic therapy — this treatment uses a light-sensitive medication and a light source to destroy abnormal tissue. 

Your doctor will arrange regular follow-up visits with you as recurrences are common.

Treating hairy leukoplakia

You usually don't require treatment if you have oral hairy leukoplakia, as it isn't likely to lead to cancerous changes and causes no symptoms. Instead, your doctor may recommend antiviral medications and topical treatments. 

Your doctor may also arrange follow-up visits to monitor your mouth or ongoing medication to prevent the patches from returning.

Leukoplakia Prevention Tips 

An overwhelming number of cases of oral leukoplakia are related to smoking, so one of the easiest ways to prevent the condition is by avoiding tobacco use. Likewise, because of the links with alcohol use, reducing or stopping drinking can help.⁶

Good nutrition is another critical factor in preventing diseases and poor health. Therefore, follow a healthy, balanced diet rich in antioxidant foods to optimize your health and well-being and minimize the chances of developing health problems such as leukoplakia.

Remember, if you notice any changes in your mouth or think you have oral leukoplakia, contact your doctor or another healthcare provider for advice.

Frequently Asked Questions (FAQ) 

What are some complications of leukoplakia?

Usually, leukoplakia doesn't damage the oral cavity or cause pain. But there’s an increased risk of oral cancer forming near the patches or within the lesions themselves, so it's sensible to attend regular check-ups so your doctor can monitor the patches.

Is leukoplakia an emergency?

No, leukoplakia isn't an emergency, but it's a good idea to make an appointment with your doctor or dentist. They can assess the oral lesions and advise you on treatment or management options.

How long does it take for leukoplakia to go away?

Leukoplakia patches typically clear up within a few weeks or months once you remove the chronic irritation. Despite that, there's still a chance that it can return, even if you have surgery to remove the oral lesions.⁷ 

What is the prognosis for leukoplakia?

You'll need to follow up with your doctor every 3 to 6 months so they can monitor the condition and take biopsies as necessary. 

If you have patches surgically removed, you should still have an examination every 6 to 12 months as leukoplakia often returns. The good news is that if a treated site remains clear of any changes for 3 years, you may not need further follow-up appointments.¹