OHL usually does not require treatment or cause serious symptoms. However, treatment is an option for people who are unhappy with the appearance of OHL on their tongues or for those with widespread lesions who are experiencing discomfort or altered taste because of the patches.
Antiviral medications, taken by mouth, are the most common method of treating OHL. These medications are usually taken for one to two weeks or until the OHL patches have disappeared:
Acyclovir (Zovirax®): Acyclovir has been used for many years as a treatment for OHL. It is a very safe oral medication. The dose used to treat OHL is 800 mg taken five times a day for at least a week. Taking lower doses of the drug for a prolonged period of time can help prevent OHL from recurring after it is treated. However, this is usually recommended only for patients who have a history of frequent recurrences.
Valacyclovir (Valtrex®): Valacyclovir is a "pro-drug" of acyclovir. Unlike acyclovir, valacyclovir needs to be broken down by the body before its active ingredient – acyclovir – can begin controlling the disease. This allows for higher amounts of acyclovir to remain in the body, thus requiring a lower dose of the drug to be taken by mouth. For the treatment of OHL, valacyclovir only needs to be taken three times a day. Like acyclovir, valacyclovir rarely causes side effects.
Famciclovir (Famvir®): Famciclovir is actually the pill form of a topical cream called penciclovir (Denavir®). Like valacyclovir, famciclovir needs to be taken three times a day until the patches have disappeared.
Other options include tretinoin (Retin A®) and podophyllin resin, two medications that can be applied directly to the OHL patches. Tretinoin is usually applied two or three times a day until the patches have disappeared; podophyllin is applied once or twice over a two- to three-week period by a healthcare provider. Another option, especially if the OHL patches are small, is for a healthcare provider to apply liquid nitrogen (cryotherapy) to the affected area or to remove the patches surgically.
Prevention
There is no sure way to prevent OHL patches from occurring. However, keeping the immune system healthy is the best possible way to prevent OHL. This means keeping viral load low and T-cells high using anti-HIV drug treatment and by adopting a healthy lifestyle.
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