Name
LEUKOPLAKIA
DESCRIPTION
DETAIL
CAUSES OF WHITE LESIONS OF ORAL MUCOSA : - LICHEN PLANUS - WHITE SPONGE NEVUS - NICOTINE STOMATITIS - FRICTIONAL KERATOSIS - CANDIDIASIS β’ Tobacco use in any form β’ Alcohol consumption β’ Oral sepsis β’ Candida albicans β’ Human papilloma virus, types 11 and 15 β’ Actinic radiation β’ Vitamin deficiency β’ Syphilis β’ Dental restorations β’ Prosthetic dental appliances β’ Alcoholism β’ Estrogen therapy β’ Chronic trauma or irritation -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS . White oral lesions that can be wiped away: . Candida . Aspirin burn . White oral lesions that cannot be rubbed off: . Traumatic or frictional keratosis (e.g., linea alba) . Leukoedema . Galvanic keratosis . Lichen planus . Verrucous carcinoma . Lupus . Squamous cell carcinoma . Oral hairy leukoplakia, commonly on the lateral border of the tongue with a bilateral distribution . Leukokeratosis nicotina palatiOTHER TESTS : * DIRECT SMEAR EXAMINATION FOR HYPHAE & GRAM STAINING DIAGNOSTIC PROCEDURES Biopsy necessary to rule out carcinoma if lesion is persistent or unexplained
TYPENOTES
RISK FACTORS: Age over 40, Tobacco or alcohol use, Repeated or chronic trauma or irritation to oral regionsAPPROPRIATE HEALTH CARE β’ Eliminate etiologic factors β’ Reevaluate in 7-14 days β’ Biopsy if lesion is persistent GENERAL MEASURES β’ Eliminate habitual lip biting β’ Correct ill fitting dental appliances, bad restorations or sharp teeth β’ Stop smoking and alcohol & TOBACC0 CHEWING β’ If dysplasia evident, remove lesion. Consider otolaryngologist referral. β’ Some small lesions may respond to cryosurgery β’ Beta-carotene may cause partial regression (experimental) β’ For hairy tongue: Tongue brushing SURGICAL MEASURES β’ Excision is the treatment of choice for lesions exhibiting dysplasia or malignant transformation DIET Regular PATIENT EDUCATION β’ If biopsy negative, stress importance of periodic and careful followup β’ Dental referral to eliminate dental factors β’ Stress importance of stopping tobacco and alcohol use β’ Encourage participation in smoking cessation program DRUG(S) OF CHOICE . Generally none needed . Hairy leukoplakia . Acyclovir 2-4 gm/day systemically is effective, but the lesions recur when the treatment is stopped . Topical retinoids . Topical podophyllin 25% resin applied twice, one week apart, but the bad taste is poorly tolerated . Leukoplakia . Isotretinoin (Accutane) 1-2 mg/kg/day may lead to temporary remission, but side effects are poorly tolerated PATIENT MONITORING Regular, close followup, even after successful treatment. Biopsy as needed. PREVENTION/AVOIDANCE β’ Avoid tobacco, alcohol, habitual biting β’ Provide well-fitting dental prothesis β’ Regular dental check-up to avoid bad restorations POSSIBLE COMPLICATIONS β’ Carcinoma β’ New lesions may develop after treatment EXPECTED COURSE/PROGNOSIS β’ Curable if detected early β’ 4-6% of initially benign lesions subsequently develop cancer β’ More likely cancerous if on fl oor of mouth or lateral border of tongue
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, BIOPSY