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White& red lesions
 

White& red lesions

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    White& red lesions White& red lesions Presentation Transcript

    • D.D of white lesion:           Leukodema White spongy neavus Heredetary benign epith.dyskeratosis Darriers disease oral keratosis Chemical burns Oral thrush Leukoplakia Hairy leukoplakia Lichen planus
    • leukodema  Faint diffuse,filmy  Numerous folds or wrinkles  Can’t be scrapped off  Disappear & fades upon stretching
    • White spongy neavus  Oral mucosa (mainly)  Nose,pharynx,genital ,rectum  Bilateral,symmetrical  spongy,velvety,thick plaque  Buccal mucosa mainly  May be other non keratinized mucosa
    • Biopsy     Hyperkeratosis Acanthosis Perinuclear condensation of cytoplasm Vacuolazation of suprabasal layer
    • Hereditary benign intraepithelial dyskeratosis  Oral lesion  Eye lesion
    •  Oral lesion:  Thick & corrugated  Asymptomatic  White spongy plaque  Buccal & labial mucosa mainly  1st years of life &increase untill teenage
    •  Eye lesion:  Thick, gelatinous, foamy,opaque plaque adjacent to cornea  Seasonal prominence  May lead to blindness due to corneal vascularization
    • Darrier disease hyperkeratotic papules  Skin lesion:  Firm harsh papule,greasy  Seborrhoeic areas as Scalp ,forhead  Skin yellowish brown or brown
    •  Oral lesion:  cobblestone papules  Palate,tongue,buccal mucosa,pharyngeal wall  confluence of papule form plaque
    •  Nail lesion:  Broad white longitudinal band  Broad red longitudinal band  Sandwich of red & white • Ear lesion:  External auditory meatus blocked by accumulation of debris
    • Frictional keratosis  White rough plaque  Related to a source of mechanical irritation
    • Cheek biting  Chronic irritation as: Suckling,cheek & lip biting  Bilaterally along occlusal plane
    • Chemical burn  Transient non keratotic white plaque  Irregular in shape  Covered by pseudomembrane  Very painful
    • Aspirin burn
    • Smokless tobacco induced keratosis  In the area of tobacco contact  Precancerous  May be wrinkled or folded  May be Accompanied by gingival recessetion& perio-destruction
    • Actinic keratosis  Patient exposed for sunlight for prolonged time
    • Acute psdeudo membranous candidiasis(oral thrush)  Painless  Soft creamy white plaque  Can’t be easily rubbed or whiped off leaving erythematous area or ulceration  Range from Small flecks-wide spread confluent plaque  Prodrome of bad taste or loss of taste sensation
    • Confirmation:  Gm stained smear shows candidal hyphae  Biopsy:hyperplastic epithelium inflammatory oemda&cells  PAS shows candidal hyphae
    • Chronic hyperplasic candidiasis (candidal leukoplakia)  Chronic  Firm white leathery plaque  Cheek,lip,palate, tongue  PAS +ve candidal hyphae
    • leukoplakia White patch or plaque  Homogenous  Nodular  Verrucous  Proliferative verrucous
    •  Homogenous leuplakia:  Well defined white patch  Slighty elevated  Fissured,wrinkled,corrug ated surface  On palpation leathery( like dry cracked mud)
    • Verrucous leukoplakia:  papillary  Heavily keratinized  Increased rate of malignant transformation
    • Proliferative verrucous:  Extensive papillary or verrucoid white plaque  Involve multiple mucosal site  May transform into squamous cell carcinoma
    • Speckled leukoplakia:  mixed red & white  Karatotic white nodule &erythematousatrophic area  High rate of malignant transformation
    • diagnosis clinically  Cannot be stripped or rubbed off  Loss of elasticity & pliability Lab investegation:  Biopsy *hyperkeratosis *acanthosis *chronic inf. Cells *signs of dysplasia  Touluidine blue test
    • Oral hairy leukoplakia  Corrugated white lesion  Lateral or ventral surfaceof tongue  Immumunodeff pt (HIV)
    • confirm diagnosis by: Demo of EBV by:  In situ hyberidization  E.M  PCR
    • Lichen planus  Skin lesions  Oral lesions:  Papular(reticular)  Atrophic  Bullous erosive
    • Skin lesions: • Pruiritic • Polyangular • Plane topped • Papules & plaques • Violaceous • (wrist,legs,trunk) • Koebner phenomenon • Scalp alopecia
    • Oral lesion: papular type: *painless *Pin head,hyperkeratotic papule *fine white lines called (wickhams stria)  Discrete  Linear  Reticular  Confluent (plaque)
    • D.D lekoplakia:     Bilateral Felxible Pliable No signs of dysplasia Cheek,lips,dorsum of tongue Rarely palate & gingiva
    • Immunofourescenct test
    • D.D of red lesions        Acute atrophic candidiasis Denture induced stomatitis Median rhomboidal glossitis Erythematous candidiasis Erythroplakia Atrophic lichen planus Angular stomatitis
    • Acute atrophic candidiasis  Whole mucosa is red & sore  History of prolonged antibiotic intake  Xerostomia (sjogren syndrome)
    • Denture induced stomatitis  Sharpely limited to area occluded by denture  Associated usually by angular stomatitis
    • Median rhomboidal glossitis  Erythematous rhomboidal area  At central area of dorsum of the tongue
    • Erythematous candidiasis  Red patch due to candida albicans  Infection in H.I.V pt  Hard palate,soft palate,dorsum of the tongue
    • Angular stomatitis  Denture wearer ( loss of V.D)  Inflamation at the angle of the mouth
    • erythroplakia  Bright red velvety plaque  Esp:floor of mouth,soft palate,ant.tonsillar pillar Biopsy: Severe signs of dysplasia
    • Atrophic lichen planus  Irregular red patch  No change in flexibility or pliability  Commonly dorsum of tongue  Desquamative gingivitis  Reimmision & exacerbation
    • Bullous erosive lichen planus  Severe pain & burning sensation  Change in taste
    • Histopathology:  Hyperkeratosis  Liguifactive degeneration of basal cell layer  Dense subepithelial band of lymphocytic inf.  isolated epith.cells have nuclear fragment(civatte bodies)
    • immunoflourescent  Shaggy band of fibrinogen at B.M zone  IgM in dermal papilla in peribasal area
    • Stomatitis nicotina  White lesion inhard & soft palate  Heavy cigarette,pipe,cigar smoking & reverse smoking  Palate grey or white  Elevated papules with red centre
    • Lupus erythematosus
    • Immunoflouresecnt test