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D.D of white lesion:
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Leukodema
White spongy neavus
Heredetary benign epith.dyskeratosis
Darriers dise...
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
p...
Biopsy
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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 li...
 Eye lesion:
 Thick, gelatinous, foamy,opaque plaque
adjacent to cornea
 Seasonal prominence
 May lead to blindness du...
Darrier disease
hyperkeratotic papules
 Skin lesion:
 Firm harsh
papule,greasy
 Seborrhoeic areas as
Scalp ,forhead
 S...
 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:
 Ext...
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
Ac...
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...
Confirmation:
 Gm stained smear
shows candidal
hyphae
 Biopsy:hyperplastic
epithelium
inflammatory
oemda&cells
 PAS sho...
Chronic hyperplasic
candidiasis
(candidal leukoplakia)
 Chronic
 Firm white leathery
plaque
 Cheek,lip,palate,
tongue
...
leukoplakia
White patch or plaque
 Homogenous
 Nodular
 Verrucous
 Proliferative verrucous
 Homogenous leuplakia:
 Well defined white patch
 Slighty elevated
 Fissured,wrinkled,corrug
ated surface
 On palpati...
Verrucous leukoplakia:
 papillary
 Heavily keratinized
 Increased rate of
malignant
transformation
Proliferative verrucous:
 Extensive papillary or
verrucoid white
plaque
 Involve multiple
mucosal site
 May transform i...
Speckled leukoplakia:
 mixed red & white
 Karatotic white nodule
&erythematousatrophic
area
 High rate of malignant
tra...
diagnosis
clinically
 Cannot be stripped or rubbed off
 Loss of elasticity & pliability
Lab investegation:
 Biopsy
*hyp...
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
phe...
Oral lesion:
papular type:
*painless
*Pin head,hyperkeratotic
papule
*fine white lines called
(wickhams stria)
 Discrete
...
D.D lekoplakia:
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Bilateral
Felxible
Pliable
No signs of dysplasia

Cheek,lips,dorsum of
tongue
Rarely palate & gin...
Immunofourescenct
test
D.D of red lesions
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Acute atrophic candidiasis
Denture induced stomatitis
Median rhomboidal glossitis
Erythe...
Acute atrophic
candidiasis
 Whole mucosa is red
& sore
 History of prolonged
antibiotic intake
 Xerostomia (sjogren
syn...
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 ...
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
dy...
Atrophic lichen planus
 Irregular red patch
 No change in
flexibility or pliability
 Commonly dorsum of
tongue
 Desqua...
Bullous erosive lichen
planus
 Severe pain &
burning sensation
 Change in taste
Histopathology:
 Hyperkeratosis
 Liguifactive degeneration of basal cell
layer
 Dense subepithelial band of lymphocytic...
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 gr...
Lupus erythematosus
Immunoflouresecnt
test
White& red lesions
White& red lesions
White& red lesions
White& red lesions
White& red lesions
White& red lesions
White& red lesions
White& red lesions
White& red lesions
White& red lesions
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Transcript of "White& red lesions"

  1. 1. 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
  2. 2. leukodema  Faint diffuse,filmy  Numerous folds or wrinkles  Can’t be scrapped off  Disappear & fades upon stretching
  3. 3. 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
  4. 4. Biopsy     Hyperkeratosis Acanthosis Perinuclear condensation of cytoplasm Vacuolazation of suprabasal layer
  5. 5. Hereditary benign intraepithelial dyskeratosis  Oral lesion  Eye lesion
  6. 6.  Oral lesion:  Thick & corrugated  Asymptomatic  White spongy plaque  Buccal & labial mucosa mainly  1st years of life &increase untill teenage
  7. 7.  Eye lesion:  Thick, gelatinous, foamy,opaque plaque adjacent to cornea  Seasonal prominence  May lead to blindness due to corneal vascularization
  8. 8. Darrier disease hyperkeratotic papules  Skin lesion:  Firm harsh papule,greasy  Seborrhoeic areas as Scalp ,forhead  Skin yellowish brown or brown
  9. 9.  Oral lesion:  cobblestone papules  Palate,tongue,buccal mucosa,pharyngeal wall  confluence of papule form plaque
  10. 10.  Nail lesion:  Broad white longitudinal band  Broad red longitudinal band  Sandwich of red & white • Ear lesion:  External auditory meatus blocked by accumulation of debris
  11. 11. Frictional keratosis  White rough plaque  Related to a source of mechanical irritation
  12. 12. Cheek biting  Chronic irritation as: Suckling,cheek & lip biting  Bilaterally along occlusal plane
  13. 13. Chemical burn  Transient non keratotic white plaque  Irregular in shape  Covered by pseudomembrane  Very painful
  14. 14. Aspirin burn
  15. 15. Smokless tobacco induced keratosis  In the area of tobacco contact  Precancerous  May be wrinkled or folded  May be Accompanied by gingival recessetion& perio-destruction
  16. 16. Actinic keratosis  Patient exposed for sunlight for prolonged time
  17. 17. 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
  18. 18. Confirmation:  Gm stained smear shows candidal hyphae  Biopsy:hyperplastic epithelium inflammatory oemda&cells  PAS shows candidal hyphae
  19. 19. Chronic hyperplasic candidiasis (candidal leukoplakia)  Chronic  Firm white leathery plaque  Cheek,lip,palate, tongue  PAS +ve candidal hyphae
  20. 20. leukoplakia White patch or plaque  Homogenous  Nodular  Verrucous  Proliferative verrucous
  21. 21.  Homogenous leuplakia:  Well defined white patch  Slighty elevated  Fissured,wrinkled,corrug ated surface  On palpation leathery( like dry cracked mud)
  22. 22. Verrucous leukoplakia:  papillary  Heavily keratinized  Increased rate of malignant transformation
  23. 23. Proliferative verrucous:  Extensive papillary or verrucoid white plaque  Involve multiple mucosal site  May transform into squamous cell carcinoma
  24. 24. Speckled leukoplakia:  mixed red & white  Karatotic white nodule &erythematousatrophic area  High rate of malignant transformation
  25. 25. 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
  26. 26. Oral hairy leukoplakia  Corrugated white lesion  Lateral or ventral surfaceof tongue  Immumunodeff pt (HIV)
  27. 27. confirm diagnosis by: Demo of EBV by:  In situ hyberidization  E.M  PCR
  28. 28. Lichen planus  Skin lesions  Oral lesions:  Papular(reticular)  Atrophic  Bullous erosive
  29. 29. Skin lesions: • Pruiritic • Polyangular • Plane topped • Papules & plaques • Violaceous • (wrist,legs,trunk) • Koebner phenomenon • Scalp alopecia
  30. 30. Oral lesion: papular type: *painless *Pin head,hyperkeratotic papule *fine white lines called (wickhams stria)  Discrete  Linear  Reticular  Confluent (plaque)
  31. 31. D.D lekoplakia:     Bilateral Felxible Pliable No signs of dysplasia Cheek,lips,dorsum of tongue Rarely palate & gingiva
  32. 32. Immunofourescenct test
  33. 33. D.D of red lesions        Acute atrophic candidiasis Denture induced stomatitis Median rhomboidal glossitis Erythematous candidiasis Erythroplakia Atrophic lichen planus Angular stomatitis
  34. 34. Acute atrophic candidiasis  Whole mucosa is red & sore  History of prolonged antibiotic intake  Xerostomia (sjogren syndrome)
  35. 35. Denture induced stomatitis  Sharpely limited to area occluded by denture  Associated usually by angular stomatitis
  36. 36. Median rhomboidal glossitis  Erythematous rhomboidal area  At central area of dorsum of the tongue
  37. 37. Erythematous candidiasis  Red patch due to candida albicans  Infection in H.I.V pt  Hard palate,soft palate,dorsum of the tongue
  38. 38. Angular stomatitis  Denture wearer ( loss of V.D)  Inflamation at the angle of the mouth
  39. 39. erythroplakia  Bright red velvety plaque  Esp:floor of mouth,soft palate,ant.tonsillar pillar Biopsy: Severe signs of dysplasia
  40. 40. Atrophic lichen planus  Irregular red patch  No change in flexibility or pliability  Commonly dorsum of tongue  Desquamative gingivitis  Reimmision & exacerbation
  41. 41. Bullous erosive lichen planus  Severe pain & burning sensation  Change in taste
  42. 42. Histopathology:  Hyperkeratosis  Liguifactive degeneration of basal cell layer  Dense subepithelial band of lymphocytic inf.  isolated epith.cells have nuclear fragment(civatte bodies)
  43. 43. immunoflourescent  Shaggy band of fibrinogen at B.M zone  IgM in dermal papilla in peribasal area
  44. 44. Stomatitis nicotina  White lesion inhard & soft palate  Heavy cigarette,pipe,cigar smoking & reverse smoking  Palate grey or white  Elevated papules with red centre
  45. 45. Lupus erythematosus
  46. 46. Immunoflouresecnt test
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