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White lesions

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  • 1. WHITE LESIONS Collected and arranged by Ahmed Samy El Nashar BDS of oral surgery , tanta university Dr. Ahmed E-lNashar(2014)
  • 2. COLOR OF NORMAL MUCOSA !!!!! PALE PINK Dr. Ahmed E-lNashar(2014)
  • 3. COLOR OF NORMAL MUCOSA !!!!! Dr. Ahmed E-lNashar(2014)
  • 4. WHITE LESIONS !!!!! Mucosa appear white in color Dr. Ahmed E-lNashar(2014)
  • 5. WHITE LESIONS !!!!! Dr. Ahmed E-lNashar(2014)
  • 6. Classification of WHITE LESIONS !!!!! 1) Keratotic 2) Non keratotic 1. Frictional keratosis. 2. Nicotinic stomatitis 3. White spongy nevus 4. Lichen planus 5. Hairy leukoplakia 6. Leukoplakia. 7. Candidal lukoplakia. 8. DLS 1. Burns 2. candidosis( Moniliasis, thrush) 3. leukodema. Dr. Ahmed E-lNashar(2014) Reactive Hereditary Immune Infection Precancerous Reactive Infection hereditary
  • 7. FRICTIONAL KERATOSIS protective action of mucosa against low-grade long-term trauma (friction) Age Sex Site 5th & 6th decades of life (average 48 years). ♂ > ♀ (2:1) cheek, lip, palate, floor of the mouth and tongue Dr. Ahmed E-lNashar(2014)
  • 8. S&S sharply outlined white patches, not indurated and has no red margin. In cases of check biting appears as Band like area of keratosis Dr. Ahmed E-lNashar(2014)
  • 9. Dr. Ahmed E-lNashar(2014)
  • 10. Dr. Ahmed E-lNashar(2014)
  • 11. Dr. Ahmed E-lNashar(2014)
  • 12. Hyperkeratosis & hyperparakeratosis. thickening of granular cell layer acanthosis. few chronic inflammatory cells may be seen. Dr. Ahmed E-lNashar(2014)
  • 13. Dr. Ahmed E-lNashar(2014)
  • 14. NICOTINIC STOMATITIS = smoker’s palate + Dr. Ahmed E-lNashar(2014)
  • 15. Sex ♂> ♀. Site palate. Dr. Ahmed E-lNashar(2014)
  • 16. diffuse palatal keratosis with red dots may be surrounded by elevated white rings. Clinical course ………. -erythematosus area  opacification  diffuse palatal keratosis umblicated red dots. Dr. Ahmed E-lNashar(2014)
  • 17. Dr. Ahmed E-lNashar(2014)
  • 18. Dr. Ahmed E-lNashar(2014)
  • 19. Epithelial Hyperpslasia Excretory ducts of minor SG show Sq. metaplasia Acinar atrophy Chronic inflammatory cells. Scar Dr. Ahmed E-lNashar(2014)
  • 20. WHITE SPONGY NEVUS = familial white folded gingivostomatitis Dr. Ahmed E-lNashar(2014)
  • 21. WHITE SPONGY NEVUS = familial white folded gingivostomatitis Age at birth . Oral mucosa Site Buccal mucosa, tongue & may occur also in the oesophagous, Rectal mucosa Vaginal mucosa Dr. Ahmed E-lNashar(2014)
  • 22. Bilateral symetrical The mucosa appears  thickened  folded or corrugated  spongy texture and  a peculiar white opalescent hue. Dr. Ahmed E-lNashar(2014)
  • 23. Dr. Ahmed E-lNashar(2014)
  • 24. Dr. Ahmed E-lNashar(2014)
  • 25. Hyperparakeratosis. Acanthosis. hydropic degeneration fail to take any stain. intracellular edema)  show pyknotic nuclei (basket weave appearance) mild inflammatory cell infiltration Dr. Ahmed E-lNashar(2014)
  • 26. Acanthosis Hyropic degeneration Dr. Ahmed E-lNashar(2014)
  • 27. HAIRY LEUKOPLAKIA 80% of AIDS patient Dr. Ahmed E-lNashar(2014)
  • 28. male homosexuals. latmargin of the tongue (majority of cases). dorsal surface of the tongue (less common) the buccal eral mucosa, floor of the mouth or palate (rarely). unilateral or bilateral hairy appearance or corrugated surface. Dr. Ahmed E-lNashar(2014)
  • 29. Dr. Ahmed E-lNashar(2014)
  • 30. Dr. Ahmed E-lNashar(2014)
  • 31. Dr. Ahmed E-lNashar(2014)
  • 32. Dr. Ahmed E-lNashar(2014)
  • 33. hyperparakeratosis epithelial hyperplasia ballooning degeneration koilocytosis Candida albicans Dr. Ahmed E-lNashar(2014)
  • 34. LICHEN PLANUS Most common dermatologic disease w affect oral cavity primitive plants w resembles FLAT algae Dr. Ahmed E-lNashar(2014)
  • 35. ETIOLOGY AND PATHOGENESIS nervous exhaustion 1. Psychosomatic origin Anexity syndrome 2. considered as an autoimmune disease mediated by T-lymphocytes + Plamsma cell + Langerhans cell against epithelial basal cells. Dr. Ahmed E-lNashar(2014)
  • 36. Dr. Ahmed E-lNashar(2014)
  • 37. Dr. Ahmed E-lNashar(2014)
  • 38. Dr. Ahmed E-lNashar(2014)
  • 39. Dr. Ahmed E-lNashar(2014)
  • 40. CLINICAL FEATURES OF ORAL LESIONS Oral lesions often precedes skin lesions and may be the only one Age Sex Site Clinical course adult ♀>♂ gingiva, cheek, lips, tongue and palate. Undergo periods of remission followed by exacerbation emotional strain , overwork , anxiety , traumatism ,malnutrition. Dr. Ahmed E-lNashar(2014)
  • 41. •Oral lesions of lichen planus has 4 different forms ……. ORAL LESIONS OF LICHEN PLANUS 4 FORMS 2 WHITE 2 RED Reticular hypertrophic Atrophic Dr. Ahmed E-lNashar(2014) Erosive
  • 42. ORAL LESIONS OF LICHEN PLANUS 1. Reticular lichen planus •Most common type. •White thread-like papules •reticular patches or rings. •" striae of wickham " Dr. Ahmed E-lNashar(2014)
  • 43. ORAL LESIONS OF LICHEN PLANUS 2. Hypertophic lichen planus •well circumscribed elevated white lesion. •Resmbles frictional keratosis & leukoplakia. •Biopsy is necessary Dr. Ahmed E-lNashar(2014)
  • 44. ORAL LESIONS OF LICHEN PLANUS 3.Atrophic lichen planus •Most poorly defined red areas may show the peripheral striae. " Dr. Ahmed E-lNashar(2014)
  • 45. ORAL LESIONS OF LICHEN PLANUS 4.Erosive lichen planus •raw painful ulcerated areas . •radiating striae on periphery Dr. Ahmed E-lNashar(2014)
  • 46. CLINICAL FEATURES OF SKIN LESIONS any where on the skin , but most common sites …. 1)Flexor surface of wrist & forearms. 2)Inner aspect of knees & thighs 3)Trunk especially sacral area. Dr. Ahmed E-lNashar(2014)
  • 47. CLINICAL FEATURES OF SKIN LESIONS 1ry symptom pruritis. Small papules , which is … 1.flat topped. 2.center may be umblicated. 3."Whickham's striae ". 4.COLOR : red -> purple -> brownish 1.large plaques covered by glistening scale. Dr. Ahmed E-lNashar(2014)
  • 48. Histopathology of SKIN Lichen Planus Dr. Ahmed E-lNashar(2014)
  • 49. Histopathology of ORAL Lichen Planus Dr. Ahmed E-lNashar(2014)
  • 50. Histopathology of ORAL Lichen Planus Dr. Ahmed E-lNashar(2014)
  • 51. LEUKOEDEMA race site S&S Blacks > whites Buccal bilateral white lesion w disappears e stretching in early stages filmy opalescent mucosa in later stageswhite cast e coarse corrugated surface Dr. Ahmed E-lNashar(2014)
  • 52. Dr. Ahmed E-lNashar(2014)
  • 53. acanthotic epithelium flattened and show pyknotic nuclei Cells of stratum spinosum are enlarged not infiltrated with inflammatory cells. Dr. Ahmed E-lNashar(2014)
  • 54. CANDIDIASIS = Moniliasis = Thrush Most opportunistic infection in the world It is fungal disease caused by Candida albicans exists in ainhabitant of oral cavity,relation evagina flora. under certain circumstances play GIT and bacterial common competitive symbiotic a pathologic Extensive use of antibiotic immuno-suppressive drugs chronic diseases Dr. Ahmed E-lNashar(2014)
  • 55. Classification of CANDIDASIS 1. oral or oropharyngeal candidosis (thrush) 2. candidal oesophagitis Mucocutaneous 3. intestinal candidosis 4. candidal vaginitis. 1. Eyes 2. kidneys Systemic 3. skin through hematogenous spread 4. visceral organs may be involved. Dr. Ahmed E-lNashar(2014)
  • 56. Any age gp common in debilitating infant Any where oral cavity localized to oral mucosa may extend to pharynx or lungs Dr. Ahmed E-lNashar(2014)
  • 57. soft, white, elevated plaques resembles milk cruds. can be wiped off leaving raw, painful bleeding surface. Dr. Ahmed E-lNashar(2014)
  • 58. LABORATORY FINDING Macerated e 20% KOH Candidal plaque Stained e PAS Candidal hyphae blood agar , cornmeal agar or sabauroud's broth Dr. Ahmed E-lNashar(2014)
  • 59. HISTOPATHOLOGY Dr. Ahmed E-lNashar(2014)
  • 60. HISTOPATHOLOGY Candidal Hyphae in superficial layer of epith. PNLS in epith. Superficail microabscess. Dr. Ahmed E-lNashar(2014)
  • 61. TEATMENT Stoppage of antibiotics Stoppage of cortisone Anti fungal Dr. Ahmed E-lNashar(2014)
  • 62. CHEMICAL BURN Dr. Ahmed E-lNashar(2014)
  • 63. CHEMICAL BURN Dr. Ahmed E-lNashar(2014)
  • 64. CHEMICAL BURN Dr. Ahmed E-lNashar(2014)
  • 65. CHEMICAL BURN Dr. Ahmed E-lNashar(2014)
  • 66. CHEMICAL BURN Dr. Ahmed E-lNashar(2014)