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White lesions(collection)

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White lesions(collection)

  1. 1. WHITE & RED LESIONS :BY DR. NAYROZ ABDEL-FATTAH
  2. 2. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  3. 3. :Hereditary white lesions 1. Leukodema 2. White spongy nevus 3. 4. Hereditary benign intraepithelial dyskeratosis Darrier’s disease
  4. 4. :Hereditary white lesions Leukodema:     Normal variation . Faint , white , diffuse , numerous folds . Dissappears upon stretching . No treatment – no malignant change .
  5. 5. :Hereditary white lesions White spongy nevus:        Oral mucosa – m.m of nose , esophagus , rectum . At birth or at puberty. Bilateral symmetric. White soft spongy or thick plaque. Buccal mucosa. May be on ventral surfase of tongue,floor of mouth,labial mucosa,soft palate,alveolar mucosa. Asymptomatic – no malignant transformation.
  6. 6. :Hereditary white lesions Hereditary benign intraepithelial dyskeratosis: 1. 2. Oral lesions: thick ,corrugated ,asymptomatic white spongy plaques on buccal & labial m. Appears in 1st year of life &gradually increase till teens – no treatment. Eye lesions: thick gelatinous foamy opaque plaque adjacent to cornea – seasonal prominance in spring & regression in summer – blindness – referral to ophthalmologist.
  7. 7. :Hereditary white lesions Darrier’s disease: lesions start before age of 30 ys.- no treatment 1.    1.   3.    4.  Skin lesions: firm papules skin coloured ,yellow-brown, brown. Coalescence of papules forms warty plaques. Found on scalp margins ,forehead, ears & nasolabial furrows. Oral lesions: white papules on palate ,tongue ,buccal mucosa ,epiglottis ,pharyngeal wall coalescence of papules forms patches similar to leukoplakia. Nail lesions: Broad white longitudinal band Broad red longitudinal band Sandwich of both with v-shaped nick at free margin Ear lesions: Blockage of external auditory meatus by keratotic debris
  8. 8. :Darrier’s disease
  9. 9. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  10. 10. Reactive & Inflammatory white : lesions       Frictional keratosis Cheek chewing Chemical injuries Actinic keratosis Smokeless tobacco-induced keratosis Stomatitis nicotine
  11. 11. Frictional keratosis   White plaque related to source of mechanical irritation. Treatment : removal of offending cause.
  12. 12. Cheek chewing    Chronic irritation Mostly in people under stress No treatment , may be plastic occlusal night guard
  13. 13. (Chemical burn (phenol    Transient nonkeratotic lesion due to caustic as formcresol, acid etchant, hydrogen perioxide, asprin ,sodium hypochlorite Emollient agent as methyl cellulose for treatment
  14. 14. Aspirin burn
  15. 15. Actinic keratosis     Premalignant Due to long term sun exposure Vermillion border of lower lip Treatment : surgery
  16. 16.     Smokless tobacco induced keratosis In the area of tobacco contact Precancerous May be wrinkled or folded May be Accompanied by gingival recessetion& perio-destruction
  17. 17. Stomatitis nicotina
  18. 18. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  19. 19. :Infectious white lesions  Oral hairy leukoplakia  Candidiasis
  20. 20. :Hairy Leukoplakia     By epstain barr virus. In HIV patient. Mainly on lateral border or ventral surface of the tongue Treatment: antiviral drugs.
  21. 21. :Oral candidosis Acute   Acute pseudomembranous cand.(thrush) Acute antibiotic stomatitis (atrophic or erythamatous)       Chronic Denture induced stomatitis Angular stomatitis Median rhomboid glossitis Candidal leukoplakia (ch. Hyperplastic) Ch. Mucocutaneous candidosis Erythematous cand.
  22. 22. Acute pseudomembranous cand. (thrush):     Painless Soft friable creamy plaque Easily wiped off Prodrome : bad taste or loss of sensation
  23. 23. :Lab. Investigation Confirmation:  Gm stained smear shows candidal hyphae  Biopsy: hyperplastic epithelium, inflammatory edema & cells  Staining with PAS shows candidal hyphae
  24. 24. Acute antibiotic stomatitis (atrophic (:or erythamatous     Follow overuse of antibiotics The whole mucosa: red & glazed Flecks of thrush Xerostomia (sjogren syndrome)
  25. 25. :Denture induced stomatitis    Upper denture Due to well fitting denture cutting the washing effect of saliva Painless red area
  26. 26. :Angular stomatitis    Leakage candidainfected saliva at mouth angles Low vertical dimension & loss of upper lip support due to underlying bone resorption
  27. 27. Angular Cheilitis
  28. 28. :Median rhomboid glossitis   Red patch of atrophic papillae Central area of dorsum of tongue
  29. 29. Chronic mucocutaneous :candidosis   Defect in cell mediated immunity or iron deficiency Candidosis endocrinopathy syndrome: familial autosomal recessive
  30. 30. Chronic mucocutaneous candidiasis
  31. 31. Candidal leukoplakia (ch. (:Hyperplastic    Firm white leathery plaques Cheek ,lip ,tongue ,palate Invasion of candida deeper in mucosa leads to proliferative response
  32. 32. Chronic hyperplastic candidiasis
  33. 33. :Erythematous candidiasis  Red macules  In HIV infection  Mainly on hard palate , dorsum of tongue ,soft palate
  34. 34. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  35. 35. :Idiopathic (true) leukoplakia     White patch or plaque Can’t be clinically or pathologicaly any other disease Premalignant Etiologic factors: tobacco ,alcohol ,candida ,electrogalvanic react.    mostly on buccal mucosa ,lower lip ,gingiva. Less common on palate, retromolar area ,floor of mouth & tongue 90% of dysplasia in tongue & floor of mouth lesions
  36. 36. :Idiopathic (true) leukoplakia 1.    Homogenous Leukoplakia: Well defined patch Elevated ,fissured ,wrinkled Palpation: leathery or dry cracked mud like
  37. 37. :Idiopathic (true) leukoplakia 2.    Speckled Leukoplakia: Mixed red & white Keratotic nodules on atrophic red base High malignant transformation
  38. 38. :Idiopathic (true) leukoplakia 3.  Verrocous leukoplakia: Thick with papillary surface  Heavily keratinized  In older pt
  39. 39. :Idiopathic (true) leukoplakia 4.    Proliferative Verrocous leukoplakia: Extensive papilary plaque Involve multiple mucosal sites Transform to sq. cell carcinoma
  40. 40. :Diagnosis Clinically:  Cannot be stripped or rubbed off  Loss of elasticity (Stretching) & pliability (bending)
  41. 41. :Diagnosis    Tissue Biopsy Toluidine blue staining: stain dysplastic & malignant cells , resist washing away Cytobrush technique: firm bristle brush to obtain cells from full thickness of epith. For cytologic examination
  42. 42. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  43. 43. :Erythroplakia     Red bright velvety area Tongue ,floor of mouth , soft palate ,ant.tonsillar pillars Asymptomatic High malignant transformation
  44. 44. :Erythroplakia
  45. 45. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  46. 46. :Lichen Planus 1.      Skin lesion : pruritic, polygonal, papules & plaque 2-4mm with angular border, violaceous color Symmetrically Flexor surfaces of wrists, legs, trunk Koebners phenomenon
  47. 47. :Lichen Planus 2.      Nail lesions: In 10% of cases Nail bed discoloration Lateral thinning Complete loss of nail matrix Scarring of proximal nail fold
  48. 48. (Lichen Planus (reticular       Slightly elevated lines “wickham’s striae” Annular lesion Eleveted papules Large plaque Asymptomatic – roughness Buccal mucosa, dorsum of tongue, gingiva
  49. 49. (Lichen planus (papular &reticular
  50. 50. Hypertrophic form
  51. 51. (Lichen Planus(atrophic    Inflammed areas of oral mucosa Covered by thinned red epithelium symptomatic
  52. 52. (Lichen Planus(erosive    Complication of atrophic type Thin epithelium become abraded or ulcerated Symptomatic: mild burning – severe pain
  53. 53. Erosive lichen Planus
  54. 54. (Lichen Planus(bullous
  55. 55. :Immunoflourescent   Shaggy band of fibrinogen at B.M zone IgM in dermal papilla in peribasal area
  56. 56. :Lichenoid reaction   L.P like lesions Due to systemic drug treatment
  57. 57. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  58. 58. Lupus erythematosus: Autoimmune C.T disease  Forms: 1. Discoid (DLE) 2. Systemic (SLE) D.L.E :  cheeks, nose bridge, ears, side of neck & scalp  Bilaterally not necessarily symmetrical 
  59. 59. :Lupus erythematosus    Butterfly rash Adherent scales on removal, its undersurface shows horny plugs that occupied dilated sebaceous canals Tin-tack sign
  60. 60. :Lupus erythematosus S.L.E:  Cutaneous erythema especially on light exposed areas  Butterfly rash  Facial edema  Photosensitivity  Chronic urticaria  Non scaring alopecia
  61. 61. :Lupus erythematosus Oral lesion:  In 20% of SLE , more common in DLE  White striated, atrophic or erosive areas  Variable patterns of white & red areas
  62. 62. :White lesions may be         Hereditary Reactive inflammatory Infectious Idiopathic leukoplakia Erythroplakia Lichen planus – lichenoid reaction Lupus erythematosus Miscellaneous
  63. 63. Miscellaneous :Oral submucous fibrosis     Slowly progressive chronic fibrotic disease premalignant Fibroelastic changes & inflammation of mucosa Inability to open mouth, swallow, speak
  64. 64. :Oral submucous fibrosis   Fibrosis by proliferation of fibroblasts, collagen synthesis, decrease collagenase production Due to nutritional & vitamin deficiency, hypersensitivity to chili pepper, chewing tobacco
  65. 65. :Oral submucous fibrosis Clinically:  Burning sensation  Vesicles & ulceration  Excessive salivation or xerostomia  Altered taste sensation  Stiffness of mucosa  Mucosa is blanched & opaque  Buccal mucosa, soft palate, pharynx, lip, tongue
  66. 66. Geographic tongue
  67. 67. Fordyce’s granules
  68. 68. Linea Alba

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