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- 1. WHITE LESIONS S A B A D O , S A N G A B R I E L , S Y RIMBERIO CO
- 2. CANDIDIASIS
- 3. Common opportunistic oral mycotic infection Term encompasses a group of mucosal & cutaneous condition with a common etiologic agent from the Candida genus of fungi DEFINITION
- 4. Candida Albicans - common cause Commensal organism living in the oral cavity in a majority of healthy persons May exist in three distinct biologic & morphologic forms: Vegetative or yeast form of oval cells(blastospores) The eliminated cellular form(pseudohyphae) Chlamydospore form ETIOLOGY
- 6. Acute pseudomembranous most common type aka thrush or oral thrush young infants and elderly favored sites: Buccal mucosa, Mucobuccal folds, Oropharynx, Lateral aspects of the dorsal tongue CLINICAL FEATURES
- 7. Acute Erythematous a.k.a: Antibiotic stomatitis along the dorsum of the tongue CLINICAL FEATURES
- 8. Chronic Atrophic/erythematous Aka: denture sore mouth Distinct predilection for the palatal mucosa Gender predilection: female Also seen in individuals with denture-related problems: angular cheilitis CLINICAL FEATURES
- 9. Chronic Hypertrophic/Hyperplastic(white keratotic) Candidal leukoplakia →when occurs in the retro commissural area, resembling speckled leukoplakia. Represents a premalignant lesion Median rhomboid glossitis →when occur in the dorsum of the tongue CLINICAL FEATURES
- 10. Mucocutaneous forms Localized (oral, face, scalp, nails) Long-standing and persistent candidiasis of the oral mucosa, nails, skin and vaginal mucosa Resistant to treatment Temporary remission following the use of standard antifungal therapy CLINICAL FEATURES
- 11. Mucocutaneous forms Familial 50% associated with endocrinopathy Triad: Candidiasis, Myositis and Thymoma Can be involved in STD CLINICAL FEATURES
- 12. Mucocutaneous forms Syndrome-associated Seen in immunosuppressed population of patients particularly HIV Associated with HIV CLINICAL FEATURES
- 13. Slough associated with chemical burns Traumatic ulcerations Mucous patches of syphilis Whire keratotic lesions For red lesions: Drug reactions, Erosive lichen planus and DLE DIFFERENTIAL DIAGNOSIS
- 14. Topical application of nystatin suspension/cream Withdrawal of the broad-spectrum antibiotics Withdrawal of oxygenated agents Clotrimazole: lozenge or tablet Continued beyond 1 week of the disappearance of clinical manifestations TREATMENT
- 15. LICHEN PLANUS
- 16. delayed hypersensitivity reaction (immune response) Subepithelial band formed by T-lymphocytes & macrophages Cheek biting or traumatic/ frictional keratosis LICHEN PLANUS ETIOLOGY family of lesions with different etiologies Immune system Primary role in disease development Subepithelial band formed infiltrate dominated by T- Lymphocytes and macrophages Stress May establish the inflammatory process Autoreactive T lymphocytes
- 17. Striae may form a network but also show annular (circular) patterns Most frequently in the buccal mucosa bilaterally Can be seen in all regions of the oral mucosa Fine white lines or striae Remember: Network like lesions Reticular form CLINICAL FEATURES Types of Oral Lichen Planus Small hite dots, intermingle with the reticular form Papular type
- 18. present with reticular or papular lichen planus Smoker film like material at buccal mucosa Plaque type CLINICAL FEATURES : TYPES OF ORAL LICHEN PLANUS Homogenous red area Buccal mucosa or palate Erythematous (Atrophic) form
- 19. Most disabling form Sharp sensation in conjunction with food intake Ulcerative Lesions Clinical Features - flat-topped, pruritic erythematous to violaceous papules. May coalesce to form plaques Cutaneous lesions CLINICAL FEATURES : TYPES OF ORAL LICHEN PLANUS
- 20. Thickening of the granular cell layer Saw toothed appearance to the rete pegs Necrosis of the basal cell layer Just beneath the basement membrane and represent brin covering the lamina propria PIC: no acanthosis only hyperkeratosis Hyperkeratosis Liquefaction degeneration Eosinophilic band Dense subepithelial band shaped infiltrate of lymphocytes and macrophages HISTOPATH
- 21. White radiating striae sometimes resembling those of OLP The striae in DLE are more prominent, with a more marked hyperkeratinization,and the striae may abruptly terminate against a sharp demarcation Clinically resembles plaque like OLP however it does not have papular or reticular elements Discoid Lupus Erythematosus Homogenous oral Leukoplakia DIFFERENTIAL DIAG
- 22. Corticosteroids are the single most useful group of drugs in the management of lichen planus. Topical application and local injection of steroids TREATMENT Similar to erythematous OLP Pemphigoid lesions, the epithelium is easily detaches from the connective tissue by a probe or a gentle searing force (Nikolsky phenomenon) Biopsy Mucous Membrane pemphigoid
- 23. LEUKOPLAKIA
- 24. Unusual white lesions (1984) at lateral margins of tongue predominantly found in homosexual males Seen also in patients who are immunosuppressed Also found in some hematologic malignancies & also people who have been taking steroids for a long time ETIOLOGY
- 25. flat, plaque like, papillary like, corrugated lesion Unilateral or bilateral Irregular surface contour that is often folded, corrugated or papillary (hairy) Smooth and macular Lateral margins of the tongue No associated symptoms Suprainfection with candida albicans CLINICAL FEATURES
- 26. HISTOPATH Hyperparakeratotic Candida albicans hyphae Alterations of nuclear chromatin Presence of inflammatory cells Presence of EBV within the cells DIFFERENTIAL DIAGNOSIS: HAIRY LEUKOPLAKIA Idiopathic leukoplakia Lichen planus Chronic hyperplastic candidiasis Frictional hyperkeratosis TREATMENT: HAIRY LEUKOPLAKIA May be a pre- AIDS sign Within a return of lesions upon discontinuation Diagnosis Response to acyclovir treatment May amplify the lesion (reversibly) Topical Corticosteroid therapy
- 28. DEFINITION Also known as erythema migrans and benign migratory glossitis. More prevalent among whites and blacks than Mexican Americans and is strongly associated with fissured tongue. Emotional stress may enhance the process. has been associated, with several different conditions, including psoriasis, seborrheic dermatitis, Reiter’s syndrome, and atopy. ETIOLOGY Unknown cause.
- 29. CLINICAL FEATURES Affects women slightly more often than men. more prevalent in the young, in nonsmokers, and in allergic or atopic individuals. Children between infancy and 10 years of age may be affected in up to 18% of cases. Appears as red atrophic patches surrounded by hyperkeratotic (white) margins. Dorsum and lateral surfaces of the tongue are usually affected. Pattern changes with time. (Migratory glossitis) Usually asymptomatic, but may be slightly painful.
- 30. RIMBERIO CO HISTOPATHOLOGY Filiform papillae are atrophic, and the margins of the lesion demonstrate hyperkeratosis and acanthosis. Closer to the central portion of the lesion, corresponding to the circinate erythematous areas, loss of keratin is noted, along with intraepithelial neutrophils and lymphocytes. Leukocytes are often noted within a microabscess An inflammatory cell infiltrate within the underlying lamina propria, consisting chiefly of neutrophils, lymphocytes, and plasma cells, is seen.
- 31. RIMBERIO CO DIFFERENTIAL DIAGNOSIS Only rarely might a biopsy be required for a definitive diagnosis. candidiasis leukoplakia lichen planus lupus erythematosus. TREATMENT Treatment is not required Keep the mouth clean using a mouth rinse composed of sodium bicarbonate in water, a mucolytic that reduces the film present on the surface of the tongue.
- 32. Case study: Geographic tongue A 77 year old man and woman inflammatory disorder characterized by asymptomatic erythematous patches with serpiginous borders. associated with common cold, work, home stress. Topical tacrolimus
- 33. HAIRY TONGUE
- 34. DEFINITION Hairy tongue is a clinical term referring to a condition of filiform papillary overgrowth on the dorsal surface of the tongue of variable color. It is a relatively common, temporary, and harmless condition that occurs in as much as 13% of the population. ETIOLOGY Not well understood Initiating factors: - Use of broad spectrum antibiotics, systemic corticosteroids, hydrogen peroxide. - Intense smoking - Head and neck therapeutic radiation
- 35. CLINICAL FEATURES Asymptomatic hyperplasia of the filiform papillae, with concomitant retardation of the normal rate of desquamation. Thick, matted surface that serves to trap bacteria, fungi, cellular debris, and foreign material Gagging or tickling sensation may be felt when the elongation of the filiform papillae become exaggerated Color ranges from white to tan to deep brown or black.
- 36. RIMBERIO CO HISTOPATHOLOGY Presence of elongated filiform papillae over the dorsum of the tongue, with surface contamination by clusters of microorganisms and fungi. Keratinization may extend into the mid portion of stratum spinosum. The underlying lamina propria is generally mildly inflamed.
- 37. RIMBERIO CO DIAGNOSIS Biopsy is not necessary for confirmation. TREATMENT Reinforcement of oral hygiene lessen colored food. Brushing with a mixture of sodium bicarbonate (baking soda) in water or gentle once- daily scraping of the dorsum of the tongue may be benefi- cial. Little significance other than cosmetic appearance.
- 38. Clinical Case
- 40. WHAT IS THAT? Guess that zoomed in picture
- 41. Are you ready to play?
- 42. What am I?
- 43. Leukoplakia
- 45. Hairy tongue
- 46. I AM A COMMON OPPORTUNISTIC ORAL MYCOTIC INFECTION
- 47. Candidias
- 53. MATTHEW SY
- 54. THANK YOU!