White lesions

WHITE LESIONS
Collected and arranged by

Ahmed Samy El Nashar
BDS of oral surgery , tanta university
Dr. Ahmed E-lNashar(2014)

COLOR OF NORMAL MUCOSA !!!!!
PALE PINK


COLOR OF NORMAL MUCOSA !!!!!


WHITE LESIONS !!!!!
Mucosa
appear
white in
color


WHITE LESIONS !!!!!


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.


Reactive
Hereditary
Immune
Infection
Precancerous

Reactive
Infection
hereditary

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


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


Hyperkeratosis & hyperparakeratosis.
thickening of granular cell layer
acanthosis.
few chronic inflammatory cells may be
seen.


NICOTINIC STOMATITIS
= smoker’s palate

+

Sex

♂> ♀.

Site

palate.


diffuse palatal keratosis with red dots may be surrounded by elevated white rings.
Clinical course ……….
-erythematosus area  opacification  diffuse palatal keratosis umblicated red
dots.


Epithelial Hyperpslasia
Excretory ducts of minor SG
show Sq. metaplasia
Acinar atrophy
Chronic inflammatory cells.
Scar


WHITE SPONGY NEVUS
= familial white folded gingivostomatitis


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


Bilateral symetrical
The mucosa appears
 thickened
 folded or corrugated
 spongy texture and
 a peculiar white opalescent hue.


Hyperparakeratosis.
Acanthosis.
hydropic degeneration

fail to take any stain.
intracellular edema)
 show pyknotic nuclei

(basket weave appearance)
mild inflammatory cell infiltration


Acanthosis

Hyropic degeneration


HAIRY LEUKOPLAKIA
80% of AIDS patient


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.


hyperparakeratosis
epithelial hyperplasia
ballooning degeneration
koilocytosis
Candida albicans


LICHEN PLANUS

Most common dermatologic disease w affect oral cavity
primitive plants w resembles FLAT
algae


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.


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.


•Oral lesions of lichen planus has 4 different forms …….

ORAL LESIONS OF LICHEN PLANUS
4 FORMS

2 WHITE

2 RED

Reticular hypertrophic Atrophic


Erosive

1. Reticular lichen planus
•Most common type.
•White thread-like papules
•reticular patches or rings.
•" striae of wickham "


2. Hypertophic lichen planus
•well circumscribed
elevated white lesion.
•Resmbles frictional
keratosis & leukoplakia.
•Biopsy is necessary


3.Atrophic lichen planus
•Most poorly defined
red areas may show the
peripheral striae. "


4.Erosive lichen planus
•raw painful ulcerated
areas .
•radiating striae on
periphery


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.


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.


Histopathology of SKIN Lichen Planus


Histopathology of ORAL Lichen Planus


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


acanthotic epithelium
flattened and show pyknotic nuclei
Cells of stratum spinosum are enlarged
not infiltrated with inflammatory cells.


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


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.


Any age gp
common in debilitating infant
Any where oral cavity

localized to oral mucosa
may extend to pharynx or lungs


soft, white, elevated plaques resembles milk

cruds.

can be wiped off leaving raw, painful bleeding surface.


LABORATORY FINDING

Macerated e 20% KOH

Candidal plaque
Stained e PAS

Candidal hyphae

blood agar , cornmeal agar or sabauroud's broth

HISTOPATHOLOGY


HISTOPATHOLOGY
Candidal Hyphae in superficial layer of epith.
PNLS in epith.
Superficail microabscess.


TEATMENT
Stoppage of antibiotics
Stoppage of cortisone
Anti fungal


CHEMICAL BURN


White lesions

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