This document discusses and describes various white and red lesions that may occur in the oral cavity. It covers hereditary lesions such as leukodema, white spongy nevus, and Darrier's disease. Reactive and inflammatory lesions including frictional keratosis, lichen planus, and actinic keratosis are described. Infectious lesions like oral hairy leukoplakia and candidiasis are also summarized. Potentially premalignant lesions including idiopathic leukoplakia and erythroplakia are defined. The document provides details on diagnosing and distinguishing between these various white and red lesions seen in the mouth.

1. WHITE & RED
LESIONS
:BY
DR. NAYROZ ABDEL-FATTAH

2. :White lesions may be
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Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

3. :Hereditary white lesions
1.
Leukodema
2.
White spongy nevus
3.
4.
Hereditary benign intraepithelial
dyskeratosis
Darrier’s disease

4. :Hereditary white lesions
Leukodema:



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Normal variation .
Faint , white ,
diffuse , numerous
folds .
Dissappears upon
stretching .
No treatment – no
malignant change .

7. :Hereditary white lesions
White spongy nevus:
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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.

12. :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.

13. :Hereditary white lesions
Darrier’s disease:
lesions start before age of 30 ys.- no treatment
1.

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
1.
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3.
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4.
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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

14. :Darrier’s disease

15. :White lesions may be
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Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

16. Reactive & Inflammatory white
: lesions
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Frictional keratosis
Cheek chewing
Chemical injuries
Actinic keratosis
Smokeless tobacco-induced keratosis
Stomatitis nicotine

17. Frictional keratosis


White plaque related
to source of
mechanical irritation.
Treatment : removal
of offending cause.

20. Cheek chewing



Chronic irritation
Mostly in people
under stress
No treatment , may
be plastic occlusal
night guard

23. (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

25. Aspirin burn

27. Actinic keratosis
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Premalignant
Due to long term sun
exposure
Vermillion border of
lower lip
Treatment : surgery

29. 



Smokless tobacco induced
keratosis
In the area of
tobacco contact
Precancerous
May be wrinkled or
folded
May be
Accompanied by
gingival recessetion&
perio-destruction

33. Stomatitis nicotina

36. :White lesions may be
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Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

37. :Infectious white lesions

Oral hairy leukoplakia
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Candidiasis

38. :Hairy Leukoplakia
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


By epstain barr virus.
In HIV patient.
Mainly on lateral
border or ventral
surface of the tongue
Treatment: antiviral
drugs.

41. :Oral candidosis
Acute


Acute
pseudomembranous
cand.(thrush)
Acute antibiotic stomatitis
(atrophic or
erythamatous)



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Chronic
Denture induced
stomatitis
Angular stomatitis
Median rhomboid
glossitis
Candidal leukoplakia (ch.
Hyperplastic)
Ch. Mucocutaneous
candidosis
Erythematous cand.

42. Acute pseudomembranous cand.
(thrush):



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Painless
Soft friable creamy
plaque
Easily wiped off
Prodrome : bad taste
or loss of sensation

47. :Lab. Investigation
Confirmation:
 Gm stained smear
shows candidal hyphae
 Biopsy: hyperplastic
epithelium,
inflammatory edema &
cells
 Staining with PAS
shows candidal hyphae

48. Acute antibiotic stomatitis (atrophic
(:or erythamatous



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Follow overuse of
antibiotics
The whole mucosa:
red & glazed
Flecks of thrush
Xerostomia (sjogren
syndrome)

49. :Denture induced stomatitis



Upper denture
Due to well fitting
denture cutting the
washing effect of
saliva
Painless red area

53. :Angular stomatitis



Leakage candidainfected saliva at
mouth angles
Low vertical
dimension &
loss of upper lip
support due to
underlying bone
resorption

55. Angular Cheilitis

56. :Median rhomboid glossitis


Red patch of atrophic
papillae
Central area of
dorsum of tongue

59. Chronic mucocutaneous
:candidosis


Defect in cell
mediated immunity or
iron deficiency
Candidosis
endocrinopathy
syndrome: familial
autosomal recessive

60. Chronic mucocutaneous candidiasis

61. Candidal leukoplakia (ch.
(:Hyperplastic



Firm white leathery
plaques
Cheek ,lip ,tongue
,palate
Invasion of candida
deeper in mucosa
leads to proliferative
response

62. Chronic hyperplastic candidiasis

63. :Erythematous candidiasis

Red macules

In HIV infection

Mainly on hard
palate , dorsum of
tongue ,soft palate

64. :White lesions may be






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Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

65. :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

66. :Idiopathic (true) leukoplakia
1.



Homogenous
Leukoplakia:
Well defined patch
Elevated ,fissured
,wrinkled
Palpation: leathery
or dry cracked mud
like

70. :Idiopathic (true) leukoplakia
2.



Speckled
Leukoplakia:
Mixed red & white
Keratotic nodules on
atrophic red base
High malignant
transformation

72. :Idiopathic (true) leukoplakia
3.

Verrocous
leukoplakia:
Thick with papillary
surface

Heavily keratinized

In older pt

74. :Idiopathic (true) leukoplakia
4.



Proliferative
Verrocous
leukoplakia:
Extensive papilary
plaque
Involve multiple
mucosal sites
Transform to sq. cell
carcinoma

76. :Diagnosis
Clinically:
 Cannot be stripped or rubbed off

Loss of elasticity (Stretching) & pliability
(bending)

77. :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

78. :White lesions may be
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
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Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

79. :Erythroplakia

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Red bright velvety
area
Tongue ,floor of
mouth , soft palate
,ant.tonsillar pillars
Asymptomatic
High malignant
transformation

81. :Erythroplakia

84. :White lesions may be
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Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

85. :Lichen Planus
1.
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Skin lesion :
pruritic, polygonal,
papules & plaque
2-4mm with angular
border, violaceous
color
Symmetrically
Flexor surfaces of
wrists, legs, trunk
Koebners
phenomenon

86. :Lichen Planus
2.
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Nail lesions:
In 10% of cases
Nail bed
discoloration
Lateral thinning
Complete loss of nail
matrix
Scarring of proximal
nail fold

87. (Lichen Planus (reticular

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Slightly elevated lines
“wickham’s striae”
Annular lesion
Eleveted papules
Large plaque
Asymptomatic –
roughness
Buccal mucosa,
dorsum of tongue,
gingiva

89. (Lichen planus (papular &reticular

92. Hypertrophic form

93. (Lichen Planus(atrophic
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

Inflammed areas of
oral mucosa
Covered by thinned
red epithelium
symptomatic

95. (Lichen Planus(erosive



Complication of
atrophic type
Thin epithelium
become abraded or
ulcerated
Symptomatic: mild
burning – severe pain

97. Erosive lichen Planus

98. (Lichen Planus(bullous

99. :Immunoflourescent


Shaggy band of
fibrinogen at B.M
zone
IgM in dermal papilla
in peribasal area

100. :Lichenoid reaction
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
L.P like lesions
Due to systemic drug
treatment

101. :White lesions may be
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


Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

102. 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


103. :Lupus erythematosus



Butterfly rash
Adherent scales on
removal, its
undersurface shows
horny plugs that
occupied dilated
sebaceous canals
Tin-tack sign

104. :Lupus erythematosus
S.L.E:
 Cutaneous erythema
especially on light
exposed areas
 Butterfly rash
 Facial edema
 Photosensitivity
 Chronic urticaria
 Non scaring alopecia

105. :Lupus erythematosus
Oral lesion:
 In 20% of SLE , more
common in DLE
 White striated,
atrophic or erosive
areas
 Variable patterns of
white & red areas

106. :White lesions may be








Hereditary
Reactive inflammatory
Infectious
Idiopathic leukoplakia
Erythroplakia
Lichen planus – lichenoid reaction
Lupus erythematosus
Miscellaneous

107. Miscellaneous
:Oral submucous fibrosis




Slowly progressive
chronic fibrotic disease
premalignant
Fibroelastic changes &
inflammation of mucosa
Inability to open mouth,
swallow, speak

108. :Oral submucous fibrosis


Fibrosis by proliferation
of fibroblasts, collagen
synthesis, decrease
collagenase production
Due to nutritional &
vitamin deficiency,
hypersensitivity to chili
pepper, chewing
tobacco

109. :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

110. Geographic tongue

111. Fordyce’s granules

112. Linea Alba