white lesions

Dr. Ahmed E-lNashar(2014)

WHITE LESIONS

Collected and arranged by

Ahmed Samy El NasharBDS of oral surgery , tanta university

COLOR OF NORMAL MUCOSA !!!!!

PALE PINK

COLOR OF NORMAL MUCOSA !!!!!

WHITE LESIONS !!!!!

Mucosa appear white in color ?

WHITE LESIONS !!!!!

1) Keratotic

1. Frictional keratosis. 2. Nicotinic stomatitis Reactive

3. White spongy nevus Hereditary4. Lichen planus Immune5. Hairy leukoplakia Infection6. Leukoplakia. 7. Candidal lukoplakia. 8. DLS

Precancerous

2) Non keratotic1. Burns Reactive2. candidosis( Moniliasis, thrush) Infection3. leukodema. hereditary

Classification of WHITE LESIONS !!!!!

FRICTIONAL KERATOSISprotective action of mucosa against low-grade long-term trauma (friction)

Age 5th & 6th decades of life

(average 48 years).

Sex ♂ > (2:1)♀

Site cheek, lip, palate, floor of

the mouth and tongue

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

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

Epithelial HyperpslasiaExcretory ducts of minor SG

show Sq. metaplasiaAcinar atrophyChronic inflammatory cells.Scar

WHITE SPONGY NEVUS= familial white folded gingivostomatitis

Age at birth .

Oral mucosaBuccal mucosa, tongue & may occur also in the oesophagous,

Rectal mucosa Vaginal mucosa

Bilateral symetricalThe 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

hyperkeratosis

Acanthosis

Hyropic degeneration

HAIRY LEUKOPLAKIA80% 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 PLANUSLICHEN PLANUSLICHEN PLANUS

primitive plants w resembles algaeFLAT

Most common dermatologic disease w affect oral cavity

ETIOLOGY AND PATHOGENESIS

2. considered as an autoimmune disease

1. Psychosomatic originnervous exhaustion

Anexity syndrome

mediated by T-lymphocytes + Plamsma cell + Langerhans cell

against epithelial basal cells.

Age adultSex ♀ > ♂Site gingiva, cheek, lips, tongue and palate.

Clinical course

Undergo periods of remission followed by exacerbation emotional strain , overwork , anxiety , traumatism ,malnutrition.

CLINICAL FEATURES OF ORAL LESIONSOral lesions often precedes skin lesions and may be the only one

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

ORAL LESIONS OF LICHEN PLANUS4 FORMS

2 WHITE 2 RED

ErosiveAtrophicReticular hypertrophic

ORAL LESIONS OF LICHEN PLANUS

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 LESIONSany 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 LESIONS1ry symptom pruritis. Small papules , which is …

1.flat topped.2.center may be umblicated.3."Whickham's striae ".4.COLOR : red -> purple -> brownish5.large plaques covered by glistening scale.

Histopathology of SKIN Lichen Planus

Histopathology of ORAL Lichen Planus

LEUKOEDEMArace Blacks > whitessite Buccal

bilateral white lesion w disappears e stretching

in early stages filmy opalescent mucosa in later stageswhite cast e coarse corrugated surface

acanthotic epitheliumflattened and show pyknotic nucleiCells of stratum spinosum are enlargednot infiltrated with inflammatory cells.

CANDIDIASIS= Moniliasis = Thrush

Most opportunistic infection in the world

common inhabitant of oral cavity, GIT and vagina exists in a competitive symbiotic relation e bacterial flora.under certain circumstances play a pathologic

It is fungal disease caused by Candida albicans

?Extensive use of antibiotic

immuno-suppressive drugs

chronic diseases

Mucocutaneous1. oral or oropharyngeal candidosis (thrush)2. candidal oesophagitis3. intestinal candidosis4. candidal vaginitis.

Systemic1. Eyes2. kidneys3. skin through hematogenous spread4. visceral organs may be involved.

Classification of CANDIDASIS

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.

Candidal plaque Macerated e 20% KOH

Stained e PAS

Candidal hyphae

blood agar , cornmeal agar or sabauroud's broth

LABORATORY FINDING

HISTOPATHOLOGY

Candidal Hyphae in superficial layer of epith.

Superficail microabscess.

PNLS in epith.

TEATMENT

Anti fungal

Stoppage of antibiotics

Stoppage of cortisone

CHEMICAL BURN

white lesions

chemical burn

lichen planus

oral lesions

white lesions

normal mucosa

clinical features

white

mucosa

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