White lesions
White-appearing lesions of the oral mucosa, obtained their characteristic appearance from the scattering of light through an altered surface, e.g. such alterations may be the result of a thickened layer of keratin that may be due to:
- Chronic physical trauma.
- Mucocutaneous diseases.
- Tobacco use.
- Inflammatory reactions.
- Genetic abnormalities.
Colour of White lesions results from
- Hyperkeratosis (thickened layer of keratin )
- Acanthosis (epithelial hyperplasia as the thickened spinous layers masks the normal vascularity (redness).
- Intracellular epithelial edema
- Reduced vascularity of subjacent connective tissue
- Fibrous exudate covering an:
- ulcer
- Submucosal deposits
- fungal colonies
- surface debris
Geographic Tongue
- Also known as erythema migrans, benign migratory glossitis
- Prevalent among whites + blacks
- Strongly associated with fissure tongue
- Inversely associated with cigarette smoking
Geographic Tongue
Emotional stress may enhance the process.
Clinical Features
- Affects women slightly more than men.
- Children occasionally may be affected.
- Characterized initially by presence of atrophic patches surrounded by elevated keratotic margins.
- Desquamated areas appear red + may be slightly tender.
- Followed over a period of days or weeks, pattern changes.
- Appearing to move across dorsum of tongue.
- Most patients are asymptomatic
- Occasionally patients complain of irritation or tenderness
- Especially in relation to consumption of spicy foods + alcoholic beverages
- Lesions periodically disappear
- Recur for no apparent reason.
Treatment
NO treatment is required because of self-limiting + usually asymptomatic nature of this condition.
when symptoms occur,
# Topical steroids especially ones containing antifungal agent .
# Helpful in reducing symptoms.
# Mouth clean using mouthrinse composed of sodium bicarbonate in water.
# Reassure patients that condition is totally benign.
Lichen Planus
Pathogenesis
- Although cause is unknown.
- Generally considered to be a immunologically mediated process.
- Resembles hypersensitivity reaction.
Clinical Features
- Disease of middle age.
- Affects men + women in nearly equal numbers.
- Children rarely affected.
Types:
Reticular
Erosive (ulcerative).
Plaque • Papular.
Erythematous (atrophic).
Reticular Form
Most common type:
Numerous interlacing white keratotic lines or striae (Wickham’s striae).
Produces anular or lacy pattern.
Buccal mucosa is the site most commonly involved.
May also be noted on:
Tongue.
Gingiva – less common.
Lips.
Plaque Form
Resembles leukoplakia.
But has multifocal distribution.
Range from slightly elevated to smooth and flat.
primary site are :
Dorsum of tongue.
Buccal mucosa.
Erythematous Form
- Red patches.
- With very fine white striae.
- Attached gingiva commonly involved.
- Patchy distribution often in four quadrants.
- Patient may complain of:
- Burning.
- Generalized discomfort.
Treatment
Although it cannot be generally cured
Some drugs can provide satisfactory control
Corticosteroids are the single most useful group of drugs in the management of lichen planus
corticosteroid
Ability to modulate inflammation + immune response.
Treatment
Topical application + local injection of steroids have been used successfully in controlling but not curing this disease
Lupus Erythematosus
Discoid Lupus Erythematosus:
- The oral lesions can occur in the absence of skin lesions, but there is a strong association between the two. As the lesions expand peripherally, there is central atrophy, scar formation, and occasional loss of surface pigmentation.
- The primary locations for these lesions include the buccal mucosa, palate, tongue, and vermilion border of the lips.
Discoid Lupus Erythematosus
Differential diagnosis:
- Reticular or erosive lichen planus. Unlike lichen planus, the distribution of DLE lesions is usually asymmetric, and the peripheral striae are much more subtle.
- Leukoplakia: the diagnosis must be based not only on the clinical appearance of the lesions but also on the coexistence of skin lesiqps and on the results of pand direct histologic immunofluorescence testing. examination.
Systemic lupus Erythematosus
- The lesions are frequently symptomatic, often consist of one or more of the following erythema, surface ulceration, components: keratotic plaques, and white striae or papules.
- They typically respond well to topical or systemic steroids. Clobetasol (a potent topical steroid) placed under an occlusive tray is very effective for temporary relief of these lesions.
