Upload
anhar-al-gebaly
View
4.215
Download
5
Embed Size (px)
Citation preview
WHITEWHITE && REDRED LESIONSLESIONS
BYBY: :
DR. NAYROZ ABDEL-FATTAHDR. NAYROZ ABDEL-FATTAH
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
Hereditary white lesionsHereditary white lesions::
1.1. LeukodemaLeukodema
2.2. White spongy nevusWhite spongy nevus
3.3. Hereditary benign intraepithelial Hereditary benign intraepithelial dyskeratosisdyskeratosis
4.4. Darrier’s diseaseDarrier’s disease
Hereditary white lesionsHereditary white lesions::
Leukodema:Leukodema: Normal variation .Normal variation . Faint , white , Faint , white ,
diffuse , diffuse , numerous folds .numerous folds .
Dissappears upon Dissappears upon stretching .stretching .
No treatment – no No treatment – no malignant change malignant change ..
Hereditary white lesionsHereditary white lesions::
White spongy nevus:White spongy nevus: Oral mucosa – m.m of nose Oral mucosa – m.m of nose
, esophagus , rectum ., esophagus , rectum . At birth or at puberty.At birth or at puberty. Bilateral symmetric.Bilateral symmetric. White soft spongy or thick White soft spongy or thick
plaque.plaque. Buccal mucosa.Buccal mucosa. May be on ventral surfase May be on ventral surfase
of tongue,floor of of tongue,floor of mouth,labial mucosa,soft mouth,labial mucosa,soft palate,alveolar mucosa.palate,alveolar mucosa.
Asymptomatic – no Asymptomatic – no malignant transformation.malignant transformation.
HereditaryHereditary white lesions white lesions::
Hereditary benign intraepithelial Hereditary benign intraepithelial dyskeratosis:dyskeratosis:
1.1. Oral lesions: Oral lesions: thick ,corrugated ,asymptomatic thick ,corrugated ,asymptomatic white spongy plaques on buccal & labial m. white spongy plaques on buccal & labial m. Appears in 1Appears in 1stst year of life &gradually increase till year of life &gradually increase till teens – no treatment.teens – no treatment.
2.2. Eye lesions:Eye lesions: thick gelatinous foamy opaque thick gelatinous foamy opaque plaque adjacent to cornea – seasonal prominance plaque adjacent to cornea – seasonal prominance in spring & regression in summer – blindness – in spring & regression in summer – blindness – referral to ophthalmologist.referral to ophthalmologist.
HereditaryHereditary white lesions white lesions::
Darrier’s disease:Darrier’s disease:lesions start before age of 30 ys.- no treatment lesions start before age of 30 ys.- no treatment 1.1. Skin lesionsSkin lesions: : firm papules skin coloured ,yellow-brown, brown.firm papules skin coloured ,yellow-brown, brown. Coalescence of papules forms warty plaques.Coalescence of papules forms warty plaques. Found on scalp margins ,forehead, ears & nasolabial furrows.Found on scalp margins ,forehead, ears & nasolabial furrows.1.1. Oral lesions: Oral lesions: white papules on palate ,tongue ,buccal mucosa ,epiglottis ,pharyngeal wall white papules on palate ,tongue ,buccal mucosa ,epiglottis ,pharyngeal wall coalescence of papules forms patches similar to leukoplakia.coalescence of papules forms patches similar to leukoplakia.3.3. Nail lesions:Nail lesions: Broad white longitudinal bandBroad white longitudinal band Broad red longitudinal bandBroad red longitudinal band Sandwich of both with v-shaped nick at free marginSandwich of both with v-shaped nick at free margin4.4. Ear lesions: Ear lesions: Blockage of external auditory meatus by keratotic debrisBlockage of external auditory meatus by keratotic debris
Darrier’s diseaseDarrier’s disease::
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
Reactive & Inflammatory Reactive & Inflammatory white lesionswhite lesions : :
Frictional keratosisFrictional keratosis Cheek chewingCheek chewing Chemical injuriesChemical injuries Actinic keratosisActinic keratosis Smokeless tobacco-induced keratosisSmokeless tobacco-induced keratosis Stomatitis nicotineStomatitis nicotine
Frictional keratosisFrictional keratosis
White plaque White plaque related to source of related to source of mechanical mechanical irritation.irritation.
Treatment : Treatment : removal of removal of offending cause.offending cause.
Cheek chewingCheek chewing
Chronic irritationChronic irritation Mostly in people Mostly in people
under stressunder stress No treatment , may No treatment , may
be plastic occlusal be plastic occlusal night guardnight guard
Chemical burn (phenol)Chemical burn (phenol)
Transient Transient nonkeratotic lesion nonkeratotic lesion
due to caustic as due to caustic as formcresol, acid formcresol, acid etchant, hydrogen etchant, hydrogen perioxide, perioxide, asprin ,sodium asprin ,sodium hypochloritehypochlorite
Emollient agent as Emollient agent as methyl cellulose for methyl cellulose for treatmenttreatment
Aspirin burnAspirin burn
Actinic keratosisActinic keratosis
PremalignantPremalignant Due to long term Due to long term
sun exposuresun exposure Vermillion border Vermillion border
of lower lipof lower lip Treatment : Treatment :
surgerysurgery
Smokless tobacco induced Smokless tobacco induced keratosiskeratosis
In the area of In the area of tobacco contacttobacco contact
PrecancerousPrecancerous
May be wrinkled or May be wrinkled or foldedfolded
May be May be Accompanied by Accompanied by gingival gingival recessetion& perio-recessetion& perio-destructiondestruction
Stomatitis nicotinaStomatitis nicotina
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
Infectious white lesionsInfectious white lesions::
Oral hairy leukoplakiaOral hairy leukoplakia
Candidiasis Candidiasis
Hairy LeukoplakiaHairy Leukoplakia::
By epstain barr By epstain barr virus.virus.
In HIV patient.In HIV patient. Mainly on lateral Mainly on lateral
border or ventral border or ventral surface of the surface of the tonguetongue
Treatment: Treatment: antiviral drugs.antiviral drugs.
Oral candidosisOral candidosis::
Acute Acute Acute Acute
pseudomembranous pseudomembranous cand.(thrush)cand.(thrush)
Acute antibiotic Acute antibiotic stomatitis (atrophic or stomatitis (atrophic or erythamatous)erythamatous)
Chronic Chronic Denture induced Denture induced
stomatitisstomatitis Angular stomatitisAngular stomatitis Median rhomboid Median rhomboid
glossitisglossitis Candidal leukoplakia Candidal leukoplakia
(ch. Hyperplastic)(ch. Hyperplastic) Ch. Mucocutaneous Ch. Mucocutaneous
candidosiscandidosis Erythematous cand.Erythematous cand.
Acute pseudomembranous Acute pseudomembranous cand.(thrush):cand.(thrush):
PainlessPainless Soft friable creamy Soft friable creamy
plaqueplaque Easily wiped offEasily wiped off Prodrome : bad Prodrome : bad
taste or loss of taste or loss of sensationsensation
Lab. InvestigationLab. Investigation: :
Confirmation:Confirmation: Gm stained smear Gm stained smear
shows candidal shows candidal hyphaehyphae
Biopsy: hyperplastic Biopsy: hyperplastic epithelium, epithelium, inflammatory edema inflammatory edema & cells& cells
Staining with PAS Staining with PAS shows candidal shows candidal hyphaehyphae
Acute antibiotic stomatitis Acute antibiotic stomatitis (atrophic or erythamatous)(atrophic or erythamatous)::
Follow overuse of Follow overuse of antibioticsantibiotics
The whole mucosa: The whole mucosa: red & glazedred & glazed
Flecks of thrush Flecks of thrush Xerostomia Xerostomia
(sjogren syndrome) (sjogren syndrome)
Denture induced stomatitisDenture induced stomatitis::
Upper dentureUpper denture
Due to well fitting Due to well fitting denture cutting the denture cutting the washing effect of washing effect of salivasaliva
Painless Painless red areared area
Angular stomatitisAngular stomatitis::
Leakage candida-Leakage candida-infected saliva at infected saliva at mouth anglesmouth angles
Low vertical Low vertical dimension & dimension &
loss of upper lip loss of upper lip support due to support due to underlying bone underlying bone resorptionresorption
Angular Cheilitis
Median rhomboid glossitisMedian rhomboid glossitis::
Red patch Red patch of of atrophic papillaeatrophic papillae
Central area of Central area of
dorsum of tonguedorsum of tongue
Chronic mucocutaneous Chronic mucocutaneous candidosiscandidosis::
Defect in cell Defect in cell mediated immunity mediated immunity or iron deficiencyor iron deficiency
Candidosis Candidosis endocrinopathy endocrinopathy syndrome: familial syndrome: familial autosomal autosomal recessive recessive
Chronic mucocutaneous candidiasis
Candidal leukoplakia (ch. Candidal leukoplakia (ch. Hyperplastic)Hyperplastic)::
Firm white Firm white leathery leathery plaquesplaques
Cheek ,lip ,tongue ,Cheek ,lip ,tongue ,palate palate
Invasion of candida Invasion of candida deeper in mucosa deeper in mucosa leads to leads to proliferative proliferative response response
Chronic hyperplastic candidiasis
Erythematous candidiasisErythematous candidiasis::
Red maculesRed macules
In HIV infectionIn HIV infection
Mainly on hard Mainly on hard palate , dorsum of palate , dorsum of tongue ,soft palatetongue ,soft palate
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
Idiopathic (true) leukoplakiaIdiopathic (true) leukoplakia::
White patch or White patch or plaqueplaque
Can’t be clinically or Can’t be clinically or pathologicaly any pathologicaly any other diseaseother disease
PremalignantPremalignant Etiologic factors: Etiologic factors:
tobacco ,alcohol ,catobacco ,alcohol ,candida ,electrogalvanindida ,electrogalvanic react.c react.
mostly on buccal mostly on buccal mucosa ,lower mucosa ,lower lip ,gingiva.lip ,gingiva.
Less common on Less common on palate, retromolar palate, retromolar area ,floor of mouth & area ,floor of mouth & tonguetongue
90% of dysplasia in 90% of dysplasia in tongue & floor of tongue & floor of mouth lesionsmouth lesions
Idiopathic (true) Idiopathic (true) leukoplakialeukoplakia::
1.1. Homogenous Homogenous Leukoplakia:Leukoplakia:
Well defined patchWell defined patch Elevated ,fissured Elevated ,fissured
,wrinkled ,wrinkled Palpation: Palpation:
leathery or dry leathery or dry cracked mud like cracked mud like
Idiopathic (true) Idiopathic (true) leukoplakialeukoplakia::
2.2. Speckled Speckled Leukoplakia:Leukoplakia:
Mixed red & whiteMixed red & white Keratotic nodules Keratotic nodules
on atrophic red on atrophic red basebase
High malignant High malignant transformationtransformation
Idiopathic (true) Idiopathic (true) leukoplakialeukoplakia::
3.3. Verrocous Verrocous leukoplakia:leukoplakia:
Thick with Thick with papillary surfacepapillary surface
Heavily keratinizedHeavily keratinized
In older ptIn older pt
Idiopathic (true) Idiopathic (true) leukoplakialeukoplakia::
4.4. Proliferative Proliferative Verrocous Verrocous leukoplakia:leukoplakia:
Extensive papilary Extensive papilary plaqueplaque
Involve multiple Involve multiple mucosal sitesmucosal sites
Transform to sq. Transform to sq. cell carcinomacell carcinoma
DiagnosisDiagnosis: :
Clinically:Clinically: CanCannotnot be stripped or rubbed off be stripped or rubbed off
LossLoss of elasticity (Stretching) & of elasticity (Stretching) & pliability (bending)pliability (bending)
DiagnosisDiagnosis: :
Tissue BiopsyTissue Biopsy Toluidine blue stainingToluidine blue staining: stain : stain
dysplastic & malignant cells , resist dysplastic & malignant cells , resist washing awaywashing away
Cytobrush techniqueCytobrush technique: firm bristle : firm bristle brush to obtain cells from full brush to obtain cells from full thickness of epith. For cytologic thickness of epith. For cytologic examination examination
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
ErythroplakiaErythroplakia::
Red bright velvety Red bright velvety areaarea
Tongue ,floor of Tongue ,floor of mouth , soft mouth , soft palate ,ant.tonsillar palate ,ant.tonsillar pillarspillars
AsymptomaticAsymptomatic High malignant High malignant
transformationtransformation
ErythroplakiaErythroplakia::
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
Lichen PlanusLichen Planus::
1.1. Skin lesionSkin lesion:: pruritic, polygonal, pruritic, polygonal,
papules & plaquepapules & plaque 2-4mm with 2-4mm with
angular border, angular border, violaceous colorviolaceous color
SymmetricallySymmetrically Flexor surfaces of Flexor surfaces of
wrists, legs, trunkwrists, legs, trunk Koebners Koebners
phenomenonphenomenon
Lichen PlanusLichen Planus::
2.2. Nail lesions:Nail lesions: In 10% of casesIn 10% of cases Nail bed Nail bed
discolorationdiscoloration Lateral thinningLateral thinning Complete loss of Complete loss of
nail matrixnail matrix Scarring of Scarring of
proximal nail foldproximal nail fold
Lichen Planus (Lichen Planus (reticularreticular))
Slightly elevated lines Slightly elevated lines “wickham’s striae”“wickham’s striae”
Annular lesionAnnular lesion Eleveted papulesEleveted papules Large plaqueLarge plaque Asymptomatic – Asymptomatic –
roughnessroughness Buccal mucosa, Buccal mucosa,
dorsum of tongue, dorsum of tongue, gingiva gingiva
Lichen planusLichen planus ((papular &reticularpapular &reticular))
Hypertrophic form
Lichen Planus(Lichen Planus(atrophicatrophic))
Inflammed areas of Inflammed areas of oral mucosaoral mucosa
Covered by thinned Covered by thinned red epitheliumred epithelium
symptomaticsymptomatic
Lichen Planus(Lichen Planus(erosiveerosive))
Complication of Complication of atrophic typeatrophic type
Thin epithelium Thin epithelium become abraded or become abraded or ulceratedulcerated
Symptomatic: mild Symptomatic: mild burning – severe burning – severe painpain
Erosive lichen Planus
Lichen Planus(Lichen Planus(bullousbullous))
ImmunoflourescentImmunoflourescent::
Shaggy band of Shaggy band of fibrinogen at B.M fibrinogen at B.M zonezone
IgM in dermal IgM in dermal papilla in peribasal papilla in peribasal areaarea
Lichenoid reactionLichenoid reaction::
L.P like lesionsL.P like lesions
Due to systemic Due to systemic drug treatmentdrug treatment
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
Lupus erythematosus:Lupus erythematosus:
Autoimmune C.T Autoimmune C.T diseasedisease
Forms:Forms:1.1. Discoid (DLE)Discoid (DLE)2.2. Systemic (SLE)Systemic (SLE)D.L.ED.L.E: : cheeks, nose bridge, cheeks, nose bridge,
ears, side of neck & ears, side of neck & scalp scalp
Bilaterally not Bilaterally not necessarily necessarily symmetricalsymmetrical
Lupus erythematosusLupus erythematosus::
Butterfly rashButterfly rash Adherent scales on Adherent scales on
removal, its removal, its undersurface undersurface shows horny plugs shows horny plugs that occupied that occupied dilated sebaceous dilated sebaceous canalscanals
Tin-tack signTin-tack sign
Lupus erythematosusLupus erythematosus::
S.L.E:S.L.E: Cutaneous erythema Cutaneous erythema
especially on light especially on light exposed areasexposed areas
Butterfly rash Butterfly rash Facial edema Facial edema PhotosensitivityPhotosensitivity Chronic urticariaChronic urticaria Non scaring alopeciaNon scaring alopecia
Lupus erythematosusLupus erythematosus::
Oral lesion:Oral lesion: In 20% of SLE , more In 20% of SLE , more
common in DLEcommon in DLE White striated, White striated,
atrophic or erosive atrophic or erosive areasareas
Variable patterns of Variable patterns of white & red areas white & red areas
White lesions White lesions may bemay be::
HereditaryHereditary Reactive \ inflammatoryReactive \ inflammatory Infectious Infectious Idiopathic leukoplakia Idiopathic leukoplakia ErythroplakiaErythroplakia Lichen planus – lichenoid reaction Lichen planus – lichenoid reaction Lupus erythematosusLupus erythematosus MiscellaneousMiscellaneous
MiscellaneousMiscellaneousOral submucous fibrosisOral submucous fibrosis::
Slowly progressive Slowly progressive chronic fibrotic chronic fibrotic diseasedisease
premalignantpremalignant Fibroelastic changes Fibroelastic changes
& inflammation of & inflammation of mucosamucosa
Inability to open Inability to open mouth, swallow, mouth, swallow, speakspeak
Oral submucous fibrosisOral submucous fibrosis::
Fibrosis by Fibrosis by proliferation of proliferation of fibroblasts, collagen fibroblasts, collagen synthesis, decrease synthesis, decrease collagenase collagenase productionproduction
Due to nutritional & Due to nutritional & vitamin deficiency, vitamin deficiency, hypersensitivity to hypersensitivity to chili pepper, chili pepper, chewing tobacco chewing tobacco
Oral submucous fibrosisOral submucous fibrosis::
Clinically:Clinically: Burning sensationBurning sensation Vesicles & ulcerationVesicles & ulceration Excessive salivation or xerostomiaExcessive salivation or xerostomia Altered taste sensationAltered taste sensation Stiffness of mucosaStiffness of mucosa Mucosa is blanched & opaqueMucosa is blanched & opaque Buccal mucosa, soft palate, pharynx, Buccal mucosa, soft palate, pharynx,
lip, tongue lip, tongue
Geographic tongueGeographic tongue
FordyceFordyce’’s granuless granules
Linea Alba Linea Alba