Atlas Oral Medicine (1)

8/6/2019 Atlas Oral Medicine (1)

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3/97

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4/97

The d B e i pli ne uf oral 'm,edi ,CAlne i J , ; , 00 nccrned \,\> i~h Ihel[,ydy :a~d nen-s ul[g;i:ca I I t rear n.h;rn!~af~d~~~3se_~:f:(e;(lin,g[[he'oral C3 ' \ m ly and :rc[~![~ldSU'U( "E:ur~ " A l ! h J l , ' : H ! , g h mlin,)' f onms, of d isea se a rein c l ud e d in th jl~'~I ide re m i ~the predu m runan ' tWlnl!en!SIl is in les ions of dO leom I,m a co u s rn em h ru n ea n d t h ese fo ~m I h e ba sis ,o f m~o; ; l ,ef ' [h.e i , U ' U ' S 1 foil[ i ons iII ' l l h i5 a t~a s ,Or,a: .1medic ine ha s in fe(cn~' ye3JS, changed 'Erol l1Flan a lmost le[lI~~reJyc'S.cJlplive sl, lJd)f 110onel i I 'El 'wh,.~chn~'cs[ji,s~tiorDl[i!roeedures are t)r.gn~:a;~mPQrta;ncc~ \ \" W I [ lh . ' this, c lhange ' hascome , [~OOig~nition that d~e ' abl lorm! i l i~u ie 's !ri~sld!i~g fro~l ' m a l i1 i J Yg~nG' i i i , ~ ' l iS iCdl s e a s e 'Pcoc.~ss:es are H r . s ~ e e i I T i. . 'I '~ ,h io ~,hcoral ca,, , ,d l~ and li:bal[earll)' di,a~nrurus,miIU lY foUorw 0:1'1 from a recogin;r f ruon of rh e ortil,~le~io.ns- ' II W , must be emphasised, however, ~b1i ,~::i ,im1p~t; visual reoog~iiio:n o r the oral m,u!Oowie$i ,rJ:Dsm , a . y no' [ be s~ff id:e n~to pm~ide a di~g;no~~_~nH l . a m y i iDl l l,[am(~:s.,A var te ty oil' itm\~'e5~ip-~~o," , :Ja1~ \C l i JJ~q u es is, a ppl i l ie l l i hi, f " l lJrthe r '! i:t ud ; o f tth ese p awm e u m s , . 'mM~ ' i , m jpt1ir[an:t: b e i n g , the b'i;opsy ~Oral rnueusal aiepsies are simple '[0 pe'r IOJWi ,tI lf 'Ed are ofteili1~ui~Jeesseatial In 0 raining a ,deHn i~,i~'~i j :l g 1 n '1 O ' S c i,o f ma mw y0 _:lh ~ Icorid - ~ jO",S. r uIIu c 5 l : F 3 i h = d i n 1 m i r S 3 ~ l as ,Th e term s fo m!IIi,o n ly u sed im d~ I [U : la~ :o l ; ij ) g~ "o desc r ibe les ii ons , (fo,.r instance, maeule, 1 P \ 3 J i J 1 i 1 ! ~ t e ) 1r na "" , be used to describe' o~1 lesions, HIl,'"e~l~r"lu~e~useQ' (he mod.eel. nature ,g.fU'H;~] rg'~,io:P'Iin[he ( ) I D " . i J I m , I l 1 L O O 1 1 l 1 le r u b r a n e s . . such t e l l l l T I J i : n o h l C Y ' i s ,much r u f: 'S~ \ \ ~ i,de~y3.pplied- The modJlical~oli)0" Of~ I le ion s "~ h h: lw fiU!i i iay :m ake mcm dHfk iU I t '[0 reeegaise 'whe'w. c on rpa red to t tqu i\ ,t a te rn s -I lim)lesions depen ds ma,rgely on lfue nature of the oral 'en v a l _ onment, Freq ueru ~ }~ "be W : ll i~ i a ] form ofthe le S [On : 1 5 , UlU ide ' f l L i n r e c o , g i l I D i , 5 4 1 t be by rhc rom b i n e d effeet 0 ' r e p e a t e d ~ ra usn a ~ '~ !le cent in lu t l iprest: nee of ~ ~ru l l , i IJ ,a n J d the in ''{an.!8JbIe seeond a ry infe erion wf~r ic l1-;~ff~ls ever,' o ra l h~ '5 k ulIJ ,.The ' f i . I l i I ! ~ I r e51 l1 1 [ o,f~he-c f~CIJ()rs is o f ten thcreplaeemeet of 3In eia.Sii~),de n~~lab'le p:ri[IlJlillJr~'Iesioaby a. nom~SipeJdfic u Icc ' rn"a~mon11Ii s r n s ,pl icula r l y true ef b~is'[em"inlmes[ons 'w'hleh i H 1 1 , 1 , y O C C ur ,j rn[~ bc e' o u th ,_ the detached Om ' sp l i t epithe~j um , . is w n i ~ f f i f i , n . y fr.~gn~a n d j n 'h:envi ro 11n1 e r n 0 '_ Uleora[ l l1:i tvim:y th!l! blisters r . a p : i d ~ ~ ' brea ~,dowu 1[0praduee ewos'iOM HII.d ulcers, ('se'e'f i : g u F e s : a '1b~I['.)~ r n : W 5[ ) , f r , e 1 l l 1 ness iH' ' ,Y!O a,'~,3i i [ n e w and e~lil:y lesions before eomwng t(Ji even ill I le :n~~ t i,~e d iagnos isin so me' o 'f ~lnesecond~tion:s~


5/97

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In . th isa tla s an al~eII I pl ha s been made to i'l[tJjS'!r~teth~ miO' fe oomiJ1o n oral so ( f t : ' ( i R 5 u e : ~es/OASas . ' ~ ' r u l l as I i ' , ~ r i . ~ : r u e s ~ , " num leer II the conditions i~~i i l1s'[ra~e , l i i ifl.aJY I~ppe:lii in , . ~ride r; ,Ui l I i IC'ofcIiln[a ~ vari 3 n~s,t Iiehe Iii! p ll n!Di lS js a lood eM iLm ple Ic'f ' ~ h m s . ) and w n r .n e S ie ' i :mS:la~lu.,;es,,a n anempt hasbeen rm.ilcle1[0' . i lUust13t1e the cDm:ple~eMnge of \ la lH.3nt 'S,_ :Hi.stc~ltog~ca.~,ec(iollI5 h a \ - 1 1 e been[m'[liodu.cedoliii ly when ' f : IJ . ! ce~a;ry ' lo UluSb,a ' [ , lb~giC'~atures ireft~c'lill"gon ~heeliaieal be''1;~a'iJiogfof the IQ i ';ndi,~~ofl'd~criib'Cd."he o r u e r 6_' t h e U J u ~,ral(io!1s adopted ' ie ; p : e ' W l d s ~ntire]y O~ cHlmli~.I. 'mmpi!l i ' l ' i ' t fn~'l ' i ' . -'imost a W lmere lomrua~ c : : ~ : a 'mea~,ions' uNe' r f 1 OD l d imc l :~a w'mges ,o , feae k"md D'. I i ,j)not~e'r and ,the-f.e is n odnub t that I.he':pr:e~.rU a tJ ~ IOO~ )IL lde ,d~~i6eJd Iqu.iJ~e' r n : f f e r i : r u : l l . y . . E . ~ r u s he ie ved t1h.wev!e, l " , thatth e p res e n r a ITan ~eme l i M , ' w ~ r ube 3lC l o n . v e m l ll e n tone 31iiiid , i~ :s 'hoped I['ha'[ i 1 'wil IIbe' 0": '~a~1Vi I .eO~ ,onlyto lhose 'wotking- i: n the ~~id eli d J t : : : r f : n i q ; I : ~ (a~!ldO', fgm, ~ed~~ rup~ iQ l P a r t ~ C l ! D J h l ! f I but. also 10 tb.osw o r l ~ ' L i I l 1 gd1 l f i~ , lber l ' i e i d l s IDr 1m~'diCiim~w h o : l J I I I a )~USlC t b , e appe : a t I lUU ! . e IDf d r n e 'ora l D 'M 1WOO1 J 5enrrubr,anea s a d ia gf tllc 5 lic indicamr, - - -


6/97


7/97

], 'Dei ......._,. I .- ~""''';Iii;il''' I... nrimil:l j,1IiIMI'l_ ,~1!!!,~1.;J , - ............ _1IfiJa ,!jIll, ,1f~"~I~'I ~e~ . s , the m:El jdl 'Y ,O'~ die . ICS"@DS .aJJre oon i . l lOO~,olhe eralmau~~ aJ]thilil1,gIlJ 'Ii!;e~i ;p& : a m d l :peri'Om~.LB.ma ~.bobe ,a ;lf~ [:ed - Th_ d:m L~sinM,!l'~~1 0 0 f t e - n mo:re ,~v,id!eml.,f\I'~,~ .. '.in & _ i : s . [fM'i l ineflt~ :~

.;I ~~ berpe_ dD:mmt i t iS :~IlmbisYD'UIp a ' l i e n t . 1 1 l r e V i= ~ 1 ~ S I O j j 1 J I t h ~ ' L i p s H\"~ :,O~ iil .fI,~)OIf ~ JD i Ij _~I ~w l e f 1 '0 5 i u; M ..

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IA, _- ---ftld: 1.... . . .IIi . . ,1 1 f i _ - - - '- . l i b ' -l l m"'wl- - ~",,:,,"'_ry~ ~Uf" ~~ _~ F(IIlli.1l' J Il g p l l! ,I J l! !I ,~ " , d I'be.-It iCJfOmr~Ul i IUS lb~ .~~ -q~ - OO'lJB[fi, o re _ e l l r u ~ d ;~ peo d 5 lU g'-_ l ,o n lm ~ i n [ e . ~ w : . J o f l l t i IJi l : 'in 'Im:nne resp :; na se o f m e ~tient ~'np p m m m r o a r e 1 ; ; - fb_d 0,1~lW p~f~!l6, ' m i t e r :e sp l} 1 l. iJ ~ i s p ;!U1 i! a -~ydefiwlfI\~, M W 'pe~l:Rtl, ~ni~ tlar;ia~esiensntIil,)l b r u l o \ \ \ ' ~ These mil,Y be p~i:pi~tcd b ' ytmUD'D'1 ( S l l I d a J as; Clcess_ive : S ;U D l li iP ~ , J O l i ' 'iI heaJrlhU l : ~ t i I r e w -e ' , , -_ ~ [ n a m e . ' ' O O L ' dsore' ) 1 . E 'ven '_ b e n"rides~re,ad ~1c.4 allte io " C iW ' : i ' l 1 'v~1fJ~ : n m l l! l l a _ 1

' C U T m~flrernwt: i 1 n : t r a Q r B J i l l ~esmM to be ~nundJ. m 'nihi~ p a l ' l 'W e - n I: eWJI - -he l i l t I~ ; I~gs'pUl~,.,."V~gJa.re s W M.3'fe pE't .~~rn:.. '~!U~~h~[t MI[h d_e:~r~-lO,pil"w~n_cl :es i '

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10/97

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11/97

l,e'" I ' , 1 " -~ I:IIIIi~ '" , tamd ii d li l, " " Th'~Iparniern'suf ie,rod & ,o ; m u r u d l e l ic ie E C 1 0:['lnlDsferfaCil~l w i d l B l ~ mher ef o: re ', a ~i@i\\' mmtaJ~Qe [~ 'O,c a : l 1 I d 1 l i d a l n ;GClt iOI t1I . T h e I~hrush=~il lke Ie . ioni , o f[[hi~ , o r n )Mu~ a re ,aSSOitml[~dwi [ 1 1ea n d i d a Imed ion of ihe fi n g e : [ ~ W L ' 3 i JS and] toena lls,

: 1 . 6 . A ~ wlf l l fecl~dl ' I l n , g c r - i r n _ a i I , o f t'~~ : P . Q ' f B 1 e a l I i :s . h o y ' 1 T I in f i g U ' r C ~,S.

~"1'illS , ,"~_~-, ,~, A,:[itdIlJ;~rp a ~ n l : : [ L 1 \ . ~ ~ ~ cmm~."i'n & .nted~p~u ring of tke '1:'Dnlllllei Ihe ead ~lJll~:of~o l i l ; g := I[eom I! l:MOn ic i:nfmio~ ( se e' l li U ~ J lu ~ eS!).

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12/97

I i: ,(I: ~Ifu ' .~1J - -~ I 'md~ "" 1 Th c r m ii !ll~. . I. . I . .In,g" i1 i I . IS _-_UfU. . I"Ua ea1.ur ie 0'" . '~epilltll!iUhewn i n fi gu r e ~7.

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13/97

,:"l i ' l l .. if"11."""i"- ' - tm,llIK' IE ~ ~d.imllllll"e. n. II ~UJ! t u . m : _ 1 , if__, I i I ' -_ __ _ _ _ ~ ' ! l .mooulh l .Dem~!.I re '~ .:f~ ~Duth i s ; 8 J . 'v ery o o :mm~n tl I!IlI~n~jfeslaj[m:mll0 ' !arndid iM i& _ ,llresui ts : I i rO I l f l 'Ile' ~oon - tb ' r y i m D L f ~ l h u ~ IOf'~n~t~d '~ beJ~rta l d en 'tiiW ~p;pl~aore - .m [ o fte i i i , a I,mUu p~ rmen'[UlPe. The p iCE~~ i~ .of: 3, : p aU t J ~ elf)the~of the raueasa ~~d by In If : den tlHe a~d:wi:ri'ctedl~oL' o'm~ 3J.~ m.om I i1neml erectedlI~banmen - IUle r.eillml1,~.r dl~1 [ ! I- O I . , c 1 e - a I i ' ~

D, --:-,'~'~'H lmmullb, hllJ 5DIDe'~S' Ime p ' i l J b t a l I D ml iW. : b e : l o V i . ~J! mill nl lppel li ( le l i m l ~ , l J r e ' : ta , l l: , e s O m J a ,~m.U 'Y a , p e a m r n ' il ,o o a s i l l l lth . present ins ' ( {9I I11~- n~l\e'was le" , -J jde:~' I D Jamdid i i i l i s is in [~ii ea se tl1 1d m n is p:rollalbtle' ' t r n . : a . l .'lhi5 ref~Il~, i i , I hypeqJ[Ia!! lic " '.~pi~ to 'lmum3tand t l~_~~~lium~mtotln:r ptalpIDl lafJ bJpe: rp l_ \~~a lD f:~ e pa te wffilb,~d]lglien.t. t8e:1i'f}~ngy~ i s ' ~ h ow n .[Iii, f ig u re ~ " .

23i C~,~~ ~i um,~,'oommuDill)~iJtm w ith d ~1l1Y 1'~ &O~ mou t h . Ii t l ' 1 t tenooWl't~'I i IOO "ft ' ,a' l ienl l ; i , wuh . de p fo1'-.;u 1 1 h ~a n . g : I ~ , of ~E mou: th , ' l ! f $ , u a i l l y pmo~ed, Ofaa:ent i1W3led ' b ~ e wean. , o f ,d e rt !l lU r e S D' ~ i i l l 1 , -OOf1'ie~1 V n j i _ ~ r n d r u m ~ l ls i'O ;m l iS " I II ' h ~ a 1 ~ h mllJ'~1~ I S l r l 'be :3 1,p~itiIJrln,g f a_o t l~U~(~~ 'Igur~, ,~~.~fj-~39}~1 1 m e~~~t~d ~~,ii ~.~a~y:~re~t~~b'y l~d id i l_1t U 'l a tl i~ 'm~ - ~ l !t ic 1 r uln 'V e m th e em! VJW (l!m ]en t 0 1 :~I, wiLim, ~ki:D. Howe'lf:l'~ 1'101 ; 3 . 1 ] I'uiom; ofa ng ubr Ic 'titeU m : i s iilliR infee~Jed b)f .andin, ~:somc, :00li~f~~l,~dI b ib;tet;tt~ ~ fip~').,

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14/97

24 CnlllWD:mat-. -_,~ did);: ". ltt 10m] ,~;1;aDdlmg.~ IIlf~Mebeiitis., ,pmlu:1Inu.a(Dusareas m : a : y f u F . l l I l I ~ " t f f i n ; e : s e are ,often bi~WJ~l:a :m~'"['0 ~ J D 1 i ~ ~ _ ' In order ~lJ" .~.im.~~ie~il::n~;i ii ' . - . ') .t 'm ay be ,oo~iiowilly '[1~~~{ ~lll!lltc,\"e; the gIian:li1aitmti mt.gicaUy_

D' 'PrimaI]~~'lItilis C~~J The p"riJn~s r p f f i ' n J i I f f i . ~ioll appears, as mll ind~t~ s V ! l' e I lm [ l . ~:5 0me tw o 0 0 f ''fh -~ , _eeb atherm l o c m : io ! l l. A i m : _ r r 'S1fie ' s . ~ d a ~ ~ m, g:la~~d1 b 1 . ! D l ~ : ~1 lS m ' d W i !5 ~nst81i1"~[be, sw;t~ 1 \ a ' I ' ! : w 'oo~mJes '!l:m~i.l:"d.Thi~ica~ 1 1 . \ ,ml~lliThi:d l J D ] 1 ' t f u i l . t the: ' l o n g ~nm~,p : t im m a i i ll J ~esiton'A . m ee-eaisrence w im L e . om t ' ! 1 f *e Sleeullthni, -- -- _. - III.1:al~ ~ : n1JL ! lWI l lS patdh. zs and ~ . ' _ . l i n ras h(see .~ ; 2 , 6 ) .

: m I,' . -_. _ --:- I -pbiIis I(m .. j pDm~Miumu:;.: p a _ t d ' n l of the itluttall ~HOO~I.. Usually lh.eseared 'eser ibei l, as IP-a in ]e~ . bum:r u n . t b~ ~ ".:_ 't h~ '~i 'O~~ 'pairrftiLThese ~ooruiatJ ~il:sicmsam llil~\-il)'.m'fttled by , t ; r ;q : ; .onaema pf.lll ' idiflnt", as are t f f ii l ~p r . i m i i l j j. f j ~eSi io l J s .

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15/97

2' ..~ SJPhll:i ,I :,~I) Oum.ma ferma-'~ j o n imr uhe Illil.l3ltal :m~~ h a s led ~o'di:nonionof the ti5S'~f," AJl.koo'lh in; :_ ' [ ,e 'v : td ,e~~,in th _ilI~tA~jcIHI~ ~he:re w as ruso l mtt ' rked l'oss, i O fpa 1aJmloone in dl is ,Pl l ! l i :eni l~ 'W I f t the f n n n a i i c : m I Jof iii mmU'l l i i : ' oronasa] ' I i - ~1ila,

3 8 , J. 'C " _ I I g 1 ! lD i b 1 :sjfplltili.is 'In p r e n i I J ! : a : 1 s } 1 P , ' b i ~ ; h ! i , ;' t J \ 1e :~1l8~11)_ l!na.~ ,PRJI[i j i~nt :e W : im l .I ! D , ~hedelrdpi~g toolthe~, ~i.o~q IU f :mJ~ ' d l i5~:nr=t I D o . D 0:' E '.tb ~'t'HfIlT : ~ n m w . r r l l b ~ 1 i ' - , . " t i l : i f e 1 _rm lu ifes t - -~ , i : O i lm - H!lIlcbii~n" ' i i l i]; i l: imm; ( 1 L l a : m e 1-shaped ,and nok~~d lin] r h e ' eearre o f [~i!i l n - d x a I edge).

,1 9 1 M 'o on 's 'mD la n (lD 'c gn il! led a Jlild w j'L h less o ~nOmmll:ai~'IDmiicaJ d e ' l a ! D i ~ )are a J , ru.rtbeif , c . l a M i c a J l ll rn2IJnrufe!i[:3J[iQ~ of OO~I~nitaJ sypb ills,

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16/97

-- ':'b ,JI,m_OO'K Im lIJ :~r !cl1etlUis, . / i t d i_ .ll~~:siI!omatmtIsdue t'(l' S i t l l p , b J , ~ , I ~ Q,Jlj~ is i j ( i n , Y ~ Iyun ~ - n in ' the b e a l t m a ~ y pa'[_~ellt~ Howc'w[ ' , . aI-t~b ,pKl~111on C if ~ O ' , a t i J - - :uh t r ,Ch~~lUt~i . -i n 1 l 0 0 l l 0 0 b , ~ 'm ,phy~1o I5 ~ e w l ' h c r 'd:ome Dir inoonju:n~[ion \lt~~ candida. ~~ is , W m J l O S S - i b [ e todiIIe,f ien'l-mii! le betw'een these IOD purel ' ,c:ilmjm],g ro u o& ' W nd . 'i s Jnu ,i e, Il ru~ :lh:e l~uianiS'm presen tw~ st l1ph. (l1U'1!~.,

ll~-'hJ~l~ ~j}-iu~ -n lhe--ea~rilyOOm!IWno~'I !IJ,pjJ~~dl piM ieftl t -he ncrmal hi l lal l rncelo,fflcra isoften ,~Ii,m~ly:tered ~i~ha [\e,[h];~_ion[Ill l u ) , s r o : ,resis hl_ _e ' ['g' -~nfertiDn. T h i s , :Wa iY leadr e r u n :F ~ E i o ! l S b)~ W ' g a n i s m . s , ',i l li i: :~ ,~~~ ~~U)'t l ]out lru' to be oomm,~ I1& ! 1J ow Ul t t h e ' , - : n B $e~ IO fI ! ! l f i1m.1 lesions p r ~ ~ d b) p a l 'hoge r....tU p n ism '!L l inl :~bisca s ,.,~S J t a p b y m ~ r n t il rush-l ike : l e s x G l l Iln~d, lIppe .a ' red on ~he lo :n&U~ of 3 : ,;::~ .. l' I~uemJ[ mJiy-e~UlIg mt.eMl~~'m:miW1~\tIp:,ress:!~'m h , m'p'), I 'Or re~ioclD.ion.a ' i8 J ' l iena I tf"im ~;Ui l ,n ' t . ,

11 7 , lubeRU l l_ - :_ -~~ ,Q , r , il I J h st!}1 l5 o f hlbil: ( lC l L I O ' I Sare ~~r - ml~~i,vel i lIJIfimm:nm-O,1Jl b l l l m , aiR ,ab 'mt~tIW , I -' de&eribed asp.re~rtII~jngW th~ '[OJllii. 0'( an ,1 ! I i l b ! I! '= M U l i L II ' seoom d ~_ ~ 1 1 1 0p~ lmD'n~ l I } ' :1 , filmh. ~, ~' I l IS ' 'WI l~1~" I h ~ ' prima'f} les io n _ a s , antile' 'b~~~ ~,Y_~. F,Ul\'f;ielll~nf,M, a, ~3Jm't ~'bhep a : t d l J with ,e~bemi1~Dm, areas nndJigli1f~),'mdlmli tedL , I l J J tO 'pSJ~IUD iW~,~UJbeoou 'i d H s ~ r u ~ ! !W ! lr e3iIl~ ru oooc :l ~ baoc il 1iJ '\l~eliemcuha ted T~m tlhemapsy 1 1 ~ _ ~ '.

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17/97


18/97

,]6' .#ll ' i l l .k: ~.;"\Vc' liin.li~ The a e ~ i i { ' i J I : o mof (Eds,oomm.{J]]J~Ij ~ m W ann:afi tLiuD enol: -uown ..amIDo. [ Ih~ ., res ,~ys .....a~ledl Ql\e~~, f " , " , , . _ ; - - . - , ; , ' ' ' ' - , , - TiI i jHI i I i~ ' i ! ' i 'M1i2'1(,Sri-", l iaJ ' i l ,ml"~i i ln and, _ 1 Im.oon~ s O~~!!!.1!I~ _I!O!I'''!!'I!


19/97

;ll1mon con: i'tion ..A~thoub itheFl is : 3 J ' , _ !'!d~ eCUium of_,_n class; .ed as OJ) of th 10UO. in g w_:, I b I t it seem .


20/97

'!Ii,~ 'I' a -mgf , - p h . ,i_';~,r A l P f r I 'U n c m ,u l o e nm~)ll-,~ 1P~IP~m~:ed b, mild tmllm!a , a s , [[01 ' Ikepal~l!U i l l l ! l 1 s m : m t e c t The :mUd ' I n I _ u : m a . from dla~&'ftclllmd : i n a : l l i ~ l i Q l r , ~al lhougb B r r J i l I, _ U"if i~m~floemtiof, i:i n i~If" hM } 1 ti tn ~ ~e t J , a pbd t um ' w e e I : ' , JDduawl f l: m ! t O O : h l W e ' .f ' l i [ p . F'Ufil]Cf:mid mb:I:lDn (mm the1 1 ' - i l h h _ , ~ _ - Ai__A -I ;j-b.' _ -- [- _-I -...I ! . . - ._:00 ! _ _ , - IC'Bu. 'C1U, m 'I.U]S ease , rD en aJrge tnem e : : 3 1 i d J p;ro[u~g t ] in ~ d l _ u _ r , a t i ~ D . @ ,f ' l J " I . e ~I_ee[.The: ru~r..a:ljioll, f f i .Q , m~~ 'I~ ~ , Iqu ru l~distillcl& em m ~- - - 1 ' _ ' - _ , - - _ . - - - 1 ' 1 - ( - . .. :i il .. . - , im . "_ _ _ __ m lip e ~Ea,wml~Ul!C ~e[r S U I I . . I l I 1 as UIIlIUn HI ' l i iglllm~e4ll) ,_,l OO.Ci1lDiR iGUjll~Y in Ii:_ W t i i ! h , 3 Jb i S i t ! f l ] l , l f ofaphti~. ~ 1~ J 's " , -

,~l n :e 'Wi' p~ ,ec jp i l a j [ i oo : by l o o n l a d - i ' th I r i I .e',h-~:uui'eJdbn;-CJ~I s ilo - , in ,6pre 4 ':1.

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21/97~, I


22/97

A h h n L 1 J : g h nliiWI~ or the I~'~mom~~,lustiriiih~d~n l i i n J ' i ! ! i , , 3 J I[ l t l involve Illhe ~t(lngue t ,og.el [her Q , d ~ 1 ; mfIt h L " r ,i!. rca'S 10 r I:h~ r a I ' I T I, I I IW C U S a ~ ~ e i f; e , : i l r e ~ , n u mb T' Illlf l[,lUildirull'ions w b ieh 'spc;( i i i , fa,~ I , , ' il ! J \ . f 1 f J I-_~I['h~ t[lglUJ~ ,!1l10~l~. Th ese are l~arg~!I}.fdependen I: IOn dime speeialiis-e:d narure of th e n O f l l J g u eep ith el ~ 1 1 ~ U l i Q J,~nd.in [pia n l i C ~ 1 I J I i 1 I J r.o~ 'I h e :pre '~ ! i1 !: f;WQe'f the II I lpillni~'wh'ich may un d~rR o di~nges inth e ir 5i n&C~UFlif aad d i ' S ~f~,but ion,The Iii ~ d, no~, have '~uch 3 speci:dist!d 'rutu.!!f:e~ Hnw \.flC~!IJ b h;eiing iruermediere in~ IUe "e i l ,~~rele I T II l I [ he mu O O 'U J , i'miemb rue 0 f ' ~,hem;olnh 8! i11;dshe _!l I { l ' r ~h,~ [fare,. some ind i - . J idU:~ lpo rumI. ,0' ;Ce hav i ou 1m " aee f, t; .A!ecu!di i ~b e :prtoduc.lff ion (j!lf ~~kmrs 1[i,ITfilned ~IO~h i ill rea,

," 1H',t qJ eliro Ji1 I'l wi~ lT ; : I!iDn ,l'il this I io,~ I@ f, [l ecumcWi i l i o r a l u ~ ( l e r~ ' r i' O \ D i I j i'h~ U.k~N, ,i


23/97

i~jfi I'::~ !\ ,.. Th' . -h . II;.. .;!I'lI1 '1IJ11.:Jiog",l!iSSIfi IS 'IS It ' .f : p~m:I~Q~'UO _11 . r u n ,f i . g u .w r e 4Y with the ' IOn.gi i ! t~ ' ~n,Y , x te l l l doo . Therestricted mevement 0 '1 lUte t u m L t g u e e3Bl~ byt m a t : '1'On.glje~tie is largel re~Mib1~' lur ~ 1 1 l t e . laek( D r abili ly m :o! l lm [nu~h~L ' W hU ~ ' l i i l i I iC l ' tO, fMS~9J~~a Imos'l ~n\/ari_a:b,~,~Id _ \f'~~ ; p m ; e !iI!~,1 blJ j i ) . r :m~di~,y~m~ cF o -g lo s ia rna' , o c c u r In a 'V,;uie[y o f s.ys~eOOC :;;,~ndi~c : m n ( e figure 1'79 ').

Sl" ''''2 IIf'lSSu;m~ I l n m g } 1 ! I . De~ fis[I!~ri~g 1 0 0 f the'Ulngu~' ~ q u ~ m ~ n O n l i l , a l~R'SlIme pi'[[e:n ts, nina!,~O~. be ,~h~Fa)'S'Lfvid.en~~ h O \ ; l! 1 : e v . e : f '~ alllu:1taesedl ,usn ' : :1Inons d~.(]\ns'fUu,::' 1b;0'~~ i i ' 5 ; \ S 1 l I D 1 r e ' S . Mal~rf u ' ea : J ime I ld~ : he , r . _,f'(1mar, ed o r- ~hn:oS'[ invisible~ ~ O O f f l w ~ g to ' l f f i n ~ ' degf'~~ . o r II~oor.ail.t)d~~-i iii D .W e il(J~glite'. -lthougJ] thesedeep, Il:aJfJ{JW flsslHe"are or d ] iemse ho'e sym.p1om]ess~they t m I l 1 3 , Y aet as.

_ :f. _ ~ '.. III h ..Ji::..J: ...rla,sitemr rnb~: ."Mu_~~SU~~ii.~..Iill.Ilmita.tloril~n i .5 " . d U ! [ ~ " p ~ b l y ~ [0 th~ ~ma~r(tti~ : : 1 m 1 t d. .[ ~ ~ i c c 'O f 1 - d i ~i'am,~he~.e IiICOU,r;:iPP " . ""1Il"'-

~ ,ll, '\\ .I'h ~ la u!'f-a W I" ooa'up'oo- d' l l 'rn :t h~ f * .a nICxb~n~h! 'd. . ilhi I~~r!l IJ~ . ems 'UJ ~~~jtJ fDa,un u su a I lea lure ,


24/97

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25/97

~n u~ iii ~/j, - ~I I',",,"N~.)l Th'~.7,- 'III.'W!~ IU'III,~ l~~, ~I!I B!'!II Jl~a;g :~ , ~clinical p resenen i n of mediMi glDssm~is l i s , ve~\\_iable, -.. ' e :W . 'showmu in '6!ure I ~ U , is, or lmc'so-eel led median . r il I : O I I : lb l i d Im:i~ ~ongth~~"11.0 [be of'd~...Jo lPn:u~ l i i~a l 'Dr i .g in .h is UO\l~ -. ~~w a t ' u ~ a I\~ io n represen L 5 3 ~1XI1r i I1 ie It",c'hl!1m~~'C! ! l ! eetinn br 'Cillniida. Thi:s, ilnr~jOnl i....poo r l y ;(espollS~\'e 'to 11 l reSL1m~~~ 3 r m t d oo~ ! . :au lhori~.i~,)'Hi)' ide'lIl[h~ lesieas ~!C)be \ ' . i n r l 1 l 3 m ~ }frrevets:ibt. ~sio:lltall)' l ( f ig lUJlreQ'}~~upe e i r a ~WDeg!~on_ay,C8~ OO~__rn, dl~ re i o n . beari~g,some resernblanee tn ,a i c~ i~ ( j 1 im~~

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26/97

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27/97

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31/97

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32/97

,,'II ' ~~"'D"fi rm_f jlgif i," '''' ....!j\~~m 'Ii, ' li n - ~'Irm; 'IlL':"!I ' _~WJl!I ~-~ - ~r~-~-- ,Il .~--. ~.11i' L.1imlv{J] 'H~d - .as, ~t~I occas i~ l ld ' } ' f - there nHr)f kpa tChy ,Mcpeci i l l . Th is , usu.aD,' iDCCW'S , i D :lemales.SJi ld m~~' be of ~~iI'l.'~ti~ :~ p o rmn ~ ~ iio ~: r n ng may ~ t :aD, ,J e I h a w [to os m a ybeaJme' perm ilJ]ellml~.

I : R @ tW u li a r I~ 11m IU.Q T h ~ ' i,lb~dMS'ic~;~prcsentallolll .t with, 'wb~ te striae on Ihe m,!J~.~n~r : I ,ged lm~ ~in~~~f r r e ' t i c u l a l l i 'manner ' . Thesere I t f ; ) ugb'L 10 t b e th e ,e qu i'Vw~~ll~0;[ I t i 1 f : '--~"'Cth~I"S st i r i :ae'o f lJbes i 'U l " I~ io~s l ; .D e ~i p,~~ Ii. lde ooQlP ~ I;}im~and aJJe !!llfiem n{J~.i~-d~Qcidel'l l lbl lru}f" The bueeal _uwsa lis 8:ff~l\~d mrn n rea ses ,o fora l l iEcl1. en .P(lanus ,Mwl1 f j j ,w \ l lCr tJl?e~

~ Reti' :1)1_ Ucheg,lB. A s J a g b t J r y 1l1l)() ifri'edr e ' h C J . W u - :p.a~l len l i 3 1 5 , - : - . Y~Ilm1~' [email protected] ; i l~'l~ng:u.e.:llf!siD',I iIS of 'the t~~gu,: Ire prese~~ in i i,p ;pmxI .. ate I, 21 : p e r . ' ,[;e~1tlf. all pa[jeUll rs \ W i l t: . om ~J j c f f i n : ~ plan~ .

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33/97

8 \ 5 ; ICo-n iuell l, ~- '. .' J~ u :f l iCheDI p~ftUS in ,t~~lesion there ~ a l ii lD W ~ of Ire llCU'1:1 tto0 H:[ [ikel~~ 'The d~ w~f: :e ,~.3~ wlh.o~gl dmi\ia.USUS]~CI., p~'n1l~Jd m : h ~ Iyp:iml 'h istcdo,g j. :ca la,ppear;~rices C l ' f Iich~n.p~lnas ...

,M , : lmDf" r rM i { " t[~ ~ p l l B D l l S The ~ntLa Iepi:tb~lia]'m111~ in l lb js :f o nQ ,of'lbe dj~a2: iR s o ~~uopb :~11u~~~;,meti__y :a lw ay .3 i d i ' l l l ; : i iS :~oc i_a l l~diJR'a/ 0 : ( 11UlJ;DiNnropliic' liclt~~1'1II- ilJriE, ~ich ! i i~ ' C ! ' . s ,a p n in 1 !f:'Ii' 1 JOIw3 rd s e lin ~cal l d'ia~m~.~is. A:p~noxi,*il1~ile~yM per cent ,of ouW ~Bi()ml:S are' Df the,A!r li~~ f ~~~! ;; ~\ f ,C ' ' ()~ ',

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34/97

: - lU h l - r I,~\ _ r J _( in ' ! ! l Imns : ~ 1 1 th is c a seth~ I~-i O i ! I ~ ~e 'moredl[nU~'h.3l1il Urnt -n o _ ~11 [ in6~'-.

aa ' ,;,_ - i "--;'",, ,-~""""m-liium of.gl.i~1-~'nO _ mDr ~~ r __ , _ _, __litis ' ,aliient, t m 1 ; , g i n iW v a ' a r~ ~f : ,~dom: i1 l i1 fM1 ' t l yaf i 'eCted. T h e . n~~llf '[!fie li~Fagi1!a,~ , m I . C S in'[his, '~hua:E[on Ied to' the use of me I~argetsu,e~-ded tef1mwno~)l 0_: ,,~~,ti~g ; im i g l V i t i l , '_ The I~giwe , 3 J I 1 e ,afFttted ' h l l l sgme'e~mt 1 m 1 1 5 ~1Ir C [ ! ' n l l o f eases o~e l : i D S ~ v e IJchenpkrHJ.s.

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35/97

I' '_W n .llaliuw~,~mu_IDg,~m,takian~~esio:n t ':1 (lS ~ :1' ~ liIi'IIJ h les a ' leuop1lakia l O f die:,oomm ~e (~,e 1 I " l . l R ' l_ ' ,) ~ Howe ,v :er., (h ebiist:O~DIY ~ o j' H elle n p , am - _ ,a ;~d,el1 \: I \ l . tua .U~tb~ ~e fOI l l re ,~ ,essed with omen p: rcseJ i i l~iiIom~f'pam 0'( ~_e ,[noullliL

1I;.'2~, '~"-I- -'")11:'6*0 Pi l . lnus :[ g l f I is,[ j i21ait i :\re r n y 1Im,l1SDaJi2llrial p'pein;se[[nof:i!LIII~) '[Il ~ ~OD arem.3Jlb-b~ dmf,e_Rim~,'''m dtc~ ,0' th~ mtFfOF l~ro~'R : r .D l lD~1lris, mml1s to~ ml cli!el1' ,pati l i~[l ts. . is of:sudd l n , lD 'nHi , ami isMltaiUr widespread ov ;e r ' tf t ',omJ'm~mp. Th ~liOO'i,o! iPmmDl~,U~I_~ad}relneA! l lu ice,(S '1~yered by .ra ised ,'::~i~:'i;~!l la~,al t~l !r i t lJ l i 1 I l g~, :il,ppeiltt.iItia:.


36/97


37/97

liYIi 'M..1 t ; , . - . . I:',.oilio.. 'll.n ..... - - ," '7 'oJ' -!!!I-'~f' I FOSI'VII ! : m2_U) _ I , " lIIU ilD S! - . ~ 1 1 : , " '"e',~ ___:__;:\~:n 'w:ll~ 10!iO~h:rms are Imss, tl!u~~ is:aJlmOS/E al,q ~ atea of ' t h e : DOfW.~~ ']\fe'".~J:Pe ',fitsent - UD :en IOn itbe' iower lip, as in ~hsW[~1Pe., Thi5, is tbe pati~lll~'.own in 6gu:re I. I.

~~ :"m, W i1h the ~I-~il~m_oono f: ~~ bMat . [ l a y e r - , O ' f ' ~ ~ 1_;pijtl'U~ti~ lb~ ,~~~ isImliec.h n ' iQ 1 U , ) f . ~ k f :H~ -d aJ l t td , ~rel,'i 11 fg~ l e p i t m t e l i u m 'D l a_Y ~ift t o ' fOnD I bull a~ , .~ m ibis.~. These hUIi l lae iH!R St:Ion-'li~ MId IdWnte_gr.a 'u! ''to f~ dl~I~I,em,ti~' 1 ~1 't ~'O : ....

! ,I L[ bm p~.:us. (J. Up ._.till ~l hi tlris,- - iii - - i; ~Ti!!".' ' 1 1 \ 0 1 0 -I' 'ilimMillfil. has ,mod i i :e ; ( i , thepa1i lel l l , l ! ; I I r " ' " " " !"!.~Jj] IIj,. ! ! l ! I -.Qi,;I! -. - - - -. -" ~ - - ' - - ' . " " ' ~ - . I f ,.,Il.-, l_i,..- .,..-m~ ~.i:N!~r linappe~JD1a (tI U! ,_ ....II 'I!.!I~ ---- -- ._. _ . I I t ":S~nlam;e.()M,erustiW glof tb ' is iimd .d s Pti~~_m U'(;' l loo ,&a:nl\L5j l in.u is .~.[eanlre o f same 0 her1~@J\d:i~QIS (s l ldh . as ':hmmlic cl1m llid :L ~ml e r : y t l l J e m a : l , . ' u . 'w t~ w h J i , ( b U dh -e l llp1 a~ lus,m. i~1H a lM iR ed [see i 6 . I } ! lc Q ! ~ e 135-)1


38/97

iB :'~ . Ii.. - ,. ~I~ ' I I . , . . , ~ " " '~ I . ~,L 'It [b~ .oJ1 'Iii., . t.,ILII l1lIWilt~ ~'[iOU.P' 'flilf umDW ' I em, . ,eJIOOS, present lfi~ ~liL wJ .:y ~ ~ IUlie orm 011.'~l[~'ters,I lH11Su U I J ' mei i r ( ) " l e ~ t t o J : i ' 0 : 1 'f t lW l id . beta. _'[b e ,epi~~eUl.Ii. or b e ' ~ w e : ~ g n (;eU .' -,aJlIl(' p~tients I l r u ave ~[, I a s we' -l,~'~.kip, .les:i~~= in pem;phigN~1 i n ,pan. ic .ub l f ' , t E e o [ E ' , a J . 11esioQS Q ] ~ y p '~ec :edeo thers l b . , a ro~slide':rab~,e.Pe r i o d, D~B,IIlOilS o I l im l e bl js , 0 : ~ the oral , lcs lQ,Qs,is qU W J [ il :poss ~ble', ~nd m , a ~ o f lead (,0 th e !el 'd l .~~ ': i :rustia'rl i o , 1 I R l ,u r t : rea l l lm1ent. ,h l I t l h i r S . g ro u .p lof d isea ses bo t!h the skim I l l l J t U a e ' an d 'mose o f lbeo ra - DmHIOOsalend to rup ;h .wf ie ' . id l J : J 1 ] ; i l d 'kaP.!l l lmll l~.,e~yi~,gern :ions IS the 'nlOSI: pIi'Omrugeml~ fea tures ,

r :-.~ " p lm . I= e m ~ ' - . ' , - _ . h is . 1 _ lOll , ! l l ( fIb~ b ack o f lri;e bamIi! d3:rJy de .C]!ostfa ' ie thebuU o . na '[w re o f' Ime dli.:rease , p raeess, a l t thoug ibthe b ~ r f I ! I ! g !~ d~ a L f i - a d b G - ~ ~ ,Io~tn,tm'f:1l,l: s . m . g e is lffite less 1 0 0 f ~ ftagilc Itp ,ilh elm um 1 0,P[(ll(J:U~ an croston 5 0 0 W m i i l r to 'thn.se ' ! . hown i l l l J'f ig l !l n !' 1 01 "

'IDI r,em ;p~: - lbu Ila _ _' i i . l l J i ~ndris 'instancerh' h L W J , _ ibuUI ,0i i i , ~lite: U , ilIti be~Iil1J:phormgrnpfa:edat 1 i ~ -IJ , ~~ &~8 r - : . h h b r u a s . 1 1 0 1 1 : time ' l h i i Sw O : u l L I d be, 'ClpelCll:ed ' 1 0 1 ,dJs.mt~L(lli' ~eav . iD1 f1 im~1 eWS110ll : 51bn i1a r t o '1lI~ ~*C~ iH1 6 , ~ ~UD l .

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39/97

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40/97

11M :Pempbilnid =ilf _.:hI lDa , i!(f' bI(iIp:! InI " .1;.', - '.1 ~ h - :- , li 'i iJ l' , a l r u -: - - ~ - I!' t ~- ..., Iii'l ~ i I i 1 I l l 3 . . i f t ' l l ilp!empnlgolu" ! I ! _ _ ~ " " , , , _ _ _ _ _ "v~"'" ,elntu ''''U II!~. iu u r~ c 1 :Oila :IQqer '~me~b~fllhme o f ~~,lPh,ig~,a!~d .m~.y~mJ3litn ei l l ; id~n' l - . ,a lU lo ug b ru p~ ure d.C I 1 i lL W g r e ~08 I )1

l_ _ ,P~pil\ligfIi[d - ~ ~mQo ~'n~ i ; s , lesicna " n . ,of b ~ rnf,~.Ilred b l l ! l l I D l a i15 ' s m l , p,resen~' ~Il,assot i i a~io n w l i r n h rn ~I~~if:d ,iLlle.a.


41/97

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42/97

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43/97

. 1 . 1 1 This i ;:of -I ~lbem.mu1i~;i~" n g eharaete .,~[j

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44/97

' ) '~ ' !; i ' E J ; . 1 l h ' f m j 1 , mii ll UH" \l iJ 1 iiIn e - , pa la k l i ! i I i l l m i C 5m t r u l O O m~p jamIJ m~, ~"a f fe~ l~d '.AltlmllD~"M, is US~it~~ m e le$Ornli h3;,,'e ~r~ik!!;n ciIlo,wmlo'.O:ml , e m . s a ' c m , . , ' U I , ~ ~1'i~liaH ! I n m t f l _ Q W i 1~~Ul!l!ll~gfD~ disease ~Jm ~ ~~Q. - " p: iSod le s 'm~} f be~:m~Ci j ,p i .uuedlby~ -'id~fiU~,g,D _If[iIJ~ f!j, - ~n r n h iease b)r 3 . !W , !: u l~ ck ,c , f reeu r ren t herpes _, blliu lnm : c a s t instances an, ,ae[[(Diloll~~ :fu~t1,r. eannotbe f D U J D ] d .

D O : _ ~ ~ , mil i l i j1 ' _:mtIi:' W m 1 J lhi:s~. \mlW ll i ~ , ~m e ; whole o ' lk!: ' ' G l t . a , 1 :llIin!Loo~, Imemb~ilne . l'",af(a:ted~~I'I~ u ~ ' h a:s,'I~lis. C i l l m i m r n ~ i ; f f : e ' , 1 i C 1 ' I i b 3 , 1d i a g ; m ; g s i s ; [ l J iDm prim:alry heimpet"c:: tom atid ma,be difficum~. -

- % :~ ~ ~ , m l l 1 l li l f D I i 'i I' B _ ' _ resft~~laI r n n n'The [lame ~mIl!!Jd[or.Qle impl.ies a ~f: lge 'D f'm O i r p f fi o : C ] '~ o g y ( ): f J h ~ l~iQ~~' o o d 'm~~10 .00001;leJ:~m'!1 ,~t~'Q. ,~~,]~c i . i~ i -ca l '-ehaviltl~~Qf' the'O ! " ; J ! ' i I iU l { l j l . . .. . . n, 11m ' --;- = - , t \ i O o :y " c t , ,..., ,,,-IiiN'~~I.4',, ... ' -,~- -I'~ l~V_ IL_ me ,t ll !; . . ~ , ! l :. l; ;] !y ! i] lu y D ! I, !I .I e: r I P .Q ~U : :I lI .! I. $ .Ik e ~orj)d!jtro~ i U s , le ss ' _ _l1e5pIl le3,d, a n d less ' s , e " l o f l : e r r ein its le;fj feCll ., This , .a r l C l n J ~ :~ , 8~ e u m p L \ e " ! O ' f '[~i~~1!lpi.

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45/97

: tU' I ' '~2l :,(JQW --:- 1 multifbrm .- 5 -~ [-- ,~--:--The d i m , 3 , 'C ; l e r i is b c s _ 1 W 1 l Ies iens M " - e ' U i s , (' tm:g;etJIlie_s:ions~I, pKdlflImina:nd, O~I I[b~ ~-dli,"m"niIiS m r n :d l_ B - t: . T h e :r e m a . , o r 1 1 ) 1 1 3 1 ) , ' 1 1 0 1 : 'be . . . ..c~tml'blsmr: if OJU~is , 'plioo~ood j~ is I~ual, ~uick'-f10 11w w l H ' r, t ilU l l L ing ~'b r :onmudi ion 1(1l!_e '~D . .The IcOO_miOIllI gf U i u ; : ' p i lt : i e l l l D i l . s h f # W D in . ' I l i ; g ; u r e 'm~ 1P~~~l:3led, b y t~.~l I I s e o : f Ib~wil~mI~S, a i W i I.had -rl~u~d C,~,~ Ilu:mw Q . ~,~o:ns. 1b~pm~ i l tQ -e f ,_ilm lesiess ~ n : _ m e s ihe ( ! I j j l i e ' l ' i , e l n i a ldiaposi.s, ' be!lw~en ery :t le ;_ lmll3JmutU&u:me 1 1 m dacute lU:qJebC s tnma' [w f ' is '-'mIB_ellml~S a Idjm_~t'ene i Ifllie' omll P:UilGjosaJ alnn~; is i m f W ) l\ '1 ~ ~'1 11 '1 1d li 1 ih ow -s a ' i ;ar ;ee~' !1~ ~ S I ( ! I ; n ' i : 1 ! h a ~[I'[m~1it ' l b ' 'C , U Q ,.ml : r u p u 'u ' i e - o f ' a t n l l l l l _ _.

,:-, " D' ~11;!~_..Ii 1- -,..,.iII - - - {j' I~~~..il, '" - : .I-~. . lfiyQ:'l1ma! '" enera ~~~-efiOOelmJlJa~ ! 5 ,a ,oollditioo 10 wmc& s ro jfme ss of' l l l~ : . ~ f :o U O 'W S 'cJun,~'es . m the.loonm~~.i ~ t~IJ_(L'Th~s, mi!:y aflect Ill.: mQudlJ at an ,~ari l - sta.8e:~redw:inlll1e sizeof lb~'I D l . m l l iIlpe.I1Ufe~

I.Hli!~ ; I=.i . . .. .. .. .. . - . ;- ,-'I':_~~:'.iI ~.,., '~'L, ,.:1 d!I!.~ ~1I!lII,iom:f' ~1illI1 U1i'U ~1lOll!lmllUC: y~[_~upm,e:fJ~ema:rnti a w ; i _ d ; ~ ;.rWJ ;ge o f: :I~ions 0 Ithe' om] mu:cM3. has :~~~, . f iC rn i !ood~ The m05tusuallesiaa is~if't ll,e' U 'i.. U l~ as thaI i]' ustmllfJd.The ~omb~oo'tion of cru~tm;g and ,,~Ihe.erntm_iutiD'Ii it s ~W i!l;3t~.


46/97

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47/97

H' .).=~ '_In '~.lI.tlrative loolh aboltt pelf _ [IU ."~ pa."ilen'[ hav . ~es~ons~hese in m u d e p)'(I;>irma~~8w t~n s a non -speeifie '!iD JS lE :u ,i eru ptien , 3 :l:DJ d_Y lemlla Dipieno urn - : 2 J j much m rel _e~ lL ruc t i ve :tDtl,djtio in wbiclb bUffcr~~ing,pus~ul are fumted Imj(:~ ',ben' rea. d n f pn ueea .e uli:::er'5. The esions m l J lL W s J t : n u e are Itho-cgilt to be f!\,ui\i~~JelDtto thes '-n 'I ! r ion an a. f r[ . e r r tiv e l d e s c r ; i 'bed . I P !os[,omfui' _ ' \ 1 ' l~fuu!~S,jj'Il' p y, > to ma U 'l i..langfi ne u r n ~ r e peed" 1 ) > 1 "11 1 1 " , " ,,II .

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49/97

'Peu lz- JeHPer"~ rs' 1 : d r 1 me Imefe is aoom:dary IdisEnlhution '0' . - I a n ' iiema_cuI Lacross th c bri,d ' , I ' - : e me " .

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51/97

'4 8 , lfiJJ [his, p~tit ':nl[ painfu.l ol3a ulcers w~re'Hlil:!~!J'I.--i~u'ed ' ~ i : I J h f o l ~ l C ! e :d d i c L l ; jf I t, , .

~ , 4 , ~ ' , r ~ b i f : D ~ n1 8I~~_l1i;m~ , B I~efieie:rl~)ll1inIY'5~IOlf ]~~d' ~ni ' lul~I ')r bl'r ~he p(J " IeSe l loe :oJ : 3 J. s(t i t i~~ 'tO~.gll~'=i 3 i ~ b 1 this ca se. The '[jed sore w~,gu~~\ \ i i . f j [t~ ~ m ' f l- o p ;h J y , ~ ~ ' the ' p ~ p i , U C I J e : i~ often pfieulIU iAp ern ic io u s [E lJ li ii t l 'l 'mi ~'Uiidt ito ~ l i t e .ease I'IllL!lIIsutli~ed,., i .I.n.piar dn~:iti[lis is a lso P I 1 1 : - . " ': ~ tlib~_)JIlli5~ ber ~ ~ a l i r l ; l ' ! \ d H, l lr e la r t i\ i' ely U llm _o o gm o~ s i I;]~~ i t 1 1 _ 'been repened I~Jll. rarely, AJ1~ U} l ll I\ gh . I li te easei l l u s l l : ~ - a ! ~ J ~ d i" 0 " ~mid~u;s, 3fl119;~rm~a f f i ~ ~ ~ [ l ! r n m ~ d .berernembered [tha'l,8 l ; ! l dellci,e:rnil: ' 'ma have atbelT'aeli,O;lo.gi .J!' f _~~ ures 1 , 4 Z ! , 14.1h :[44, ).

: 4 2 : 'B n~ ;-'-~ '_ --'-L -~ _- - ~ 11r l .s~ t i~ f1u , f f iU I l !~m' leds;u f fered ~ - ,~~iex: m aleb scrn -,. ~" ~ _dmme- t r - - . . . . . .: r ' f : $ ~ : [ _ i lmU i g ~ n m~cl1 I ' ~~~red Sf 'ru l l i11 l l 'ollilte ,~AdB.~,~~~f~-I~_The peripbe:m I --~ d I fUm,Khowcdma~l fOCy' IJ-~ ~n-a~mi>a , a ft td [!he W8RlOW w ,a ,mega.hJ~~~:ic. .-~-few, a sa J gene~d l ' t~j~~~~uJce:r,r,ni~ll ,and ,~;g)i~i!i is . -

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1:-7'.-, lal A lmn - l lT I , ) ,du id J ~mlia. I~ Udspa'lient M l J a ] r n ~:y.m!Ph~_ar~:Iiik,e:e~ts h a ve been1 3 id 11 l i r l !M !~ S I l D I o c U : l i j n c ; : - c ul~dJ

1, , The ~~f IDpb_omjQ" 'U~c lepoS ' i . t s p:ues.eo ,i~Itoo o r a l r n Ij(O~ ~ a v ~ bR)_~O dlllWfti to t r r u i m ~ 1p ~n . ru~ ' f : I l d i pef5iiS!~)~ntulcers,

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: 1 ' " " , ~nan ex - - r a s e d ,(Of:m..m-iJ1 k ed - -u bi i n g u a lart I~J- ~m}f a --i 0 " 1l1)~rte~t 11 andperipheral vessel ineom - re ce,


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[r'g-i duee C-~ - - " " . Ies in . . tinc . 1 . ,d i D I : c e,.~ .~ ._ ic !-:burns'~S~I ~1!iWl1Ullque.~b!~)Thm, de_rlDS'tl[:alU~~:, . re~~u i \ tC I } - fOl~~d.e , g w e e ' 1 ]memia.1 bum of the [On.gl~U;;'," l i f t diarn~,gl( i i~tng]alilg,effi due ~o d ep 3p i L la h o H. The: I~ion W_ c , " "caruI- d b)l the i~ :ca ud ~m IU~ of a. pipe~te ' M . f I W ha dJIIJ~~'m'lll lJ j~o n 0 :: . 00 ' ~mhydwo: t ide- Con tae tW~ S I uarntS~~nt~

'b _ . C lh lmL ita li -um 1011'blq,;tlle' {RiOt tlie81iOl ,n~;mM"eam; nts~ l1I!~ more' '''Y,~f;~ burn __a'l;;c aused by th e ~ea age o f a liOO1' C3~id sl ie:r i l iL l f iD,g. a~en i [ which '~Ia s bei ll ~ 1'in I~ontae~,,-rim the: l l@ n g u g:rol."~nl~ 't~e- H~a.lin.g.:as s l .cw -"(b,Verli l l ,perioo0' some tWD l . ~C ' 5.

(,I ,. '. - .E litn 'hlllm The It ~u koph.l1~a.'I'k e les ion( " t ra~ufa ;c ter is l ic t O r ( a s p i rin bu m is U 5 U iB l ~IIYm en u n' the i~u eea I S U leu '"elese ~iQlItca r i ous ' tO O ' lI 1 m , . Such~l Ieion CJIn ~ i p i l i o o l l ! l l c e d I")' tbe' dhs~h'~n.g_ ,;]i. 1 . g h : aspi rin-ecaea i ' n J r ung 'I able' l , in the area"

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17 . 1 \ ' 1 Jan~j pi ,.ntsJknll - . J d " ' ~ ~ " " " " 1 I l 1 J.r f n h y pmd re fl1 aH .m n m lim o ,'i po. maoa p pea r 01'1 [h.~ .. ~Il , ~ : r i I d iom the 013'1 a,uco: ilnalmost an.' ~~~,~n rnus pane nIth e pl,gm$n'[~Jion.'a, co - ned '[0 the rud~e o l\~mrpl. ofpi~l;'m tion of ~ .ara!lmucosa of nan-endocrineri,g in~ . '., n i fi J~~..1-,


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64/97

The' s ert n l e u l k o p h a ' k j i a , fv.rhite p ll th")1 i: a n e m ' l iW " c ly . ' le:5Cl l ip~ i i :e ,DiU!, , t iJ l idilW ' . used p r e ~ v r n o . l J l S l , } 1- '0 ind,ude tlli .e fi!ILI1,ge 0 'while h~~ion~" 'Jf '~heoral mUCC l . I~ H'nr~~c'ller!,it isa ~ ,erm 110~ u .e d j 'n:re srricted manner , 3 1 C ' , o ord~ n . l ! O t he ' d e: fin i r~ ,OITIll p;r.i[JJ:W~dby iP i n dL. 'r,g: " ' , 8 ~vb~i'[e p . a t c h l on ' ~ : h : eo,ral f l m l ueosa w t d c : : ' h can Dot be ",-f~p d 0 ,Md ~ .not us:cep 1 tib1!e to aj[['~o m : h e ' : r ,d in . ic:~. I !cliiilig;nos is~~lndl is 'wa~'"a r u a rge range 0f \!r.fh~t~esioas, '(lu;h, ill 'Ihoe e r r Iichen ,P l~nus) are ' !exci l ludJ: ld '[ruml- ' h i p r e c i s e de~ mitio n I see ' f i : g t J l l I " e 'IMJ .leillJ~opW ak ia ha s _'01 f f iong b ee~ con idered a an ~S'sen'wa]], ' pre~m~' l rug f . ]Jan t ~o,nd i lW OEl t~ " i['h m : h e ;;tdo'p~,~o:no f iP in d -'. :[S~S d e f il f l~ r , i ~ 1 m J w~ r i , c l h .rol l fJJ ' l .a~ns, :0 ,0 e e.,e:n.~ o f p r F O , g n o i s 0 - 1 ; 'hh;[,o]Q-irc~1 m l P t ~ , [ '~ l i ' ti , O I I T l l S . this in l le! ip ' ,reJ,3J' l ior tW, can 0 0 hl~gei" be aceepted as be~1 [ rue' in idilC..a~5 or, even, 'i n th e ma -'ori,l Qif ca;. ". The tenm Weu o p , 1 il' ta rerna -n Ian el ! , . t~ trem~ i n r u c m ~ oneillnd i s ,;ene-ra,~ , ) 1 accep red as, in r p W y in g ,3, le5;iOml 0': ncn-spe~i:'c ~islology" w i ,m : n !~',~ r i a b l ebe'ha~'i:l]'i1r' pattern hut W~I[han U 1 o p r r e d i :e r ~ : 9 l[ a i~ e ( 1 b 1 J '1 sl[ali;sfCIilU)~:1 essable] uu~dency to .ma' i i g n a n r '[raru : f o r m , 3 J t ion. A ~umbe iii ,o f ~esion 5 have be,en fiecQ.lniS'~d,~ h a,ving ,a -dm_e : r : e ' ~ 3 1 : ~ Q J nbip w i,d ] Ie u I ,P1a k i aIlk 'the ~are also ~Uus't f : ' l :U1ed j n "be pme5eillleC[ in.

~:~, l,,:~ul,~telfiiB Th~ is l J f u : e ~ IIle'rm used I l i OI f : ri~ a cOfldi ion b n . ,bt~b the oral ,m,ucmaa J w t d . in pilf:1icu.iI1i.. l~e' b110cai M U .O O s a . p e e s e n r sw~lh ill , g r , r e y ,3,'ppearnJilOe~ lrariltle!'[ as if a sup:iitici.a IfU m Ui . 1~ , fe I , y i . f i l l ; o n . ~ h ~ ~qJOO~, i_i~lf O p : i 1 l l li i I D ] ! IvU}' (]JOOi.H1 ~ 1 r i s o~~d i t ion - oom e eolDi5t~d~'f'it 1 mb e; a aormal I~mding '" ,~ hlle o ~-h er s a sse eia re ~~Mth 10 .baeea smo :ing, Oae reasen or theeii{trlerlle ,,'~ri~bjli;tym ' i :M, reported nrt(.',id~n~,..' w e , c o n d i lion in d : i f ellen t ' ' ~n 'Ct '& ! l i m iI,)r " , , " ' e ~ I : ~th e dj:ffi[lJ~t, iii it s v isu a l il ls a t < i o O W I u ud il: [ c e r . 1 m n_ n i J 1 c : i: d ~g;h~:mUl r nes . Th~ ,pa ' lh :n ' l W W . h .l S l lm ted! ; , V , - ,3) cila~l~ '.~k~r (,30'dwt) and, a! S ~ 1 ! i j ,Rllft'riaib~~yhe case. 't~c'l:ie.i'e re ml 5fJnPlo.m~a J W : L l : i l li J ll .. u l1 L b ~ e L i ll da;e ' le lLk ioof iem3J .

~ '82 PR ~iUI.ih, - 111.15 is 9 . term used lDd , ' s c - r i b e 3 1 d '. ~ruse'w h r u t e ~ e 5 i o n D f [ 'i n c ' 'm IU O O s .a ,less dense ~~d 1~~,w ~U',~d than l e ' t l i ! ~'lIlpl~k.i$~U L '5 considered t~ilt 'I'~is mi I J r l s " h '-'wg.)' I$~age[ m J j we p rOOM t ;:I:io n of hnu;:opJak~iiI~The p;:uieo'l:,W ~-tn 1!e.ti ~ 3 J W 3 , vesr-cld o o ' ~ - l ' : rum i ! I J i W I I 'i I v~ ~ r"rj{h a ,~el1el l i_C8lU, de~'e,rmrined 'EemtD1.e ;RCj tDo r a l ~~u k iD p 13 km a 5 . s c ! i ! l ; i a IQA i m l b GeSiC1 l l~3 '~ca re tnoma and Il,ylMIs (p ' J : j j im3J1 i I~ 'P~I !Ua: rhyper-'emil) ,is,). : h " ' i tt l ese~ilie rr D b th~',rellc 1 . 1 . IOpj l_t . i i f isof ohddhood I ; ! J E f ~ I~v~nly~l, [it!placed b yleukopl '.'~Hill adu]i[ life _


65/97

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:~801, :LeulJiJ jplla .klia 'D~ tQmm~ ,udl 1.1!i~~[ fUu eesa 11\i lh omog iC n o tl'S f f ie u :k o ;p : na k l a ~ m ~~ h a rac! ' t r isd c si t e, ~luJ,," ' fe:d. c e ' l i ! . f~j ,gn 'S 0. epj'[h~liid~uypiuun b~ops,.The' , p i! ,i "i em , s :m :o k e d ]0 d~:r-enes d~]~' ~~ l t iUlt~r,ewas 1 1 ; 0 , a,~mu te evidenceof a ca usa l , r . e ~ a m . i o i J m i I[p o

1 SS ~t Ild~p; t t~d l - " , l~ g u;p~m, Thi~ , 'e ~irn n! l ) f I~he I n o o r " O f - 'I i I 1 I l D U i li I ' : rid 111O~~U'e shows [heso-called "~bJ !ung [10lep3nre rn , l t, ~-ralS [cnne:rlyd t a O U , g j 1 I - ' ~ 1--_l0~''S-llm ,as' t l I is w a s , oh ie l r c ' l ! l ]pn lenUl il i l ] ( r i g i n and ' 4 - r i 'm m ' O l p rema !m ign~~~J i ( l I t ~ fn i f ! . l l ,b u tit f~! real ised ['bat ~ .be ,oo~ i l J v i; . o 'l lm i lrs si'm!it~rte Ih:n 0; -lfilH:r h~mDgew~tL~ I ~ I U J IDpl~li.1S.

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I t~ .opla :k iia tlf - r~1'mutb nis,widespread 1 _ ~ u k o p l 1 1 1 k . k 1 o f' thl: ah l \eo ] i i lF mucosaand ' f Ioogj - ( lF .oIJUi ')!huw~d m a J r ' k ' e 1 epi~:helia~,a,Q'pia I I l ! I l l U l bioJ15~r. S ' I ! [ r g i c a J , e : l l ; c ! & i u n \ il i.ta5 me:reBSaty_The W f I t h e r d t' . n s e 'h~1U.1Ut! a n d . W 'R I . 8 !M J la .r .w rflll,(:e'isseen ,0 en , t~Dugh nom ru ll tva .n f lb' ly , . in [he'mol't!hls~o~(}gicD,I~~,[\~s~~\".!! ~(;~J-@M. A~ssme:nl[ ofprerna I l igna uru~po ~t; 'nrn i I l : ~ rs 1 i X ~ ible' only tBl f ierh l ! S t a ~ f . J t ~ i c a l Si~:udy_ cl iD i~ ~a~~&m~nt ,alon ~unre Ii~bl~'~

1l_81':,peeXlid I ukopliakJia In !;,~Clk:~l!d. leuko-p]jj~b~ whiu: areas a leemare with areas u fa r l r o : p h i : c re d epithe I j l lW l m . These b ~sB~ns:Hefreqaen tly ~ seclated Q ilb eandidal infecncaa nd have a mu c i h h l g i : 1 l er i J ! iH . ."i;d~H~e{if m , : d j ~ _ i J . n ittaflldunm~u.ionth ea n ~ mo ge n ou s le~ d;;o p l; jJ kw !" ,A . ~ ~ It ; ,1 iJ l . IP t i~ w i ' i J l I l a reeognisabte Clmdid3'~1i ~ f l hmt iDn ( g f the I . ; : p ~ I J I _ ~ . lr u u : m .and an lhC l i l f 'p r e s t : ; u r u ~ m g c~i]iliQlUy~~ijli;n~d a:o:u.;D r i3JU'oph~__red epimtn::rum (el}f tW nlmplaki3J) mesr be ru~~t~dW i l f i l h 5 .u s p i~ io irn~ h a v in g a .[ieLa'l]'VJel)!' b i , g , h c h a n c eof mal.gnan'l'!!::~~.

l~and l: d lW J I le u f t .m . p h l l k ia ~n [ m I D I ' S . ~li,~mJ,.s ~ i m 1 . i ; , - d~tb ~ - r i - o d l l c acid _.Sehif f reagenl. I h ecandid m "~udf)..~~'Ph3~3Ie' see n pe net ra t I ng .Ik e ou ter ~rl)'tts () la~ ~pi,dtii:'I,i1llID,Thi5 i r . I .~ 1 : iQ J r n , c' f t l r a i C Jesion 'S~C~'1lU1 i : n f i ~ n r . 1 : ' , I~)-

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67/97

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~! ,~,200> ~m;tF 1- - fill", ,~, Thisis a. rolldi,tio~w b J i c i l 1 1 IOO:_, vwnua l l . y exd!UJri~~y ; a m o n g in-oob i~_; l:$ ,'O 'W ' n d i a , , M a t i i lJ s . i l lJ , ~ : d I ' I l ~ r n : i ' f ceuatries,Dmse fibrous '~H!les ~id d~ ill the Sl!lb:mu~le : r .ud i~~,hl a iIlindwlilg d , wn of the 'Iongu:~,eda,resnl.c non i l i l mO!!l , th o,pen~Il!t.Th,5, is ' ~Uow~db s .au-o,pW c' cha lm~ ,es , ill ~h~ omJ e;pi - he l ! ium\ \ ~ l i i :C : ha k e s IO n a ,maJrb~:ed ,appe _q_[Jce". "iUao~w ~ , ~ na t k l f a own . , i.~ ceJ ;~ ' i nu , t '[0 be a , pm-e~'maH;g !J ]3Jm,1 o o n d w t iO~I. . i[ Ii~ ; u~~S i l ed ~ m .UlUl,'~ f l fUl ' l rnon o :f the : al1:ecl,ed ,e:pittu;; 'l i~JJ] ~ 1 l J 'ledap,1alcia and th~n.I[(!I,,- -~Ol:l"lil may f r e q n e : 1 ' m i t "oeeur, Tht; I-~ of this ,wnd i i t loJ ia I is ~~I'k ~ o '\ n - h iy p ernen:siti:\Ji1jf [101 chi:l~[~ ~ ~ d otherspices h a s been 'SJIlJI~ Ii!~ b 1 ! l J J [ ~he e~ide:ru::e' isl t J y n ( ] 1 a eans j ! jo ] lc l iU6' i " l le~

. , , - ' . h is i l J n l J i S tt ; a r ~ ~ W h e :m a l b ~ l .t d ,_ pp i t~ :~_mce o f 'ihe l la:biaJI ,m'Y~~ ~Il sulbm l tOOWi5 Ii-m s is .. .

'Ill] 'l:Irtrek,,' /6-;' Thel~io!lll shown i f u t e r e :is ' l ]1 'p ica loh l l ig :cse: ~t!J~li~-I ~t.o;m;) 1 hee'k Il':~e _i~gIh~bil.h-"lr.e" -Ii . er 'ed a rea s ltd 1:C- se ![~IS' ofp, l i la l i I ,. d : e t il _ m e : d .m .umus , , ! i l lemb.ran~' i~ l ]t,mgw ; j 't l ) _ i : r n aage o'f [he OOCI~F- .~p ~ a n e 'of :l imc'~if!elthi w a l \f lW V e d L

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,2 . 1, 'hll.mfitf{r-\~in._~ ~n"'nm:- In m . h ' G S ~ - 'drome (810 knewn as the' Pa'U~rwfimB,w*n-. d t) ! '~Y fu ,1 J 1 i'nme.~ e re i s :a m ~ ~ ~ iOIii ~'lwe~pir on d c l1 J ;ie ~ anaemia 3nd d S P \ m ~ g i ; _ a . , eften,~ l ia tcd W i U l l i h e pre - ~nc t 1 :uf S J I ' I ,oom,p~3.~~aJ~web. There' {; s om;~n ~tI01ph)' n t~,e H~p~11papillae and, M in i lhis lease. I~ere m~y ~~areas lof l eu kop t i! l_ i a J IP:rese Il~ O'mJ jhe ~ol l l lgue.These 'Ie u k o p la ik . ia ~ have a sinister reputationOurrna I i . l lJ i l [nu '[:ruli\iS'~(!I'fm~~ion.

2 _ 0 ] :Rad.i!ionl a n ; - - ~ - III I h : uLlm~ ntl.[fi~ _ b ~ ,is ,M iJ - - J ! ~ ~ io n (bi' ~h e b l l i l l ~ r .: a .I Dm 'W Ie e s a IDf !'l,9'li~n~ 'w h had 'W1de~ne h i i S h \ 'o l~1fI,~ rndlia'l lOriWih ern p J fo r 3 1 RtlH;:y ' lum eell Si~i ' f :OOma.u n 'the ~hee~_The m.U_Q:UD , a p p " ' ars ~twph~(; 'widi11 p~k'hen f t hem atOll! are~ ! l , a1rJ.d n I!Im6 r{J~, dilatedca;ilmrie-..

, 2 M , !o~d i J~u . ' , " 1 ' _ . l 1~ .f f io ond l iJ i n .U l IJ ~ ru .nc lud l ; :~in ~ he 'p r' -'e-ri 't . C l t g . ~ , 1 l i ahh 'lmgb~I represents , 3 !o o m p , l e l e J y ' i"lo:Dill sitH r i c f r i l m lfOM)a 's s .1 J O ~ s ,a re the: 'sefua~E g l:amu h o f' I [he on~ ,m U.UiQ'S3' \ !. 4 r u : c ' h ' v a F J _ ] i } ~ h : r e e - q b l ] t f r o m pa t i ; ( H U [D p - a . ' f i . e n ti lI m J nwn bei r . .d J : i ~ t r i bW l f t l i { D ! J i ! n d I P m m lJm eu C le r D ~ rin ge,~es of miM ' s J~ l O m 3 ! l r n [ is (as,. ' ~ o r JftSitm"la; ~~u.riog; 'l~'H':~I~OliJ~~ ~f i G h ( ; : '~_()m[f.l~~1 rc;oid]1 'Ikeg l 2 L Q d S m~y oome in to more ~ ; h ~ 1 I l 1 u s a a l

~ "T"lIi., Ii'~.. hlP,mlIMliIDelDl~ _ ",I ! l! l.~1r ,~~l~ ~h. sIgn I '~1ruI l1_'!ilW~e"f~r~ is th e ,ilc:[ I U i a a . ' 1 ~I;u~,are rl-eq~ent - y mis-L ' a J e n ['0:1' , p a ' l i I n : h J g i _ m l : s I 1 : r u r ; : r n ' u res ,~Uljjso are of't im'rg,~JUmoe. in ,d i f t~r lc'nt i i3m dia;,~n~~,.

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_ _ l~ .~ IL h , c d l E i ' t v n i ii to I I I "~pi iii~'i~po,lyp 01 1 ' the dorsern 0' .he '[ n I l lt .e - , n ~ n u,! u.ai~c.


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~O(1 .m,lurc gt"dHl!tl-m The tlentum gfflIf:i~~l o rna is a ,similar le - t i lCn 10 m e fibro--e'l~hdis I,~Iyp, 'modi[~db}~dlie'morpllu!)J[l'gJcf ~~etissuesWidb~ ' [~e ~atu r e lOi( ' '[he imtilin [ I( in i l I ~ i 1 i I C 3 I s e '[lie. 1 ' ange 1 0 .' ,~ , de~t' l . ! lre )1 , A s in Ihe case 0 _ 'rhe' lib[i()-epBiihe~1.a polyp. ~lH~den l l i l l l f C ~~nulom~is ~ol1:ii;delie~10 be ' M em:1re~ b e l l U _ i , , p I I lesion,

,nt.' ~.bfill_' ~ IJ gf I The i!tr.OU ! C , P i L ! I l ~ ~ ' ~ ,It;; e w t L i ; r u U , eoa ~-.,'Iingfl m~JUlL~' r a n !J.hu.iont tm sU I::' tJ l!1 IIT1 ,'! .! ,\'Ssil iowlu' and oftelil causes [h~- I ~ . . . . . . ~p aiefl it: H~th~~mub~e_ T I L ' S precise 00'100 r aadrexm re d ep e o d i, :1 1 t~ru;:'d~g[\C'e() , rnaruri ly o~'1 1 m c ' ~ e siQn and OW l the presen ee eli'r~b~D{_"~ (),'_eQOlnd i t J rn } ' - _mf lammi l [Or_:{ ~ i l i uanges . For somenot, e : r y clear ~a5(](f]I the re is, a !pare In~eraneecd r \ e r n ~ h; p~t~C!A - aJifi l :ong tnrn)(D~' _ iIi, anepulis (4: W ) ~

.lot -_InDIlIS ,e,ILlU.5 In some ,u:I~~'n: . ~ . .gk~'D,o:~ the s}-mpllOm-,r;ree ~ e - i c m , -.;g 'J 1 !e~d to t l i ! i e 'P JOO~(riD n -o f u ID ilJ u sl; i~ re~ y3J~ge ,~p l lW ide~ 3S i ill[~.e, ~ r n l ~ Imt ioJ i1 l . Th~se a re p,r;a;c[~F~I)'~ Iwil)\.t ~UD_ i i l l : ~d , " heace ~~ond~riW )f ulcerated ~~,Qthe p,~n~ iR s1m nce~nellie 'sec rns ~~ be ' ~iue,if " a m i )" , pf;,~.r:n~:U n 3 1 r u l P ' O ' I !f ! ' n l. ~ c a I im l the 6 !' Ie lions:~J~h~h i[ nlfYSt be: re~ e ;; ml~'~d lh:lll~,'"~i1O!l:easica~ II~ ~~J! ' f i~- , -p !~ I e i i l . h e - l i i pr:~ma.11o r : 5 e o : J 1 li 1 : d a (\1 I m a , a l l ! 1 l '1 1 ! !' : 'a : tn ( ! h ! i s , s i : u : _ .1 1 ' 1 rF~


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, " "Q g - e- il if e g ) HU l U loma , n.b 1S a '\.~ari:zin~0 : ~he ~bf'Q~ ~ ' u U ~ , ln w h i :c :b . ~ ! i t ~ , ~m 1 u 1 ~ mionI i - te rem a ll ~SOiI:3Jr;:J.!!dj.mm::iJmuf.IC. ' 1 : ' 1 ~"i~therefere, a h~lhlCrecUi!i~arwn 'DJe i l ~ :and~ ~ S Pma .mip;~ \ l 'a C I Jm r come.OJI [han 'Ih e m ore c um mo :nfibm~, c p u r u i ! i : _

2 : ~ G i lit l l'el lJ ie,uUi ii ln ~he g i i J J l U re'lJ]1 ~ I P ~ I i s .the ,r:;U]Ulfi~j~IJlltissue of '!Alh i r : 1 r u the I~ ion iisf o nmc c l i l I l I I d u,( f i . ~ijIJ t1~ ' too~e:n ic ~omp : lmten 'D :~O n t1 istol l lgi f" '41 CKIm~f!;a'[ilOn 'Ih I ! ! 'L m ue , i ; s seen~tl,con ta in a ~'ati~b~enum,be'! '" '~lfmuj~inli.teBl! i ! ,dgiM~ tens 11 t i s is t p ankuma r l in lire m n _ : _ m a t u 0 0If o:m '! ij, 0 ' t lhe ~ ~ ~ i . ; o 1 i r u ~hi l : ID ,h~ ,rnOr.,e Ii:5;[abl~hoo~I io ns b o ae 'fcnurualilJn. 'miiJm oeeer, Gi~f t [ , I~~U~pu l id :e~ oc-> cu r r n w ; m : f i m ' ~ q l u e i f u .1 ' L A el l ildren .a feither s ~')I; Qi!i' ~n 'Womel ! l i l l c f chil_dl-lIrn;arillg ag,e'.- ~~emju.lI~S,,i lJ;,er:a Rh' a ffeC led ... .

2 m : ! : P a ,W J l f t L E I ,1 \ p i l i p i l ~ ! l \ r g r u l - ' r n . ~ nD~ an in-f1:ammaJ~()ry o\l\er,gmwt~ bl! llit :~ a r~!: I l . l e ~ i . g : _ m I J~p,ilhe'lilidn eD ,p ],a sm, T his iI ll u s~ . ra '[j fo l ] I ~ ' 'o ~ S l J c ih JO J _ ~~s ! t n Oft ~~ \l'~f:llrnm S'~df!OO 'O f a h e ! tul .m,~ue.,btu, it i mmonl 'oulIlidl ~II,' l :h~'junetien ,~f th~ha r d 3lM, :son 'P a l l, ue ~ 0 ral l l'i il J J il lm l nm~ do IiIO'[hr.l,\1;': ~ h e t e n d e n e y to m ~ H g n B l J n r u r u :r,3.MfORnaJ110lrnJ,lllo'!.l.f1l by those in the ~oweiljgut,

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,J~).2 :1 ] P piU omlM J, 10 ' ( ' pbl Im~~ 'I , I i IM~1I ! I r ; , I'\ \f he[ ll li a IP-Rpih:unB WO~ , beloVo, '~he6uiflg 5l!irl~~D an u,pe.~denn..l ]J,e m ~ 'Dften aUDDlie;5! :0!~~ne[g;edd~~i' e ann ,hj!ib is compressed ~ntil adepl ' ,essi 'ui l l ml~e; pa h l J mu_oo~ . n ~ ~iol~id e v e l o p e d m ~ . oa , small b i g r n g : e a ' , I I J [ w:lil tid"~be'fI'ap--f -ce' le iC;I mal' be' d.i~placed d __Dwar .ds .: 1 0 1 m ei r U ' l lt id l i ts~ ~ru zdP l l irjoll, t hese ]~on Jl1ai}t~ le;a ,s_~ )~missed OH CU f SOfJ )' &1( a 'mu~na ln ;~mul .

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1:[4- , J .~$ '\-I'ir,aI watb, Th ese i3 Fi e pa'p i~~'oma,-~Ilkeesiol l tS, .ruc~eeeu r l i n respease ,[0. in1iCc'C~io~1y :a ~cilc'~, ru : ! i~The, mmm: OOmm,[H:B - OOCur o n . ' ~ ~e ; h a n d _ ~ ~ 1 L d ' f : in,gen and m _ 3 , y 'be [;ra"i&!ilmi,U!~d, a .in t l b i s , case, '~U th eoral Im~~o~O~'~i ,psb i ' y b i t l i m : g or che jog ' O I ' l J .e5e ~~i:g:ns'.U~U~~ [mt;;'p ; ! i I p~ t l om~Siv~mJ . an .'S ,t u'\ c ,I W - n w le d .~i ic U J l d ' s .ponU i l oo ~s : !ie 'SQI~ t io f fi ll may lbe It':~[.ed witb;iw ,a ,year~

l,~16 ~nmm;li: miDI 10 1 'ImD ' IU - ' , A n ~ I j ; 1 J m na t ,oysIe ions . . ~~~h~f~,f lin: Ibfoo,d vessets Om ' - o f 'l~~l;mphiJi~e 'v~~, 'j : r r U l i y '(3(iCUl' n) here in' 'Ih:e

!I ' , ..-:'1 ' 1 I f - ' " 'V ~ ~ - -)i-] t st m : 1 C 'on,u, m l ll J ,l id O J 5 3 iiUlumay n e n a . e m j j j ! l i a i a .m .. _ljfit:a~i:m~'fr .m~J,~as m tile , P l ' i e s c : ott i~ma aee, ~hDWev ide t ice ' o f s ign i t - iean ' l ellaaI(ig~lneD tEven 001 ~!~'is by' ,,-,0 m~al'lS certain. tOi l ( t~~ :t~!D.RSr e p l i - : f . . 1J. true ;De~p~amrr:lS~ .~ 'm _ a i " \ ; ' i I ,1 i~n be [ l 1 r u ~ u ,Ih~ , a re ., i n fHJ~l.hmTIafljCJ,nuus~del:EOif:ig,,~han.~~i F i , I lhe " , ;, ~sc~ l . n rd~~nn[~s~se,eigulre ~S4).

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, . 2 2 4 " ' a1if'imo 1 0 1 ' :!d~ = - L ;[r . This ~s,a p .] ~ "c_m.'11 l es ia e :[cnd'n' r~ t n , buccalm u o c : a 'i n d l tlh~ flo 'r"iJf~1IllI1.l t h ~ n l h i C3Seul~el. 'in " miftim, IIand lli L e s w J l r u had be, nmeta _ , e m O { J f a deDl~.g're ~lIiliJu]om,.

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D6, l .~InDwa of . -1P"ild '!~nImllb 'This . Iesion0'( Ih e fI'OO["iCif-:mo!Jw, wirth i 3 l i m l l l ~ l I:H~ns i - c~ C: I ruinIlhe al~'eolmmll!tw~ .~'!iid~~t PJOI:I ' i~&ed slIIm-c i e m , t ) .y , . 3J ~ H l I R s , sl l !age. ~O' c a ~ r n d , i } g m p f i a . i _ C B ~ I D yderecub: le ' beae loss,

.2 ,2 ' .. '~j'dftD'ma, 1 1 l ! ! ' f 1 . - Rlimlln ' mUJ . _his~ e : s i [ i l i n . in een trnst 10 Ih3~:O ' f I f :i ~ ur e 2 ~ ~ 1 ~ wafS, a c s & C i c i a l l : e . d ~,~~h:g!lilO~ ,d~$~:fiI'C't~,O~1 (j,'r th e~l ldeiUi ly i l1g: ma' l ju~ ILb~e '

.2 18, '" id -pf (~d ~~niJjma 0; ol'1llll m _GmsBThis ru i h . i s ' t m l ! : , e " 3. ' S : i " I U i l i l [ l i 1 J ! 1 in ,; hich tl~e'K ~,' ~ : -despreadn1a!ij~iUU.~M~g~ o-~ r : t he . ;pilhr:Uwnf inuS!ll~ ilhewhc!e ora I Cit\i'i'l)' ri :10 .Y - c l 1 easesi:idi!IIw'I~.w d e tenulne 'Wib;~l'h.er 'mi5 ~FHeseli l" l:r5,b'a'lTh-sfDml~rlic:~f a IPf~~lis'lij].g, leij ' op lak ia , erh _'b . 'I.. I~ . 'k _ -~i i i i ' : : : IA~ . e r n e r [J&e~a][:m n a s ~ . f l . : : o i ~ ! l . (::f '~I! ~ ~r~y_~ ~ ! ! - e l l l ! . . l .0 0 r " n i l i. t J l . . 1 ' 1 . w o uld a pp ea .f'o ; l li u J o l ! W e l l ', e . r , ' lh i l l : t 'so.mei : o ~ ' r i i t r S i l C ~ae ' . , o f ~t3.bi.I~~.of dil,~oral epi 1~;eHu_mjj, i_nvohted . _

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J~rtI:'iondistan .


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, ' 1 . . ' . '~mn'U H I . m U O O iL I " i:l' a ' Iy.i~in the fl r-u ~nl l I ! J l h ilIl d . rising ~m une 1l~C' l i ' \ / ' - I}l I:~ .ures 1 J R ' t i h i s , area..

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83/97

"he teeth are Itable structure ,and pla}f ~d~tu~1I)Imo part in rJlle~abo[c(f ease a ter thejr [finalC~ l e if i e . a t i0 [1 and ~n I " ~o n , It f o ~ iC fW ,. '[ h e r e ' o re , d I D ~ nU D l e teeth represetrt ' 1 : 1 1: cond [~io:n,) , I he~~u' [et i [ 3 J l d l e ' ~ - rume]ir: c a k ifiCiU io n , :1n enspted I~eelh ( , a J m d ' lI i \ - r it h ~ e ,e:'~ep t ~on o f c a rie s II 0 .dy DuO!Si~,oo l l r ld~[ io I . I ""I f f i i ' i r fb~ead lIn ~c ' " ,o f ~ee l~1b ! ! W b , I, a c e - ere i on" abr,d/s'ifin., c u . n ; I~ , f f ic n _ , SiEJli 11ca rn~ : h 'a.__eet the r u r : f 3 l I P l l' e a J a n ce . However j ex~rip:5 .e ,~it~j", 5 , m r u a y ~e; ac,q~'ied , a s ~'ifHl~'irnrinsic CO[Olfirur~olilo f 'i ndi~ i c l J U , ~ l (,eetb~Hsua ] Iy a s , '[h ie result 0 :: '~Ia.IlImJ[Ja.'~I., , e~ide 'nt ' I . , fn leeeS3.~ w h en co n s id e riTI\g the rela , ~ o n ' h'iP o f the Olr~I l~iss!ues [0 gt':'ne'raJ is e ddisease ro r ec cg nee ,3J ~ i:m ,'o ':m :u ) lit i:e :,~ ' tooth stnu;:ru.rc~3lnd representatiee c X 3 ,m : p ru e ~ ef u~:elbMooi:fied b , ~ ,ft,mir; ,~ Ib f : tO ,r inH l l iH I~rne.are U l m - l . ntl'~, here,

DI'i' 240 Ab_~li 'mall il~~_ . o r I~' illl emlPtitllD(!tleid t 4l:, " w i d,Y,~:-1;- _'i~ ~I Te~lb m:issil1g, f [i 'o:mrube'~rnormal :place r u n ' the' dental a rc h cou ld havebeen le"'flmLtI~d~ma,~'be Ir:\olllen iudJ, abse ~I['or'..(Xrh~P'51 b e ' : t ! !l i iH! 'rup'~r:d. , ~'n ge~eral t erms :p~ni~Iarrodaaria i t s , a p~ r d ' y local c : O ! n o itin~ " , , " ' i ~h no5,ySt~ mc' 'mialn i e l t3 :I~Cms._lH,D~ ve r, t J 1 i o i!re eM i, ~si i i , w i d e n ~ r nb n W ' ,o f (;cunbi n ed lJn~~~~,aI~C ~todt,;rm id,~~pl4,js.i~~in 'W f hid l'l 1 1 ~ ' l ' ~ l { ; :I~ areeither m u m i [ I ; Q g O D T of ,iii :re:la~i\le~.n m 1 h ' V C ' f o r m ,I~ r r u n '~h i~h the re a re a h R o r m a J r u l l ~ e 5 m l ~bee r u p ' l . i ~ U i I JI~f I ~ .h e I ~ e o t n lh_ T l Im , ~ p : I ' \ e S i e n ~ . i 1 r n u ,l:mlh~tI J i sl o , f , a 20 y ~ { ! J w ~ Id r:.:m~'h:: a l l l \iihic~, I~h~:1p;p~rerUiii b m D m u l ' l w w ' ! I ' ""\lS I j ~ e l i fe'enw io n e,f ~~I,~ l C a ) d 1 l [ l ; a : ~ , U l Steeth , In [ael l . , ' th is db es , n o ' U represe u n ' ~ h e ; ~ ~ ~ ,of pennanarn teeth .br l ! l l~'~on [ih;eoom: tr a 'fY . . t W i ep r ~ ~ ~ n ~ ' 'D f m.an) ' ~4 i I ;pw:mumeml l ' J' lee~fIruwi jg ich.[o.g,e[!he'r u ~I[hE.~,~~h,o f [b~normal ser ies . .~ i'ema: i[1Unen iVpF led . b~ ~ le i~ :r aJ fii a J d y - oo . .[w$. Ilbj5denra i i1 1 lbl lmlO. lmj) iI[), i s a s so e ia te d wi'lll. d ef ec ts inm~mbromu~: boIiH~'l 0m18tLC Im J w : b i d n J , . ~n ' r l m ei r t um~lea d 'to bos..~i ig 1 0 0 f ~;h~ ~m' J i u~ i ~ones and IIdefieie n e in caIcl l i f ica'[ [ .i i i O:m' e ~ e l D 1 ~ompl~ I I )~albserntlee 0 : the' elavleles, ne re are m~mly~cfg( 1 ' ) f id ] J t i 'C M r (ll itnly af _ O C I 1 f i n g ,benesand '~ c e ~ l l - i L f f i r u i . S 2 : 4 0 1i s I P r o l ! J~ b l) f 'tlffi~'b~'~ k ~ g \ ! ; , 1 n _


84/97

. 2 ; 4 , 7 I, _ l 1 1 ~s lp , t u ~~m, ~as,~ n 1 .~ .m ~ II " 0:[ a f 3 ' m m i ! ) 1 all o ~ whom J i ' quy . "~dIde~~ino,g;ell~sisimpri'e~13.~_aryiog degrees ~ : r1[) i.5[eo,genesi5 " impel" I t,~ , . , and b~ue".:_e ra .

m I IY ( H 1 . p l !i s i :3 : d n e 1 1 0 iMI~ililml 1 l S J ' a J lJ i s o r p l : D J l] 1 I i l J g;ene~L n'~ltritiolil,id 1 f , ! J i C " 'i'S pl~~ ,~ern) 'Uldewi,e; in ~h;eprod i i l i c b a J[l0 ' a[uu;o r : r m 3J ~ i t i e s 0' Id\enl~I"[issue'. In ilhis mre a~. ~helilew~s a majnr. a bn@lnna ]~~} 0' c a J c i u n m iDbsnrp~iom ~ .. 'hC( : . t~q t !enm. d l ~ f i c ; i ~ f t l i ! G ' i m q l the t d e r m l l ~ a , 1 tissues asy , , " ' e U 3 i S . i m J Ilhe b o n e s , ~ " S ch o u l d be l~ m p h a s i s e ddiul ."tsueh ae '1 ie 'Iogica 'I f :ac lo:fS are ei' i:lJ'm e I) Ira re .

" 'l lh il il l' ii ' 'l Ii ,;Ii !l , "Ii d~"i Ii -"l~~' "!ii,~~ . ,', ...,"" ... lIIf....I , ; ' n . " " , cl:"""'oiimD'.~:iF.t! ~,! Ii It~1 ,~JJI~1 Q~.~~.:JI Il,Ui : J i l l . . , U!HE 3 1! i. l1 _1 .1 : _ ~" I lbe~ teur.acycl i' Ie ;life a dm i [! J ~.'~red d l r r i i i J l . gIlbe ~r ioo ~f tooth formcation, stilliming of tn ~dentine and enamel m3 JY OOCUf'. fie' ooiCllJlrnplr'tOO~ ~fe' v aria ble a s i dn,~'i,fiIJ~~'Mil . 0 :[ ' d " n ; e ': n a i : r n i n : . . ~ .~ n 6 , ,Ke ,ml tb [I~ is d __ !J5~ y , c ' i 1m:,s m a i n m , g M,1hi :d l l ' ,not a s s o e i a t e d y ii h ; ] l ! l i I ! ell~id~Ji~

h~ilm~3. ,~ , f .'the 'I:llO'ri sub ~"~ In IiItI:~,lSQ, B~,;. J 'variable. deg)l1ees of . 'bypopJ -i)am p reseOO]ltu t W ~ _ .~ re pm~3hlJ depe;6den~mare Oail 'd t I'lleifa~ d~e~ P[\~ [Dr. w,1l"c\b. e ! l! e l t W 3 . c y c lm e ; s , w e r e adMi ' rn isE~foo,dum en'~cll~ of U te t .em:u::Jt iine i.tsellL


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'i[ih' renall [[Ii . ~' nit ,~~ wim'I ..n m idfure d o . (0n phrotie s -:ndrumt;.

151,- . ~ Mllr~Jedlet;mc.ycliffi~s ta: imLI l ,~~ u 1 . lD epal[~n[ _ l i u i agrnlnw~oc [ .is ill lrn[e li n;fj lI iI lre. ~J


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( ee rul figure." i i i ' ~ ~4.I

jjJ!L~__--, I ' 1Q t::JmJDpli:'\ l ! i , f l ! b in 3l cha : le: tich e n 'en iQ tlhe

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, c m jc flit, os"mp~e' bone


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2 3 " ' 7 I-!,; ;rudlioarap~ r : 'Ik~ p~~i~,rd,>bon ,~Dr i g u f 1 e ; - " ' : ' 6 1 8t0"W' ob i i lern ' l i ,~( f iJ o : f Ilhc m Ba 11~: f )1s : i m w . b 'dle Done gtr~l'l'h 0 I 1 b ( [ - { ! ! ~5 dJS~lasi.a.

9 3


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25' ,

,of~h


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HI

The r :adJgg ; [3 ,p~n l (l i f '~ ~ pa~ielm~'silo .n ~11. lur.e 1 _I emo 1 [_ - ti ~h twOI d BSe m.a~1]lf a .bn c,p :md 0 0 . ~ in a 'h m~KiIIRe .


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91/97

1. I '__01".a phth 0 , "UlilZr,-til-nl' ~ lUi 'Z) [-4]1 uleers ,~Jl ~ o i m n ~ .Sa variab le - usua-Iy ,2-'~",mmdiamet r,D I U ration short ,_L l E S U ' , 1 ' 1 1 1 - da ," 'variabJe: I lee reno eS \ffi~ e' n o ~ 'Ibma t 1 0 , 1 1 ealate, " ea din - witho~.t :cw;s ,~I" ,

,~ ., ':' - , '~ r:' p fllb o ~ I ee;rtiD, figu~e,~,4 1 4 4 6 1 ) , _ a riab e Ilumber 'of"_J , dom.ina .aU, laf)le U 'c , _ ' f ' S 1 .] ] J . w ration long ~ ,ma' be menths,S(' ,e~ aIr - r _ e - i m l . D eral m " andoro~pb ',OlL Healing" -'th r f o rm a ':~Q< n +

3 .

, 'Q:CI~(JII,'_ d' Iesions ~ ,e I i . ' t e e..Of .s l in Iesi .Jl m !Oocasion~d ..I'.'."_'. ~Ijo' 'E J I l l '(- Be It at~I syndr :me ,I.

Dil ifBfl.O; is-m~in] b clini~11_-ea~_re,. S~ppl m n l _ : : _ r y iln"esf.~c:,ltio I,-Ih_r,je juna~1bjop'~~. /mpr r tlU;i't: d 'j ff i" en" f'iu l d iu : Ino ,Ca oci oma ( ' 0 1 ' m majar s b ' hoy !l~oe\t~ndin . ' 16C l i f t i (rom hClrPeufrum 'U ~ , n ,IEresi e lichen . 1 . a D l u sIf urn I( ;' U J . k : : - r,

(8,1 AcuteL

tmp ti ~ ijj' fenri(li di. 'll:O':!:lUIn 3' " ult - from e--,thei nll l ;[Jlti l !fOl""meIn ,chUdren- ~ om acute leuka rnia,


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2 . . b)1lb 1 ! I i i 1 I . :m u l _ d f J tu m ~ ( .t 5 .,g U m ' ie i11'"""120 .1 V esletes 0 1 1 1whole lo f oral l mueosa _.OIfben 0 n mOWlC! rn l P ~ Vesicles . p~dJ!.ybreak d ir t: o ~ ,o: r~ fW 1 j l i l l l 'oc'r5 ' w w t h crust.g ~ip"A mC~fi ' t tOl i i ldwi~: ion. A. t ta ' c : ' l cs l 1 i 1 i a . be ,rec",im:l~d, by ~ .var ie y o f ~~C1Ullg. iDf0C~iou,! ,dm.:gs,etc,Y !(J U i~ ll a d u 1 ~ s [C lomDl , i on~, ra f ieo1ed .

(b) C'hro'l~ic-Of Sui}\tJt;U'feJ.., Pieim;p"'., (figrvin:s,lOO~ ~'04.)Jadl:l.~~a.eapid~y b J } e 3 1 k i n , g C!o~mto ",}nn 1 ros~on~~ 10 1 : m u m s a .ethe r ,m uo ou s t m I ' I , e : m b r a l ll [e ! i , and s l d r i i a . :If[~['M(t 3 I U o f a ll I~S bc,l~ runmtl l l !Jth~: P f . 1 c d t J ,m i w u ' U y 4D_ fD . ., cm] "~ lds~Je-Msh, p ; : , r u U S ' I l i t S h a l . , _ e I b J g ; b i n e i d e i i i l ! c . f : ' . . P.roFe~ii~e d l ~ i s ~ s e .Di~jFU;Jjis _ h i: o 1 0 , g ~ ~ lmrnl (I ll f iOiogica -_ (im l 'm : t ! ! ! l r ! o B u o : r e s c f ! l l 1 I lo e ) ~ y ~ , c ' l o g ) ! o f b U L J l . a J ' E l h w i i d .2 .. l If ', t:mpJh i 'o ld , ( , f: ii gures ,~07:_. .Ur ) 1 R."'I31,j : \"e~~ 'f irm bu ll e, Oral 'mu c os a :3 llF eete d 'in Q~11~' .0 per

Ci~ :n .~ 0" pa tients .6 0 1 yea rs ~ . ,:_'ot a . t r i i 3 1 1 P! i ' " t ; ; ; \ \ " [ !h~ j1O; :. ' ' ,~s , l r~prndl , progressive 'Lh~.Qpa:mpbm,~S;. , b u t [[l! cu :n r en ~ .

3. Bel l1~gg ImUreQ ' ,m em ln l'a J D '. ~p~ - !l id l ( :f i( :gwceII~ ) ''B ' lIl Jlll a ,~oifmlleOUtS,'Mem'b:raJ1 RlP~:lIrimg,3JflU b;e~Ung 'willi ~a r 'r jQ1'IlI1~Jio:n.. A J f f i i e o t 5 : restrieted areas cspeei~lIt, SO( f t p~]ah~ andco r ru j unc t ivae, P :red omilltlliru u; . r 'em~de i P 3 ! . t i . , e n [S ( 2 ; 1.)1aged 6 0 y~:rs, + . . . - '0 ' T 1 i I , ~ i ~ _ I ,p f ie 'Va~emce~Rc,lat i " ' e : l y st~'[ ie bu.~ m i!i}~cause b l t D i n d l l i i l e s s .

D~:.n()\ds- a s p e mpil:igt u;"4 ,. DuU ' o u lifhD , I a n u s , ( f il lW l J 1 " e9 1 , ) A . r . e l t w ' t i . ve ,y:mm' :arialll~.'o,'flidl~ 'p,lalln!lll~I-:.a.~:fe a 'tF,~D!S~e~t.'5ta,le. : f r : 3 , g i t e bu J I;a e: rap~d.I(Jr \~ak iml dei.. 1 ~,ufo . eroS!tD.III., US-UilUy as~ila:lred areas (j~I[IOD-bdoIlWS, .lichen :p],3Jnus~

See ~dlst1,~:' l C h ~nm,3~i'[i ke' l1P~l i fo( i t i l l l i i5 I t fig'Hllu I. ~ I),Ep~de:(:rru:d)~8j~b U I U o . ~ i ( 6 g u : r F ,e s ! ' ~ IJ....J~5:)


93/97

r u . " Tnn, l !m3_t i 'C ' l kc :g I0 '1~ 1 ( 6 g u ' i r e 1. 9 ') 1 ~deruJ i f ied Ib , f : l : e I _ 3 J ' E i o { [ ] s : l : i . ~ p 1 [ 0 ' , i l iTit 'ill ( c " g . broken ~ O , ~;hl'A l_aJ be a so c ial[~d \\4,~behee "O~ i i ; p che W iW lg h b i l l ' S . . "oss' bl.Y as ,_ ~ia t, d - i j j j Iee ra t ion m

, 2 . , " ~ h ~ D l i ~ 8 1 1 h u l l l " i n (f iJ g u re .~ . lJ lJslI lI:aUy d lUJelo' alspwlili. a n d near' 1 3 J carious. ' I n o l L l l r u . . Au~e'oaset ,Thi>ekelu::d dense ~~h i te [p an ch - 'ma .~ fbe pain " ] W I I .

J. L~I ] [~" p i \ 3 J k i a (ngure ' s , I' ,I;'~] _-.d e 'ra ng .e o r C r n i n l c .a i l :p( f ,e~n,[ i i idol i t i is, il1dudi:f1\g ~aJri i '8 Jn n :b O r n i J o g e ~ o u s . . ' S : P c ,,:led I,fi:g!~iU1! - : B I ~ ,erytlv,opktl rna( ' :g 1 W l _ r e1 1 9 ; 2 ) .Sporm~am~(nws or ' ~soo i 2 l ! lEed , w~~lh ftObacro Ol;pl~ :UHI'-)'I)o r 'ca.~d.idai i lmf~cltrJiQII(l igurle"s ill,_'-I 9)m

l'mpoN(lnt' d-ifl~rentitddi~l~QJle'SF rOm c a , f . l d nom,~ " Hc:hen p'i~IUS.

!:k Lich~n,Iau ( E ' i i C l U r e s , : ' , 1 ~ - : - ) , 'RY p l T ' e s e n t asG 0 ! 1 1 1 ~ h . u ! n t . b~u~'!'les~o.~ ( : f j , g u . r ~ . s , _ _ _5:) a s weU3'5 r e _kil l lated Of -erosive I ' O o m S I (~~ev, i i rr iam1'[~, 6,gulresl _ 2 : , - > - I) e-

'"J:PQrIQl~~'~fff!p!i!1idal , (J j ,agl~'oisFrom acute p ,eud .omembr .~JrUJ! , i IS ,~and~d~a5i.sU ' D I . r 1 " , _ t s h l UT~g~.re1 . 4 . ) . .

See also:',.hrollJ ie dis.co~d.~UIPQ'( f i 'gu;re ~.lS)1Smoke r's ke ra~o\S~o f: p a la se ( l 1g . un~ :1 ._ . ) 1

' 1 . 1


94/97

m Tnu.a~ii'' (figullre 4.3) 10 f t! t ' U ) , Ir5S ~cia~ed"ri~h. . a J b . i : l r s . 1 'Ommo.~lf , 3 J 11 1 1 he I~ 0 ar [he root o'lTIie[I!1:Ulp! . Ia of rn a m '(Ii'l_ ~ am. ride-.'E . m f r i n it (. , m g . . broken to .~'_)_

3 . . '_ : , . - ,r 1 ,0 _,U'iQJIiI'_-,mahl'"j'c-l-bno' fill ( l f i .gumoes701 . , "~ l t , .~31 : - l4 ,1~May ~ e d p a p i l ~ ted,red , rul.ceralA, , o , r , - I' . o t l l Y n .'1 i I 'I l ru3 _ i O J 3. _ ; p - ar.a fi. I ,e ,~han, ..5, " II ~ :. see e n1 ' arion.

6 . A nH lb ioli' , r e ' I O m '" l I I- e ' ('ligre ,3)=. a tro _hic cand~di.Mi':, red and ] p in 11.1. : 1 1 , U ' 'QUo . in.~co u ..u ' I I : U:1'T3:. cline ,)D'l gnt JlSu _ . froR), hi Ilory.1'~ ~ 1 : lm : i ' i 1 in l ' . ilB (,g)ure

,ln~pOJ'I' llf til' r . nRQI dial 'no.s i .sFrom Ii, th opla 'i,~or car inoma,

, U r l


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.., R~:d I,pi . .. .. ..o: . . . ~n .b . ' I Jo .] (fi,gu.re' 17') D'~ffus.e~~II!O~ ~ntense ~ l 'jn,81' ae~-'; n ecu r i l W l all r a ce +~ -

4 , . ,

~. "faI'!;II 'nt milluDm_ I il)UUi~Z lOI) __ "-res -\~_neoplasm.~1'1)'f _C c ifuse n r - papuilar.Ma\ r !_ e amel n __ie,.

6 ~ D ru '- , , , , m d u - _ - pi __~.lI.la'iin H.ea, 'VJ 'me-tau n o' _ -~ , re~~-r ~!i i t iv,oled, A - f 1 I j ti r .m l a : ~ a r i a l ~ ; ~( ii, _,ooh)Ii3~~on0 butta~ , I n d p i 8 ! 'l a t a J ' lMu c . .o s a}l. a. n d o r n j, eo J l'tmoe; pl'i_ el _I-av, _ ' " t : n i n , g , o i f l a b i lOliO _ ,C 0J ll1 1mtonly [m,I'cared,

'"",-01"1: - if differet! r ia l _ 1 '~InQ:Sf!3,_,'_ali ) f_~ Ofir lU],om fl'tD'm a 1 . ether eate orie.s'ff.iDmJi h a e - M i I D ioma1va ri_5 etc,:_ee abiu.,Hbri ~]'["5' _ndr me f U,;Vfe:mehl~o,tit Ip ig rw eln a~ io D ma y ~uxompafl' o:r 'o U o _ _ ~niHmlIima.IO)f lesion.. h 111 ,

_ _ _ U tl f in ~ ic 'b : ill pl nus a n d "D !l _ me le .u '_ oh lk tB, b t ~ius lWla l dereeted hist !Cl fog i _ IJ l - notclinically.


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'1 1 .II. ill'l!u.li'lilJi , ,; .11 . _ I!'II Ifn -It ~,,, Il.... - Ii'i'~"i i i " ,n.~_h.: W . 1I.,a.;n~ : 1 1 1 , 1 1) 1 ," 1 :1 , 11UO' 11:n.-,, hidllow ~Jrer ,0,0 gin i~, I papillae, 'Destrucnon O rp ~ p E1 Ia , _1 "l a~a ,~s ;e~~~m p h a l d ! . \ ; ! i m i 'l '~pyre!l; i_'nsor.i ':etl c

(fi!g~[ . . ; 1 ' ' ' '

3. R,: uf-::--nl b ,,'rpe,,- '~ I_glJre's ' ,, : , Ut I 'e l-u] r lesion 01] or R ar m j p :'w . f i jde',pre:-.. Ru p t u r [0,(\ft~iG]e', nllowed Ib)~cru sting, Olf 'en reeu rent ~n!Pre '!pi:~a' d -; t ,U 'li_~,~trau rna er de bilita - '~.n cond~,-on ~

A s s o e ! ,fed ronditions - common 00I.-~ rare l 1~~Lrae: rnia,, up~p,re 011.,Immun -

~. '_iundiidiasi( _ _ I ) -_mk _,rd .~m uc:w ,~- " "" ~-r aDO~ _ ,ca__ r I j .,' ' -hl" i lH'ih I i _ : i l ! J re ' I ' . J _ h i r l e panche l(jl\l't!d ~~ig,awm.J I~ " , " - 1 1 1 1 , ~ ~ \ a r" . . . aJ[ tche:scontain aJl l l ld ida~ hyph' e ..(J:j ' , : u t i i 'ion, -

(b)

Ie

'IUl


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J~Ofe.~ala ' lgu ~aehe iJit is and med iaD , eraeks o lf [he ' ! I m _ "ma , ! b e i~fecH~dL $ i ~ : ' b e [ [ ;by cand ida , ,CH by't .a phy :lo e -o cr erli born I" figulf~s2J,~ '1 74 " .d) Chf .D f i i l l : b J ~ - fP ;18 'it tao_dEuam (c a nd id a l llteu k lo p l\ ' ill I ( f f igu r o e ~ 1 , : " _ Ap'pe,3i:J as a'~e-uk ,oiPL~k ~a~u;w .ogetiJJ u;s or~pecJded., CaI tId id : tl ~ 1't!1l~m'b~epHhe:~iu. The ro~e 0':[the'ca n "'ida l i s , 'naif kD'OWD. High pretn ~lign a n ' ~ ,po~~ r t w a l

See aJsu :L ess . 'c omm ,(j n I in~~C I, ive oond~~ionin eel ; : 0 n Ig u 'res ~ - ,J ' '.

Atlas Oral Medicine (1)

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Transcript of Atlas Oral Medicine (1)