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Transcript of White lesions
Dr. Ahmed E-lNashar(2014)
WHITE LESIONS
Collected and arranged by
Ahmed Samy El NasharBDS of oral surgery , tanta university
Dr. Ahmed E-lNashar(2014)
COLOR OF NORMAL MUCOSA !!!!!
PALE PINK
?
Dr. Ahmed E-lNashar(2014)
COLOR OF NORMAL MUCOSA !!!!!
Dr. Ahmed E-lNashar(2014)
WHITE LESIONS !!!!!
Mucosa appear white in color ?
Dr. Ahmed E-lNashar(2014)
WHITE LESIONS !!!!!
Dr. Ahmed E-lNashar(2014)
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 !!!!!
Dr. Ahmed E-lNashar(2014)
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
Dr. Ahmed E-lNashar(2014)
S & S
sharply outlined white patches, not indurated and has no red margin.
In cases of check biting appears as Band like area of keratosis
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Hyperkeratosis & hyperparakeratosis. thickening of granular cell layer acanthosis. few chronic inflammatory cells may be
seen.
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
NICOTINIC STOMATITIS= smoker’s palate
+
Dr. Ahmed E-lNashar(2014)
Sex ♂> .♀
Site palate.
Dr. Ahmed E-lNashar(2014)
diffuse palatal keratosis with red dots may be surrounded by elevated white rings.Clinical course ……….-erythematosus area opacification diffuse palatal keratosis umblicated red
dots.
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Epithelial HyperpslasiaExcretory ducts of minor SG
show Sq. metaplasiaAcinar atrophyChronic inflammatory cells.Scar
Dr. Ahmed E-lNashar(2014)
WHITE SPONGY NEVUS= familial white folded gingivostomatitis
Dr. Ahmed E-lNashar(2014)
WHITE SPONGY NEVUS= familial white folded gingivostomatitis
Age at birth .
Site
Oral mucosaBuccal mucosa, tongue & may occur also in the oesophagous,
Rectal mucosa Vaginal mucosa
Dr. Ahmed E-lNashar(2014)
Bilateral symetricalThe mucosa appears
thickened folded or corrugated spongy texture and a peculiar white opalescent hue.
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
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
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
HAIRY LEUKOPLAKIA80% of AIDS patient
Dr. Ahmed E-lNashar(2014)
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.
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
hyperparakeratosis
epithelial hyperplasia
ballooning degeneration
koilocytosis
Candida albicans
Dr. Ahmed E-lNashar(2014)
LICHEN PLANUSLICHEN PLANUSLICHEN PLANUS
primitive plants w resembles algaeFLAT
Most common dermatologic disease w affect oral cavity
Dr. Ahmed E-lNashar(2014)
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.
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
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
Dr. Ahmed E-lNashar(2014)
•Oral lesions of lichen planus has 4 different forms …….
ORAL LESIONS OF LICHEN PLANUS4 FORMS
2 WHITE 2 RED
ErosiveAtrophicReticular hypertrophic
Dr. Ahmed E-lNashar(2014)
ORAL LESIONS OF LICHEN PLANUS
1. Reticular lichen planus
•Most common type.•White thread-like papules •reticular patches or rings.•" striae of wickham "
Dr. Ahmed E-lNashar(2014)
ORAL LESIONS OF LICHEN PLANUS
2. Hypertophic lichen planus
•well circumscribed elevated white lesion.•Resmbles frictional keratosis & leukoplakia.•Biopsy is necessary
Dr. Ahmed E-lNashar(2014)
ORAL LESIONS OF LICHEN PLANUS
3.Atrophic lichen planus
•Most poorly defined red areas may show the peripheral striae. "
Dr. Ahmed E-lNashar(2014)
ORAL LESIONS OF LICHEN PLANUS
4.Erosive lichen planus
•raw painful ulcerated areas .•radiating striae on periphery
Dr. Ahmed E-lNashar(2014)
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.
Dr. Ahmed E-lNashar(2014)
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.
Dr. Ahmed E-lNashar(2014)
Histopathology of SKIN Lichen Planus
Dr. Ahmed E-lNashar(2014)
Histopathology of ORAL Lichen Planus
Dr. Ahmed E-lNashar(2014)
Histopathology of ORAL Lichen Planus
Dr. Ahmed E-lNashar(2014)
LEUKOEDEMArace Blacks > whitessite Buccal
S&S
bilateral white lesion w disappears e stretching
in early stages filmy opalescent mucosa in later stageswhite cast e coarse corrugated surface
Dr. Ahmed E-lNashar(2014)
Dr. Ahmed E-lNashar(2014)
acanthotic epitheliumflattened and show pyknotic nucleiCells of stratum spinosum are enlargednot infiltrated with inflammatory cells.
Dr. Ahmed E-lNashar(2014)
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
Dr. Ahmed E-lNashar(2014)
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
Dr. Ahmed E-lNashar(2014)
Any age gp
common in debilitating infant
Any where oral cavity
localized to oral mucosa
may extend to pharynx or lungs
Dr. Ahmed E-lNashar(2014)
soft, white, elevated plaques resembles milk cruds.can be wiped off leaving raw, painful bleeding surface.
Dr. Ahmed E-lNashar(2014)
Candidal plaque Macerated e 20% KOH
Stained e PAS
Candidal hyphae
blood agar , cornmeal agar or sabauroud's broth
LABORATORY FINDING
Dr. Ahmed E-lNashar(2014)
HISTOPATHOLOGY
Dr. Ahmed E-lNashar(2014)
HISTOPATHOLOGY
Candidal Hyphae in superficial layer of epith.
Superficail microabscess.
PNLS in epith.
Dr. Ahmed E-lNashar(2014)
TEATMENT
Anti fungal
Stoppage of antibiotics
Stoppage of cortisone
Dr. Ahmed E-lNashar(2014)
CHEMICAL BURN
Dr. Ahmed E-lNashar(2014)
CHEMICAL BURN
Dr. Ahmed E-lNashar(2014)
CHEMICAL BURN
Dr. Ahmed E-lNashar(2014)
CHEMICAL BURN
Dr. Ahmed E-lNashar(2014)
CHEMICAL BURN