WHITE LESIONS

WHITE LESIONS

  • Overview of white lesions by Dr. Lana Shabur Talabani.

Erosions & Ulcers

  • Erosions: Moist red lesions often caused by the rupture of vesicles or bullae as well as trauma.

  • Ulcers: A defect in the epithelium characterized by a well-circumscribed depressed lesion over which the epidermal layer has been lost.

Pustules & Papules

  • Pustules: Raised lesions containing purulent material.

  • Papules: Small raised lesions; detailed characteristics to be discussed.

Nodules

  • Nodules: Deep lesions in the dermis, over which the epidermis can be easily moved.

Papules & Plaques

  • Papules: Solid lesions raised above the skin surface that are smaller than 1 cm in diameter.

  • Plaques: Solid raised lesions that are over 1 cm in diameter; they represent larger papules.

Macules

  • Well-circumscribed, flat lesions that are noticeable due to their change from normal skin color. They can be:

    • Red from vascular lesions or inflammation.

    • Pigmented due to melanin, hemosiderin, or foreign material.

  • Macules are flat and cannot be palpated.

White Lesions of Oral Mucosa

  • White lesions are caused by:

    • Thickened keratin layer

    • Epithelial hyperplasia

    • Intracellular epithelial edema

    • Reduced vascularity of the subjacent connective tissue.

Causes of White or Yellow Lesions

  • May be due to:

    • Fibrous exudate over an ulcer

    • Submucosal deposits

    • Surface debris

    • Fungal colonies.

Types of White Lesions

  • (1) Leukoedema

  • (2) Leukoplakia

  • (3) Lichen Planus

  • (4) Candidiasis

  • (5) White Sponge Nevus

  • (6) Nicotine Stomatitis

  • (7) Geographic Tongue

  • (8) Hairy Tongue

  • (9) Dental Lamina Cyst

  • (10) Fordyce’s Disease

  • (11) Perleche

Detailed Study of Leukoedema

  • Definition: Generalized opacification of buccal mucosa; variant of normal; identified in a majority of the population.

  • Etiology & Pathogenesis: Cause has not been established; factors include smoking, chewing tobacco, alcohol ingestion, bacterial infection, salivary conditions, and electrochemical interactions.

  • Clinical Features:

    • Usually discovered incidentally and asymptomatic.

    • Symmetrically distributed on buccal mucosa.

    • May appear gray-white, diffuse, filmy or milky.

    • Opaque changes dissipate with stretching of buccal mucosa.

  • Treatment: No treatment necessary unless diagnosis is in doubt, then a biopsy may be performed.

Understanding Leukoplakia

  • Known as Leukokeratosis; defined as a white patch or plaque that cannot be characterized clinically or pathologically as any other disease.

  • Clinical Features: Unable to be rubbed off; biopsy is mandatory for diagnosis.

  • Types of Leukoplakia:

    • Mild or Thin

    • Homogenous or Thick

    • Granular or Nodular

    • Verrucous or Verruciform

    • (Proliferative Verrucous Leukoplakia - PVL)

Proliferative Verrucous Leukoplakia (PVL)

  • High-risk form; characterized by multiple keratotic plaques.

  • Tends to spread slowly, involving additional oral mucosal sites, often affecting gingiva.

  • Lesions can progress to squamous cell carcinoma within 8 years of initial diagnosis.

  • Predominantly affects females with minimal association with tobacco use.

Erythroplakia (Speckled Leukoplakia)

  • Represents dysplastic changes; may be invasive with no clinical change.

  • Findings may show immature or atrophic epithelial cells.

  • Areas may exhibit red and white lesions indicative of dysplasia.

Clinical Features of Candidiasis

  • Common opportunistic infection due to Candida albicans, predominant in immunocompromised patients.

  • Types of Candidiasis:

    • Acute Pseudomembranous (Thrush)

    • Chronic Erythematous

    • Hyperplastic Candidiasis

  • Symptoms range from painful plaques to distinct oral lesions primarily targeting palatal mucosa in denture wearers.

Treatment of Candidiasis

  • Simple infections are treated with topical nystatin.

  • For severe cases or chronic mucocutaneous candidiasis associated with immunocompromised conditions, systemic antifungal medications are necessary.

White Sponge Nevus

  • Autosomal-dominant condition characterized by bilateral white lesions, asymptomatic and no treatment required.

Nicotine Stomatitis

  • Tobacco-related keratosis, with risk factors for malignant conversion in reverse smokers.

  • Clinical features include erythematous changes followed by keratinization.

Geographic Tongue

  • Also known as benign migratory glossitis; typically self-limiting and benign with no treatment required.

Hairy Tongue

  • Condition of the filiform papillae overgrowth contributing to an asymptomatic appearance; treatment involves good oral hygiene and tongue scraping.

Dental Lamina Cyst

  • Often asymptomatic; lesions resolve spontaneously in infants, observed in alveolar ridge.

Fordyce’s Granules

  • Normal sebaceous glands seen particularly after puberty; no treatment necessary.

Perleche

  • Inflammation at the corners of the mouth, exacerbated by irritation from saliva; treatment includes antimicrobial creams.