White Lesions Flashcards
Leukodema and white spongy nevus commonality
Both have - can not be rubbed off - bilateral cheek - in young patients - asymptomatic -hyperkeratosis and acanthisis - intracellular edema of prickle cells Cells with clear cytoplasm and small pyknotic nuclei
Leukodema And white spongy nevus differences
-wsn ..folded ..spongy ..extra oral manifestations Vaginal esophageal and conjunctival mucosa ..in 👅 .. hydropic degeneration in superficial cells of prickle layer ..eccentric nucleus .. perinuclear cytoplasm condensation -leukoedema ..dissappear if stretched unless advanced .. common in negros .. grayish white Milky white Diffuse
Derrier’s disease / follicular keratosis clinical
50 % oral manifestation
Skin
..symmetrical popular lesions on trunk and face
..thickening of skin of palm and sole
Oral
..on pharynx and nasopharynx difficulty swallowing
..on keratinized mucosa
Witkop disease HBID clinical
-bilateral eye conjunctival hyperemia
-intraoral folded keratosis on every mucosa except sulcus
عدد
-appears first year of life
Follicular keratosis histology
o Acantholytic epithelial cells (loss of adhesion () cells due to cutting of desmosomes).
o Supra basal vertical clefts.
o Supra basal bullae.
o Corps ronds and arains:
o/Round cells with small pyknotic nuclei, a perinuclear clear halo and eosinophilic cytoplasm.
o Compressed cells with elongated nuclei.
HBID histology
Acanthosis, parakeratosis.
o Hydropic degeneration within stratum spinosum layer.
o Dyskeratotic cells →→ enlarged, hvaline, waxy
H/P
eosinophilic cells.
Dyskeratotic cells may be surrounded by adjacent cells producing (cell within cell appearance),
o Few inflammatory cell infiltrate in C.T.
Etiology of thrush
- newborns older than 6m and elderly
- immunocomporomised –hiv leukemia and diabetes
Site of oral thrush
Anywhere mainly
-palate dorsum of tongue or buccal mucosa
Acute atrophic candidiasis caused by
- corticosteroids and antibiotics prolonged use
Median rhombus glossitis is it symptomatic
No
تقسيمة الcandida
-oral thrush
-erythematous candidiasis
..med rhomboid
..acute atrophic candidiasis
..angular chelitis
..chronic multi focal candidiasis
- chronic atrophic candidiasis
- muco cutaneous candidiasis
-chronic hyperplastic candidiasis
Chronic multifold candidiasis site
Dorsum
Angle of mouth
Junction of hard and soft palate
Angular chelitis
Predisposing factors for angular cheilitis include nutritional deficiencies in vitamin B. folic acid and iron
If it was reported in dentuolus loss young patient it’s an indication of HIV infection
Denture stomatitis
Rarely symptomatic
Can be caused by allergy from denture material or poorly cured denture
Sites of candidal leukoplakia
-bilateral anterior buccal mucosa triangle tapering posterior
Dorsum of tongue
Risk of candidal leukoplakia
- 50% of cases has sognes of dysplasia
- speckled are more risky
Mucocutaneus candidiasis
- severe form happening in immunocompromised
- nails scalp and oral
- thick white oral plaques can’t be rubbed off
Histology of candidiasis
- candida shown by special stains of koh 10:20% and PAS
- hyper para keratosis
- Acanthosis
- hyphea in keratin layer
- mico abscess in superficial spinous layer and keratin layer
- long rete pegs
- chronic inflam.cells in ct
In frictional keratosis what might make you think its idiopathic leukoplakia
-areas of induration
- ulceration
Redness
Sites of frictional keratosis
- areas that our Commonly traumatised
Buccal mucosa at the level of occlusal plane
Lip and edentulus ridge
Why tobacco cause white lesion and is it dysplastic
- carcinogenic material like nitroson and nicotin
- high pH of 8.2 to 9.3 buffered slightly by saliva
Yes
Site of nicotinic stomatitis
-posterior palate
Histology of NS
Squamous Metaplasia of excretory ducts with keratin formation
Hyper k and acanthosis
Chr.inflm inflt at gland
One of the most common oral forms of
keratosis.
Nicotinic stomatitis
Etiology of actinic chelitis
Represents accelerated tissue
degeneration of the lips (especially the lower lip) secondary to regular and
prolonged exposure to sunlight.
Histo of solar chelitis
Epithelium atrophic with hyperkeratosis,
Hyperchromatic basal cell layer.
Basophilic change in submucosa due to degeneration of collagen
bundles.
Etiology and pathogenesis of lichen
T-Lymphocytes secrete Gamma-interferon which:
:
Epithelial basal cells are the primary target in lichen planus.
o Related to 2 factors:
External factor→ 95% of cases associated with psychological disturbance. (2) Internal factor (HLA-DR) major histocompatibility complex.
The mechanism of basal cell damage appears to be related to a cell-mediated immune process involving Langerhans cells, macrophages and T-lymphocytes.
Langerhans cells & macrophages contact and recognize an antigen in epithelium →→ secrete Langerhans cells/macrophages lymphokines (“interleukin-1” IL-1) which Attract T-lymphocytes to the area stimulating it to secrete IL-2 causing Proliferation of T-lymphocytes which is cytotoxic to basal cells.
Induces keratinocytes (basal) to express the class II histocompatibility
antigen (HLA-DR).
Increase rate of differentiation ( thickness of epithelium).
Degeneration of the basal layer leads to liberation of a factor analogous to IL-1 →stimulation and proliferation of T-lymphocytes.
Lichen
Is it uni or bi
Male or female
Steady or not
Bi in 90%
has periods of remission and exacerbation.
Reticular lichen clinically
The most common type
Numerous interlacing white keratotic lines (Wickham’s strale) in a lacy or annular pattern.
Mainly in buccal mucosa.
(2) Lateral side of tongue. Less frequently in lip & gingiva
Asymptomatic
Plaque/ hypertrophic lichen clinically
Elevated and smooth plaques (raised patches). Resemble leukoplakia clinically.
Mainly on the dorsum of the tongue.
Posterior part of buccal mucosa.
Asymptomatic
Atrophic lichen clinically
May be seen with reticular or erosive variant.
> The surface is granular and erythematous & at margins of the atrophic zones, whitish keratotic striae are usually evident, radiating and blending into surrounding mucosa.
Attached gingiva in a so-called
Symptomatic (burning
“desquamative gingivitis” pattern.
Erosive lichen clinically
The surface is brightly erythematous.
Keratotic component peripheral to site of erosion with either reticular or finely radiating keratotic striae.
Burning
- The bullous variant clinically
The most unusual form.
The buline or vesicles range from a few mm to several cm in
diameter.
- The bullous variant
> Bullae are short-lived rupture leave 1 ulcerated,
extremely painful surface.
18uccal mucosa, (posterior and inferior
regions adjacent to the third malars). 2. Lateral margin of the tongue
Extremely painful after rupture of bullae.
- Rarely on the gingiva and along the inner aspect of the lips
Do of lichen
- leukoplakia
- drug eruptions
Dle
Sq.c.c
Atrophic candidiasis
On gingiva — mmp
Skin lesions of lichen appears in …% and where
20:60%
Flexor surface
Is there candidiasis in lichen why?
Yes
50%
Altered cellular immunity
Ttt of lichen
- symptomatic
Topical and sys corticosteroids
-asymptomatic
Vit a as it regulates epi differentiation
