White lesions Flashcards

1
Q

What is this?

A

white sponge naevus

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2
Q

What is the aetiology of white sponge naevus?

A

inherited (autosomal dominant), may also be sporadic

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3
Q

What is the epidemiology of white sponge naevus?

A

rare - 1:200,000; birth/infancy/childhood/adolescence; F=M

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4
Q

What are the signs and symptoms of white sponge naevus?

A

asymptomatic; patient may feel roughness and/or notice white areas

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5
Q

What are the clinical features of white sponge naevus?

A
  • white/greyish white patches which merge with surrounding normal appearing mucosa
  • firmly adherent
  • no associated erythema or ulceration
  • surface is folded, soft and spongy
  • any area of the oral mucosa, variable extent
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6
Q

Is there others site involvement in white sponge naevus?

A
  • oesophageal, nasal, genital, ano-rectal mucosa
  • skin, nails, hair, teeth not affected
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7
Q

How is white sponge naevus investigated?

A
  • diagnosis normally made on clinical grounds =/- family history
  • biopsy if doubt
  • genetic testing for mutation - keratin 4 and/or 13
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8
Q

What id the management of white sponge naevus?

A

explanation of condition, not a potentially malignant disorder

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9
Q

What is this?

A

leukoedema

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10
Q

What s the aetiology of leukoedema?

A
  • ?secondary to low grade mucosal irritation, causing intracellular oedema
  • due to oedema in the epithelial layer of the mucosa
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11
Q

What is the epidemiology of leukoedema?

A

estimates vary from 24% to 90%, wide age range

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12
Q

What are the signs and symptoms of leukoedema?

A

asymptomatic

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13
Q

What are the clinical features of leukoedema?

A

buccal and labial mucosa filmy white/grey appearance, soft on palpation

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14
Q

How is leukoedema investigated?

A

diagnosis normally made on clinical grounds

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15
Q

What is the management for leukoedema?

A

explanation of condition, advice re. potential source of irritation

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16
Q

What is epitheliolysis?

A

oral mucosal peeling - shedding of the superficial layers of epithelium

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17
Q

What is the aetiology of epitheliolysis?

A

secondary to mucosal irritation by toothpaste, mouthwashes

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18
Q

What ingredient probably causes epitheliolysis?

A

probably caused by the irritation from SLS in toothpastes

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19
Q

What is the epidemiology of epitheliolysis?

A

prevalence uncertain, wide age range

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20
Q

What are the clinical features of epitheliolysis?

A

strands of gelatinous milky white material removable by wiping, no significant abnormality of underlying tissue

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21
Q

How is epitheliolysis investigated/diagnosed?

A

diagnosis normally made on clinical grounds

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22
Q

How id epitheliolysis managed?

A

explanation of condition, avoidance of SLS containing products, cease mouthwash use

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23
Q

What is this?

A

traumatic keratosis

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24
Q

What is the aetiology of traumatic keratosis?

A

secondary to physical (frictional), chemical, or thermal irritation
- usually friction when in the mouth, persistent low grade irritation/trauma to the mouth over a longer period of time

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25
What is the epidemiology of traumatic keratosis?
prevalence uncertain, wide age range
26
What are the signs and symptoms of traumatic keratosis?
asymptomatic, affected area may feel rough or ridged to the patient’s tongue
27
What are the clinical features of traumatic keratosis?
white plaque not removed by rubbing/scraping, may have a shaggy surface, appear macerated or be associated with ridging, clinical appearance should match cause
28
How is traumatic keratosis investigated/diagnosed?
diagnosis can be made on clinical grounds, biopsy if cause not clear
29
How is traumatic keratosis managed?
explanation of condition, management/removal of cause. if lesion does not resolved - biopsy
30
What key questions should be asked when investigating oral trauma?
- can you or the patient identify a source of trauma? - does the lesion have the right appearance? - can you remove the presumed source of trauma?
31
What is this?
stomatitis nicotina (nicotinic stomatitis)
32
What is stomatitis nicotina a specific type of?
specific type of traumatic keratosis
33
What is the aetiology of stomatitis nicotina?
smoking related
34
What is the epidemiology of stomatitis nicotina?
M>F, 60% pipe smokers, 30% cigarette smokers
35
Is stomatitis nicotina a potentially malignant mucosal disorder?
no
36
What are the clinical features of stomatitis nicotina?
generalised white/greyish white apparence of the hard palate extending onto the soft palate soft red dots
37
How is stomatitis nicotina investigated/diagnosed?
diagnosis made on clinical grounds
38
How is stomatitis nicotina managed?
smoking cessation
39
What is the aetiology of of oral lichen planus/lichenoid reactions?
unknown in approx. 75% of cases; approx. 25% of cases reaction to medication, dental materials. N.B. other conditions can mimic oral lichen planus e.g. lupus erythematosus, graft versus host disease
40
What is the epidemiology of oral lichen planus/lichenoid reactions?
probably affects between 1-2% of population, 1.55% Europe, F>M; wide age range, majority >40yo, can occur in childhood
41
What are the signs of oral lichen planus/lichenoid reactions?
- any site - tongue, cheeks and gingivae most commonly affected - usually bilateral if lichen planus - palatal mucosa rarely affected but may be in lichenoid drug reactions - different types, may be a combination fo these present resulting in a mixture of white +/- red +/- ulcerated lesion
42
What are te clinical criteria for orla lichen planus (not lichenoid reactions)?
- multi focal symmetric distribution - white and red lesions exhibiting one or more of the following forms: - reticular/papular - atrophic (erythematous) - erosive (ulcerative) - plaque - bullous - lesions are not localised exclusively to the sites of smokeless tobacco placement - lesions are not localised exclusively adjacent to and in contact with dental restorations - lesion onset does not correlate with the start of a medication - lesion onset does not correlate with the use of cinnamon-containing products
43
What is this?
reticular lichen planus
44
What is this?
papular lichen planus - slightly raised small papules, may be fused together
45
What is this?
gingival lichen planus - desquamative gingivitis
46
What is this?
gingival lichen planus - reticular/plaque
47
What is this?
plaque lichen planus
48
What is this?
atrophic lichen planus
49
What is the classic appearance if the dorsum of tongue is affected by atrophic lichen planus?
loss of papillae
50
What is this?
bullous lichen planus
51
What is the rarest variant of lichen planus?
bullous lichen planus - blister will rupture leaving behind an ulcer
52
What presentations of lichen planus can be seen here?
erosive (ulcerative), atrophic and reticular
53
What is this?
erosive lichen planes
54
What is this?
erosive lichen planus, multiple sites
55
What are the range of symptoms of oral lichen planus/lichenoid reaction?
- asymptomatic - affected area may feel rough - soreness only eating e.g. spicy, salty, acidic, rough, hot foods and tooth brushing - soreness present at all times exacerbated by above factors - symptoms tend to wax and wane in severity - stress may be an exacerbating factor
56
What other sites may be involved in oral lichen planus/lichenoid reaction?
- skin - scalp - nails - genital - may be particularly problematic in females - vulvovaginal gingival lichen planus less commonly: - oesophagus - larynx - anus - bladder - eyelids - lacrimal glands
57
What investigations are done for oral lichen planus/lichenoid reaction?
- diagnosis can be made on clinical grounds if presentation is classical - biopsy - swab if suspect super-added candida - blood tests if associated disease suspected
58
What is this?
lichen planus skin lesions
59
What areas are lichen planus skin reactions classically found on?
flexor surfaces of wrists/forearms
60
What is this?
lichen planus nail involvement, vertical ridges on nails
61
What is this?
lichen planus scalp involvement
62
What is the initial non-pharmacological management of lichen planus in primary care?
- explanation of diagnosis - ask re. other site involvement and refer if necessary - advise that potentially malignant - counsel re. smoking cessation and alcohol moderation - baseline photographs - consider need for referral to secondary care if concerns re: - possible malignancy - diagnosis - ability to manage in primary care
63
Is oral lichen planus a potentially malignant disorder?
yes - 1% rate over 10 years
64
What are indicators of orla lichen planus becoming malignant?
indicators may include tongue involved tissue, atrophic and erosive pattern but can occur in any type