White patches

Question 1

gendermatoses = “white sponge neavus”

Answer 1

white grey patches that merge w/ normal mucosa
do not wipe off
soft, folded, spongey surface
no pain
not potentially malignant

Question 2

leukoedema

Answer 2

unknown cause - likely mucosal irritation causing oedema in superficial epithelium

no pain
white/grey appearance of buccal and labial mucosa
soft on palpation

Question 3

Epitheliolysis

Answer 3

oromucosal peeling
secondary to irritation from toothpaste & MWs
no pain
strands of gelatinous white material - removed by wiping, normal underlying tissue

Question 4

linear alba

Answer 4

from physical friction, chemical or thermal irritation
associated w/ clenching, cheek biting
ridges at level of occlusal plane
cannot be removed
biopsy of cause not clear

Question 5

stomatitis nicotina

Answer 5

white/grey appearance of hard palate - extends onto soft
small red dots - inflamed openings of salivary glands
smoking related - mx via smoking cessation
not potentially malignant

Question 6

lichenoid reaction

Answer 6

reaction to metal or medicine

Question 7

lichen planus

Answer 7

inflammation due to unknown antigen

Question 8

LR & LP have similar symptoms - a range

Answer 8

mix of white/red ulceration
no pain
transient/constant pain
area feels rough
affects any site in mouth - lateral tongue most common
if bilateral usually LP
biopsy to diagnose

both are potentially malignant - take baseline radiographs and do alcohol/smoking cessation

Question 9

what drugs can cause lichenoid reactions

Answer 9

antihypertensives
oral hypoglycaemics
NSAIDs

Question 10

name diff presentations of lichen planus

Answer 10

reticular
papular
gingival
desquamative
plaque
atrophic
bullous - a blister
erosive - ulcerative

Question 11

where else on body does lichen planus affect?

Answer 11

flexures of wrists and forearms - red spots and dry crusty patches
scalp - hair loss
nails - pronounced ridges

Question 12

give 3 risk factors for lichenoid reaction or lichen planus turning malignant

Answer 12

smoking
alcohol
help c infection

Question 13

what mechanism underlies lichenoid reactions?

Answer 13

type 4 hypersensitivity reaction = contact dermatitis

Question 14

what is graft versus host disease? what does it usually resemble?

Answer 14

systemic disorder when graft’s immune cells recognise host as foreign and attacks the recipient’s body cells

it usually resembles lichen planus

Question 15

what disease is associated w/ lichen planus?

Answer 15

hep c

Question 16

lupus erythematosus

Answer 16

disease of connective tissue
lesions in mouth can resemble lichen planus

Question 17

hairy leukoplakia

Answer 17

white patch that cannot be removed by scraping
appears on lateral border of tongue
caused by EBV
strongly associated w/ HIV
can arise in pts who are immunocompromised/suppressed and pts taking inhaled topical corticosteroids
corrogated surface, uni or bi lateral
candida on top
biopsy and HIV testing required

Question 18

give 3 candidosis types

Answer 18

acute pseudomembranous (thursh)
acute erythematous
chronic erythematous
chronic hyperplastic

Question 19

thrush - acute pseudomembranous

Answer 19

remove patches w/ scraping
causes - dry mouth, steroid inhaler, systemic issues, extremes of age, nutritional issue

test for anaemia, haematinic deficiency, diabetes and thyroid

bacteria usually candida albicans

gold standard test = oral rinse

Question 20

chronic hyperplastic candidosis

Answer 20

firmly adherent white patches - cannot remove
common in commissure/anterior region of buccal mucosa
often bilateral
cigarette smoking major diagnostic factor
biopsy to diagnose

no longer considered potentially malignant - used to be called candida leukoplakia but no longer used