Classification of white lesions of the oral cavity

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R V SUBRAMANYAM WHY ARE WHITE LESIONS WHITE?  Thickening of the epithelium – acanthosis – leukoplakia, white sponge naevus  Hyperkeratosis – e.g. Frictional keratosis, verrucous carcinoma, papilloma  Intracellular oedema of epithelial cells – e.g. Leukoedema,  Juxtaepithelial hyalinization – e.g. oral submucous fibrosis  Pseudomembrane – Diphtheric white patch, oral thrush  Hypopigmentation - albinism A) According to Pathology 1) Keratotic a) Leukoplakia, Frictional keratosis, Verrucous carcinoma 2) Necrotic / pseudomembranous a) Oral thrush, Aspirin burn, ANUG 3) Non-keratotic / non-necrotic a) Oral submucous fibrosis B) According to Aetiology 1 Normal variations of oral mucosa a Linea alba b Fordyce’s granules (yellowish-white) 2 Developmental a Leukoedema b Epstein’s pearls c Bohn’s nodules d Geographic tongue e Oral lymphoepithelial cyst 3 Genetic Disorders a Oral genodermatoses i Acanthosis nigricans ii Benign Intraepithelial dyskeratosis iii Darier Disease (Keratosis follicularis, Darier-White disease) iv Dyskeratosis congenita v Focal dermal hypoplasia vi Hereditary Benign Intraepithelial Dyskeratosis vii Pachonychia congenital viii Warty Dyskeratoma (Isolated Darier’s disease) ix White sponge naevus of Cannon b Inherited genetic disorders of metabolism i Acatalsia ii Hyalinosis cutis et mucosae iii Xanthomatosis 4 Traumatic Lesions a Mechanical i Frictional keratosis ii Morsicatio buccarum (cheek biting) & morsicatio linguarum (tongue biting) iii TUGSE – Traumatic Ulcerative Granuloma with Stromal Eosinophilia 1




iv Atypical histiocytic granuloma b Chemical i Aspirin burns ii Mucosal damage from H2O2, Silver Nitrate, Phenol iii Cotton roll stomatitis c Thermal i Hot beverages / Pizza burn d Radiation i Radiation mucositis e Electrical i Galvanic white patch Infections a Bacterial i Diphtheria – Diphtheric white patch ii ANUG – punched out ulcers with pseudomembrane iii Syphilis – pseudomembrane over ulcers in primary syphilis; mucous patches and condylomata lata of secondary syphilis; syphilitic glossitis of tertiary syphilis iv Tuberculosis – ulcers with pseudomembrane v Noma (Gangrenous stomatitis) vi Leprosy - lepromas b Fungal i Candidosis – oral thrush (pseudomembrane); Candidal leukoplakia (acanthosis + hyperkeratosis), Chronic mucocutaneous, Endocrinecandidiasis syndrome, Chronic multifocal (red + white), ii Histoplasmosis – irregular ulcers (white) iii Blastomycosis – white plaques ± ulcers c Viral i Oral hairy leukoplakia ii Herpetic stomatitis (ulcers with pseudomembrane) iii Herpes zoster – white opaque vesicles iv HPV – verruca vulgaris, multifocal epithelial hyperplasia (Heck’s disease) v Molluscum contagiosum – white papules (DNA pox virus) vi Condyloma acuminatum (white growths) vii Measles (Koplik spots) viii White lesions associated with HIV d Chlamydial i Lymphogranuloma venerum Mucocutaneous Lesions a Lichen planus b Lupus erythematosus (esp. discoid type) c Focal epithelial hyperplasia (Heck’s disease) d Pemphigus (ulcerations with white pseudomembranes) e Dermatitis herpetiformis f Scleroderma g Dermatomyositis h Psoriasis Premalignant lesions / conditions a Leukoplakia b Tobacco pouch keratosis 2



c Oral submucous fibrosis d Solar keratosis e Proliferative verrucous leukoplakia f Nicotinic stomatitis (Smoker’s palate) Tumours (Benign & Malignant) a Papilloma b Verruciform xanthoma c Squamous cell carcinoma d Verrucous carcinoma Miscellaneous / Allergic / Immunological a White hairy tongue (coated tongue) b Transient lingual papillitis c Recurrent aphthous ulcer d Graft vs Host disease e Contact stomatitis esp from cinnanmon flavouring f Lichenoid reactions


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