White& red lesions
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Transcript of White& red lesions
D.D of white lesion:D.D of white lesion: LeukodemaLeukodema White spongy neavusWhite spongy neavus Heredetary benign epith.dyskeratosisHeredetary benign epith.dyskeratosis Darriers diseaseDarriers disease oral keratosisoral keratosis Chemical burnsChemical burns Oral thrushOral thrush LeukoplakiaLeukoplakia Hairy leukoplakiaHairy leukoplakia Lichen planusLichen planus
leukodemaleukodema
Faint diffuse,filmyFaint diffuse,filmy
Numerous folds or Numerous folds or wrinkleswrinkles
Can’t be scrapped offCan’t be scrapped off
Disappear & fades upon Disappear & fades upon stretchingstretching
White spongy neavusWhite spongy neavus
Oral mucosa (mainly)Oral mucosa (mainly) Nose,pharynx,genital,Nose,pharynx,genital,
rectumrectum Bilateral,symmetricalBilateral,symmetrical spongy,velvety,thick spongy,velvety,thick
plaqueplaque Buccal mucosa Buccal mucosa
mainlymainly May be other non May be other non
keratinized mucosa keratinized mucosa
Biopsy Biopsy
HyperkeratosisHyperkeratosis AcanthosisAcanthosis Perinuclear condensation of cytoplasmPerinuclear condensation of cytoplasm Vacuolazation of suprabasal layerVacuolazation of suprabasal layer
Hereditary benign Hereditary benign intraepithelial dyskeratosisintraepithelial dyskeratosis
Oral lesionOral lesion Eye lesionEye lesion
Oral lesion:Oral lesion:Thick & corrugatedThick & corrugatedAsymptomaticAsymptomaticWhite spongy plaqueWhite spongy plaqueBuccal & labial mucosa mainlyBuccal & labial mucosa mainly11stst years of life &increase untill teenage years of life &increase untill teenage
Eye lesion:Eye lesion:Thick, gelatinous, foamy,opaque plaque Thick, gelatinous, foamy,opaque plaque
adjacent to corneaadjacent to cornea
Seasonal prominenceSeasonal prominence
May lead to blindness due to corneal May lead to blindness due to corneal vascularization vascularization
Darrier diseaseDarrier disease hyperkeratotic papuleshyperkeratotic papules Skin lesion:Skin lesion: Firm harsh Firm harsh
papule,greasypapule,greasy
Seborrhoeic areas asSeborrhoeic areas as
Scalp ,forheadScalp ,forhead
Skin yellowish brownSkin yellowish brown
or brownor brown
Oral lesion:Oral lesion: cobblestone papulescobblestone papules
Palate,tongue,buccal Palate,tongue,buccal mucosa,pharyngeal mucosa,pharyngeal wallwall
confluence of papule confluence of papule form plaque form plaque
Nail lesion:Nail lesion: Broad white longitudinal Broad white longitudinal
bandband Broad red longitudinal Broad red longitudinal
bandband Sandwich of red & whiteSandwich of red & white
• Ear lesion:Ear lesion: External auditory meatus External auditory meatus
blocked by accumulation of blocked by accumulation of debris debris
Frictional keratosisFrictional keratosis White rough plaqueWhite rough plaque
Related to a source of Related to a source of mechanical irritationmechanical irritation
Cheek bitingCheek biting Chronic irritation as:Chronic irritation as:
Suckling,cheek & lip Suckling,cheek & lip bitingbiting
Bilaterally along Bilaterally along occlusal plane occlusal plane
Chemical burnChemical burn Transient non Transient non
keratotic white plaquekeratotic white plaque
Irregular in shapeIrregular in shape
Covered by Covered by pseudomembranepseudomembrane
Very painfulVery painful
Aspirin burnAspirin burn
Smokless tobacco induced Smokless tobacco induced keratosiskeratosis In the area of In the area of
tobacco contacttobacco contact
PrecancerousPrecancerous
May be wrinkled or May be wrinkled or foldedfolded
May be May be Accompanied by Accompanied by gingival recessetion& gingival recessetion& perio-destructionperio-destruction
Actinic keratosisActinic keratosis
Patient exposed for Patient exposed for sunlight for sunlight for prolonged timeprolonged time
Acute psdeudo Acute psdeudo membranous membranous candidiasis(oral thrush)candidiasis(oral thrush) PainlessPainless Soft creamy white plaqueSoft creamy white plaque Can’t be easily rubbed or Can’t be easily rubbed or
whiped off leaving whiped off leaving erythematous area or erythematous area or ulcerationulceration
Range fromRange from
Small flecks-wide spread Small flecks-wide spread confluent plaqueconfluent plaque
Prodrome of bad taste or Prodrome of bad taste or loss of taste sensationloss of taste sensation
Confirmation:Confirmation: Gm stained smear Gm stained smear
shows candidal shows candidal hyphaehyphae
Biopsy:hyperplastic Biopsy:hyperplastic epithelium epithelium inflammatory inflammatory oemda&cellsoemda&cells
PAS shows candidal PAS shows candidal hyphaehyphae
Chronic hyperplasic Chronic hyperplasic candidiasiscandidiasis(candidal leukoplakia)(candidal leukoplakia)
ChronicChronic Firm white leathery Firm white leathery
plaqueplaque Cheek,lip,palate,Cheek,lip,palate,
tongue tongue
PAS +ve candidal PAS +ve candidal hyphaehyphae
leukoplakialeukoplakia
White patch or plaqueWhite patch or plaque
HomogenousHomogenousNodularNodularVerrucousVerrucousProliferative verrucousProliferative verrucous
Homogenous leuplakia:Homogenous leuplakia:
Well defined white patchWell defined white patch
Slighty elevatedSlighty elevated
Fissured,wrinkled,corrugFissured,wrinkled,corrugated surfaceated surface
On palpation On palpation leathery( like dry leathery( like dry cracked mud)cracked mud)
Verrucous leukoplakia:Verrucous leukoplakia:
papillarypapillary
Heavily keratinizedHeavily keratinized
Increased rate of Increased rate of malignant malignant transformationtransformation
Proliferative verrucous:Proliferative verrucous: Extensive papillary or Extensive papillary or
verrucoid white verrucoid white plaqueplaque
Involve multiple Involve multiple mucosal sitemucosal site
May transform into May transform into squamous cell squamous cell carcinomacarcinoma
Speckled leukoplakia:Speckled leukoplakia:
mixed red & whitemixed red & white
Karatotic white noduleKaratotic white nodule
&erythematousatrophic &erythematousatrophic areaarea
High rate of malignant High rate of malignant transformationtransformation
diagnosisdiagnosisclinicallyclinically Cannot be stripped or rubbed offCannot be stripped or rubbed off Loss of elasticity & pliabilityLoss of elasticity & pliability
Lab investegation:Lab investegation: BiopsyBiopsy*hyperkeratosis*hyperkeratosis*acanthosis*acanthosis*chronic inf. Cells*chronic inf. Cells*signs of dysplasia*signs of dysplasia
Touluidine blue testTouluidine blue test
Oral hairy leukoplakiaOral hairy leukoplakia Corrugated white Corrugated white
lesionlesion
Lateral or ventral Lateral or ventral surfaceof tonguesurfaceof tongue
Immumunodeff pt (HIV)Immumunodeff pt (HIV)
confirm diagnosis by:confirm diagnosis by:
Demo of EBV by:Demo of EBV by: In situ hyberidizationIn situ hyberidizationE.ME.MPCRPCR
Lichen planusLichen planus
Skin lesionsSkin lesions Oral lesions:Oral lesions:
Papular(reticular)Papular(reticular)AtrophicAtrophicBullous erosive Bullous erosive
Skin lesions:Skin lesions:• PruiriticPruiritic• PolyangularPolyangular• Plane toppedPlane topped• Papules & plaquesPapules & plaques• ViolaceousViolaceous• (wrist,legs,trunk)(wrist,legs,trunk)• Koebner Koebner
phenomenonphenomenon• Scalp alopeciaScalp alopecia
Oral lesion:Oral lesion:
papular type:papular type:
*painless*painless
*Pin head,hyperkeratotic *Pin head,hyperkeratotic papulepapule
*fine white lines called *fine white lines called (wickhams stria)(wickhams stria)
DiscreteDiscrete LinearLinear ReticularReticular Confluent (plaque) Confluent (plaque)
D.D lekoplakia:D.D lekoplakia:
BilateralBilateral FelxibleFelxible PliablePliable No signs of dysplasiaNo signs of dysplasia
Cheek,lips,dorsum of Cheek,lips,dorsum of tonguetongue
Rarely palate & gingivaRarely palate & gingiva
Immunofourescenct test Immunofourescenct test
D.D of red lesionsD.D of red lesions Acute atrophic candidiasisAcute atrophic candidiasis Denture induced stomatitisDenture induced stomatitis Median rhomboidal glossitis\Median rhomboidal glossitis\ Erythematous candidiasisErythematous candidiasis ErythroplakiaErythroplakia Atrophic lichen planusAtrophic lichen planus Angular stomatitisAngular stomatitis
Acute atrophic Acute atrophic candidiasiscandidiasis Whole mucosa is red Whole mucosa is red
& sore& sore
History of prolonged History of prolonged antibiotic intakeantibiotic intake
Xerostomia (sjogren Xerostomia (sjogren syndrome) syndrome)
Denture induced stomatitisDenture induced stomatitis Sharpely limited to area Sharpely limited to area
occluded by dentureoccluded by denture
Associated usually by Associated usually by angular stomatitis angular stomatitis
Median rhomboidal glossitisMedian rhomboidal glossitis Erythematous Erythematous
rhomboidal arearhomboidal area
At central area of At central area of dorsum of the tonguedorsum of the tongue
Erythematous candidiasisErythematous candidiasis
Red patch due to candida albicansRed patch due to candida albicans
Infection in H.I.V ptInfection in H.I.V pt
Hard palate,soft palate,dorsum of the Hard palate,soft palate,dorsum of the tongue tongue
Angular stomatitisAngular stomatitis Denture wearerDenture wearer
( loss of V.D)( loss of V.D)
Inflamation at the angle Inflamation at the angle of the mouth of the mouth
erythroplakiaerythroplakia Bright red velvety Bright red velvety
plaqueplaque
Esp:floor of Esp:floor of mouth,soft mouth,soft palate,ant.tonsillar palate,ant.tonsillar pillarpillar
Biopsy:Biopsy:
Severe signs of Severe signs of dysplasiadysplasia
Atrophic lichen planusAtrophic lichen planus Irregular red patchIrregular red patch No change in No change in
flexibility or pliabilityflexibility or pliability Commonly dorsum of Commonly dorsum of
tonguetongue Desquamative Desquamative
gingivitisgingivitis Reimmision & Reimmision &
exacerbationexacerbation
Bullous erosive lichen Bullous erosive lichen planusplanus
Severe pain & Severe pain & burning sensation burning sensation
Change in tasteChange in taste
Histopathology:Histopathology: HyperkeratosisHyperkeratosis Liguifactive degeneration of basal cell Liguifactive degeneration of basal cell
layerlayer Dense subepithelial band of lymphocytic Dense subepithelial band of lymphocytic
inf.inf. isolated epith.cells have nuclear isolated epith.cells have nuclear
fragment(civatte bodies)fragment(civatte bodies)
immunoflourescentimmunoflourescent
Shaggy band of Shaggy band of fibrinogen at B.M fibrinogen at B.M zonezone
IgM in dermal papilla IgM in dermal papilla in peribasal areain peribasal area
Stomatitis nicotinaStomatitis nicotina White lesion inhard & soft White lesion inhard & soft
palatepalate
Heavy cigarette,pipe,cigar Heavy cigarette,pipe,cigar smoking & reverse smoking & reverse smokingsmoking
Palate grey or whitePalate grey or white
Elevated papules with red Elevated papules with red centre centre
Lupus erythematosusLupus erythematosus
Immunoflouresecnt testImmunoflouresecnt test