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- Chapter 032. Oral Manifestations
of Disease
(Part 5)
Dermatologic Diseases
See Tables 32-1, 32-2, and 32-3 and Chaps. 52, 53, 54, 55, and 56.
Table 32-3 White Lesions of Oral Mucosa
Condition Usual Clinical Features Course
Location
Lichen Buccal Striae, white Protracted;
planus mucosa, tongue, plaques, red areas, ulcers responds to topical
- gingiva, and in mouth; purplish glucocorticoids
lips; skin papules on skin; may be
asymptomatic, sore, or
painful; lichenoid drug
reactions may look
similar
White Oral Painless white Benign and
sponge nevus mucosa, vagina, thickening of epithelium; permanent
anal mucosa adolescent/early adult
onset; familial
Smoker's Any area White patch that May or may
leukoplakia and of oral mucosa, may become firm, rough, not resolve with
smokeless tobacco sometimes or red-fissured and cessation of habit;
lesions related to ulcerated; may become 2% develop
location of habit sore and painful but squamous cell
usually painless carcinoma; early
biopsy essential
Erythroplaki Floor of Velvety, reddish High risk of
- a with or without mouth common plaque; occasionally squamous cell
white patches in men; tongue mixed with white patches cancer; early
and buccal or smooth red areas biopsy essential
mucosa in
women
Candidiasis Any area Pseudomembrano Responds
in mouth us type ("thrush"): favorably to
creamy white curdlike antifungal therapy
patches that reveal a raw, and correction of
bleeding surface when predisposing
scraped; found in sick causes where
infants, debilitated possible
elderly patients receiving
high doses of
glucocorticoids or broad-
spectrum antibiotics, or
in patients with AIDS
Erythematous Course
type: flat, red, sometimes same as for
- sore areas in same groups pseudomembranou
of patients s type
Candidal Responds
leukoplakia: to prolonged
nonremovable white antifungal therapy
thickening of epithelium
due to Candida
Angular cheilitis: Responds
sore fissures at corner of to topical
mouth antifungal therapy
Hairy Usually White areas Due to
leukoplakia lateral tongue, ranging from small and EBV; responds to
rarely elsewhere flat to extensive high dose
on oral mucosa accentuation of vertical acyclovir but
folds; found in HIV recurs; rarely
carriers in all risk groups causes discomfort
for AIDS unless secondarily
infected with
- Candida
Warts Anywher Single or multiple Lesions
(papillomavirus) e on skin and papillary lesions, with grow rapidly and
oral mucosa thick, white keratinized spread; consider
surfaces containing many squamous cell
pointed projections; carcinoma and rule
cauliflower lesions out with biopsy;
covered with normal- excision or laser
colored mucosa or therapy; may
multiple pink or pale regress in HIV
bumps (focal epithelial infected patients
hyperplasia) on antiretroviral
therapy
Note: EBV, Epstein-Barr virus.
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