The authors present a case of proliferative verrucous leukoplakia (PVL) in a 78-year-old man. It was initially presented as leukoplakia on the tongue but a microscopic investigation in 1991 revealed it to be a mild epithelial dysplasia. [ncbi.nlm.nih.gov]

A 75-year-old man presented to the dentistry and oral surgery department with an asymptomatic white spot on the right lateral border of the tongue that had been present for an unknown period of time. He had a history of hypertension. [ccjm.org]

• Candidiasis

  The diagnosis of leukoplakia is one of exclusion; other conditions such as candidiasis, lichen planus, leukoedema, etc. Must be ruled out before a diagnosis of leukoplakia can be made. [icd9data.com]

  • Actinic radiation • X-irradiation: therapeutic & dental • Hyperplastic candidiasis • Certain strains at the laboratory level have produced nitrosamines that have been implicated to carcinogenesis • HPV: 16, 18, 31, 33 • HSV: most likely not • HIV [quizlet.com]

  KOH preparation to exclude a diagnosis of oral candidiasis as well as consideration of a cause for immunocompromise or immunosuppression in the affected patient. [derm101.com]

  In oral leukoplakia, the lesion will remain intact, while in oral candidiasis the plaque will be removed upon scraping and will bleed.2,11 A potassium hydroxide smear should be performed to identify Candida albicans as the causative agent. [clinicaladvisor.com]

  Evaluation Differential diagnosis of an oral white plaque includes: infectious (oral candidiasis, oral hairy leukoplakia, syphilitic leukoplakia) normal variant (Fordyce' s granules) traumatic (chemical burn, frictional keratosis) immunologic (Lichen [step1.medbullets.com]

• Asymptomatic

  It is characteristically asymptomatic, though patients may complain of dysgeusia, dysesthesia, mild pain, or concerns regarding cosmetic appearance. [derm101.com]

  A 75-year-old man presented to the dentistry and oral surgery department with an asymptomatic white spot on the right lateral border of the tongue that had been present for an unknown period of time. He had a history of hypertension. [ccjm.org]

  They are usually asymptomatic. Ætiology The exact ætiology remains unknown. Tobacco, alcohol, chronic local friction, betel use; sanguinarine use and Candida albicans are important predisposing factors. Others include Epstein Bar Virus and Syphilis. [exodontia.info]

  This form is usually asymptomatic. 2. [dermnetnz.org]

• Inflammation

  SUBJECTS AND METHODS: Immunohistochemical appraisal of these cases was carried out by a panel of markers, related to cell proliferation, cell cycle regulation, angiogenesis, apoptosis and inflammation. [ncbi.nlm.nih.gov]

  Chronic frictional / factitial keratosis: Shaggy / macerated parakeratosis with superficial bacterial colonization Epithelial hyperplasia with keratinocyte edema but no epithelial atypia Variable fibrosis, acute and chronic inflammation and leukocyte [pathologyoutlines.com]

  Most prove to be benign (usually hyperkeratosis or chronic inflammation), however, up to 20% may exhibit histological changes consistent with dysplasia or carcinoma. [exodontia.info]

  Periodontitis is inflammation of the gums and is more common in people with dyskeratosis congenita. If untreated, periodontitis can lead to loss of teeth and increase the risk of heart disease, strokes, premature births and cancer. [dcaction.org]

• Weakness

  The symptoms that are highly suggestive of oral leukoplakia are tongue lesions, hemoptysis, skin swelling, gum pain, mouth pain, elbow cramps or spasms, elbow weakness, excessive growth, underweight, low back weakness, and wrist weakness, although you [symcat.com]

• Anemia

  […] nonhomogeneous appearance More key diagnostic factors Other diagnostic factors male sex age >40 years Other diagnostic factors Risk factors tobacco use alcohol use areca nut (betel quid) use chronic candidiasis genetic predisposition immunosuppression Fanconi anemia [bestpractice.bmj.com]

  Teles, The Salivary Microbiome and Oral Cancer Risk: A Pilot Study in Fanconi Anemia, Journal of Dental Research, 10.1177/0022034516678169, 96, 3, (292-299), (2016). [doi.org]

  Detection of anemia and deficiencies of hematinics and vitamins by appropriate investigations must be undertaken and necessary remedies prescribed. (7.2) S pecific treatment of chronic hyperplastic candidosis / candidal leukoplakia Various modalities [cro.sagepub.com]

• Dysphagia

  As the lesions increase in size, pain, dysarthria, and dysphagia may result. Biopsy Endoscopy to detect second primary cancer Chest x-ray and CT of head and neck Any suspicious areas should be biopsied. [merckmanuals.com]

  […] must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture Diseases predominantly affecting the oral cavity Oral Candidiasis Dysphagia [wikidoc.org]

  Conditions associated with mucosal atrophy include iron deficiency, some vitamin deficiencies, oral submucous fibrosis, syphilis and sideropenic dysphagia. [en.wikipedia.org]

• Aphthous Ulceration

  ulcers Painful, red spot or bump that develops into an open ulcer Being a female Between the ages of 10-40 Family history of aphthous ulcers Physical examination Diagnosis of exclusion Oral cavity Self-limiting, Pain decreases in 7 to 10 days, with complete [wikidoc.org]

  Management strategies for HIV-associated aphthous stomatitis. Am J Clin Dermatol. 2003;4:669-80. 22. Barrons RW. Treatment strategies for recurrent oral aphthous ulcers. Am J Health Syst Pharm. 2001;58:41-50; quiz 51-3. 23. [hiv.uw.edu]

  Salivary immunoglobulin A levels in tobacco smokers and patients with minor aphthous ulceration. Oral Surg Oral Med Oral Pathol 53: 461 –465. Google Scholar | Crossref | Medline Bird GW, Tovey GH ( 1982 ). The blood groups. [doi.org]

• Oral Ulcers

  In one series, it was present in 11.5% of HIV-infected individuals, designating it as the fourth most common oral manifestation in this population after oral candidiasis (39.3%), melanotic hyperpigmentation (19.5%), and oral ulcers (11.8%). [derm101.com]

  For this reason oral white patches are sometimes generally described as keratoses, although a minority of oral white lesions are not related to hyperkeratosis, e.g. epithelial necrosis and ulceration caused by a chemical burn (see: Oral ulceration#Chemical [en.wikipedia.org]

  […] significant morbidity. [ 2 ] This topic will focus on common HIV-related oral conditions, including oral candidiasis, oral hairy leukoplakia, ulcerative disease, and oral malignancies. [hiv.uw.edu]

  Beresford and Direkrit Chiewchengchol, Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: A Review of the Literature, American Journal of Clinical Dermatology, 10.1007/s40257-017-0286-9, (2017). [doi.org]

• Dysgeusia

  We suggested surgical excision to allow a complete histopathologic study of the lesion, but the patient requested observation only, because of the risks of paresthesia, dysgeusia, and motor dysfunction of the tongue. [ccjm.org]

  It is characteristically asymptomatic, though patients may complain of dysgeusia, dysesthesia, mild pain, or concerns regarding cosmetic appearance. [derm101.com]

• Aphthous Stomatitis

  Diagnosis No causative agent has been identified for aphthous stomatitis. The diagnosis of aphthous stomatitis is based on clinical presentation and exclusion of other possible causes, including HSV, syphilis, neoplasm, or drug reaction. [hiv.uw.edu]

• Ulcer

  Women, adolescents, and people with a family history of mouth ulcers are at higher risk for developing mouth ulcers. Mouth ulcers aren’t contagious and usually go away within one to two weeks. [healthline.com]

  Painful, red spot or bump that develops into an open ulcer Being a female Between the ages of 10-40 Family history of aphthous ulcers Physical examination Diagnosis of exclusion Oral cavity Self-limiting, Pain decreases in 7 to 10 days, with complete [wikidoc.org]

  Leukoplakia of tongue associated with HIV disease Lip leukoplakia Mucosa and tongue leukoplakia On examination - leukoplakia on tongue Oral hairy leukoplakia Oral mucosa leukoplakia Smokers keratosis Speckled oral leukoplakia Syphilitic leukoplakia of tongue Ulcerated [icd9data.com]

  In some instances, the lesions progress to thickened, white lesions, showing induration, fissuring and ulcer formation. [patient.info]

• Skin Disease

  On DermNet NZ Oral cancer Hairy leukoplakia Oral leukoplakia Other websites Leukoplakia, Oral – Medscape Reference Patient information: Leukoplakia (The Basics) – UpToDate (for subscribers) Books about skin diseases See the DermNet NZ bookstore. [dermnetnz.org]

• Pruritus

  She denied any history of rectal trauma, pruritus, laxative use, perianal abscess, or fistula. The clinical examination and laboratory data were normal. A digital examination revealed anal tightness and a granular, hard sensation in the anal canal. [doi.org]

• Fracture

  A benign epithelial response, usually due to trauma from a fractured tooth or dental restoration Leukoedema Lichen planus Linea alba buccalis Submucous fibrosis In selected situations, these conditions, particularly oral submucous fibrosis, may coexist [screening.iarc.fr]

• Aggressive Behavior

  behavior of these lesions. [nejm.org]

• Irritability

  They can result from irritations such as an ill-fitting denture or the habit of chewing on the inside of the cheek. Sometimes leukoplakia is associated with oral cancer. Your dentist may recommend a biopsy if the patch appears threatening. [mouthhealthy.org]

  Patches in the mouth often clear up in a few weeks or months after the source of irritation is removed. In some cases, the patches may be an early sign of cancer. [mountsinai.org]

  Typically a sign of bodily irritation in response to cigarette smoke or tobacco chewing. In 10% of cases, these lesions are considered precancerous. [medical-dictionary.thefreedictionary.com]

  Human papillomavirus, types 16 and 18 Sunlight Vitamin deficiency Syphilis Dental restorations/prosthetic appliances Estrogen therapy Chronic trauma or irritation Epstein-Barr virus (oral hairy leukoplakia) Areca nut/betel (Asian populations) Mouthwash [unboundmedicine.com]

• Burning Sensation

  […] curid=19772899 Burning mouth syndrome Burning or tingling on the lips, tongue, or entire mouth Nutritional deficiencies Chronic anxiety or depression Diabetes type 2 Menopause Oral thrush or dry mouth, or damaged nerves transmitting taste Female gender [wikidoc.org]

  They are usually associated with a burning sensation, and the white plaque can usually be wiped away with gauze, leaving a tender, red area beneath, which may bleed Fordyce granules Reactive hyperkeratosis. [screening.iarc.fr]

  Patients with either pseudomembranous or erythematous disease often complain of burning sensation and of altered taste. [hiv.uw.edu]

6 Diagnosis of Oral Leukoplakia The differential diagnosis should include oral candidiasis, oral lichen planus, oral erythroplakia, oral hairy leukoplakia, or nicotine stomatitis in smokers.2,6,11 Scraping the lesion is important during the initial workup [clinicaladvisor.com]

• Candida

  Krogh et al.(1987a), who found association of C. albicans with 82% of leukoplakic lesions, identified the following species of yeasts as well: Candida tropicalis, Candida pintolopesii, Candida glabrata, and Saccharomyces cerevisiae. [doi.org]

  […] transformation are nonhomogeneous oral leukoplakia, presence of red lesions (erythroplakia), large lesion size (> 200 mm2), location on the tongue or floor of the mouth, age over 50, female sex, no history of smoking, and the presence of severe dysplasia.4 Candida [ccjm.org]

  Cited by Identification of candida albicans and nonalbicans candida resistant species in tobacco users and oral squamous cell carcinoma patients: Comparison of HiCrome agar and automated VITEK 2 system. [pubmed.ncbi.nlm.nih.gov]

  A higher malignant transformation rate has been reported in Candida-infected leukoplakias. [eaom.eu]

• Staphylococcus Aureus

  A comparison of rinse culture and imprint sampling techniques for the detection of yeast, coliform and Staphylococcus aureus carriage in the oral cavity. J Oral Pathol 15: 386 –388. [doi.org]

• Treponema Pallidum

  DNA, and Smith antigen Treponema pallidum serology More investigations to consider Emerging tests chemiluminescent spectroscopy molecular and chromosomal markers photodynamic diagnosis (PDD) using 5-aminolevulinic acid (ALA-PDD) vital staining with toluidine [bestpractice.bmj.com]

  It is not considered to be a type of idiopathic leukoplakia, since the causative agent Treponema pallidum is known. [en.wikipedia.org]

3 These treatments may be effective for resolution of the lesions; however, there is no evidence that they prevent malignant transformation.5 But regardless of the treatment, long-term observation and periodic biopsy are important to monitor for recurrence [ccjm.org]

Treatment begins with removing the factors that contribute to the lesion: quitting tobacco or replacing ill-fitting dentures or bridges. [mouthhealthy.org]

Abstract Various treatment modalities have been described for reducing or eliminating malignant development of oral leukoplakia, but no treatment has gained universal approval due to lack of randomized clinical studies. [ncbi.nlm.nih.gov]

Prognosis is poor for this seemingly harmless-appearing white lesion of the oral mucosa. [ncbi.nlm.nih.gov]

In addition, some dysplastic lesions may have a worse prognosis than isolated carcinomas without leukoplakia. However, dysplastic lesions can regress spontaneously. Therefore, the behaviour of dysplastic lesions is unpredictable. [patient.info]

Floor of the mouth is the are with worst prognosis followed by the tongue and then Lips. About 50% of the lesions in floor of the mouth show features of epithelial dysplasia, carcinoma in situ and invasive carcinoma. [juniordentist.com]

INTRODUCTION: Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. [ncbi.nlm.nih.gov]

Evil of seven “S” namely Smoking Spirits Spices Sepsis Sharp tooth edges Syphilis Susceptibility ETIOLOGICAL FACTORS Tobacco Chronic irritation Alcohol Dietary components & deficiency states Tertiary syphilis Actinic radiations Viral agents Candidal [intelligentdental.com]

Our results regarding the epidemiology of OL showed a similar trend to those reported in western populations and provided preliminary epidemiological information on the Chinese population. [ncbi.nlm.nih.gov]

System(s) affected: gastrointestinal Hyperplasia of squamous epithelium Epidemiology Develops in middle age, increases with age Most common in India, where more people smoke and chew tobacco and areca nuts Prevalence 0.1–0.5% of the adult population is [unboundmedicine.com]

Epidemiology Frequency International OL occurs in fewer than 1% of individuals. Mortality/Morbidity OL is considered to be potentially malignant, with a transformation rate in various studies and locations that range from 0.6 to 20%. [emedicine.medscape.com]

Etiology and Pathophysiology Hyperkeratosis or dyskeratosis of the oral squamous epithelium Tobacco use in any form Alcohol consumption/alcoholism Periodontitis Candida albicans infection may induce dysplasia and increase malignant transformation. [unboundmedicine.com]

45:317) Characteristically a disease of older males (M:F = 3:1) Sites May present on any mucosal surface Associated with highest incidences of malignant transformation when occurring on ventrolateral tongue or floor of mouth (Oral Oncol 2009;45:317) Pathophysiology [pathologyoutlines.com]

Edit Stepwise progression from normal tissue to precancerous lesion to invasive cancer The pathophysiology of precancerous lesions is thought to be similar to that of cancer, and varies depending on the disease site and type of lesion. [11] It is thought [en.m.wikipedia.org]

Thus, idiopathic leukoplakia is considered a premalignant lesion. [1, 2] Pathophysiology The etiology of most cases of OL is unknown (idiopathic). [emedicine.medscape.com]

Regular dental check-ups to avoid bad restorations Diet rich in fresh fruits and vegetables may help to prevent cancer. HPV vaccination may be preventive. Commonly Associated Conditions HIV infection is closely associated with hairy leukoplakia. [unboundmedicine.com]

Chemo - prevention, which prevents leukoplakias from becoming malignant, entail the use of retinoids (such as 13-cis-retinoic acid and fenretinide ). However, problems with side-effects, lack of availability and recurrence limits their use. [exodontia.info]

Green tea is well known for its preventative use against cancer, which is why it seemed logical to attempt to use it to prevent oral leukoplakia. Studies have shown that EGCG is the most effective compound at preventing cancer (chemopreventative). [oxfordvitality.co.uk]

Objectives: To assess the effectiveness, safety and acceptability of treatments for leukoplakia in preventing oral cancer. [cochrane.org]

Therefore, the early diagnosis of this pathology plays a crucial role when trying to prevent a malignant transformation in PVL or at least when trying to prevent de development of extensive carcinomas. [wjso.biomedcentral.com]