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