Leukoplakia

Answer 1

Definition

Leukoplakia is a precancerous sore (lesion) that develops on the tongue or the inside of the cheek in response to chronic irritation. Occasionally, leukoplakia patches develop on the external female genitals.

Alternative Names

Hairy leukoplakia; Smoker's keratosis

Causes, incidence, and risk factors

Leukoplakia mainly affects the mucus membranes of the mouth. It is caused by irritation. Sores usually develop on the tongue, but they may also appear on the insides of the cheek.

Irritation in the mouth may be caused by rough teeth or rough places on dentures, fillings, and crowns. It may also result from smoking or other tobacco use (smoker's keratosis). Persons who smoke pipes are at high risk for developing this condition, as are those who hold chewing tobacco or snuff in their mouth for a long period of time.

Leukoplakia patches may develop on the external female genital area, but the cause is unknown.

Leukoplakia may become cancerous.

The disorder is most common in elderly persons.

"Hairy" leukoplakia of the mouth is an unusual form of leukoplakia that is seen mostly in HIV-positive people. It may be one of the first signs of HIV infection. It can also appear in other people whose immune system is not working well, such as after a bone marrow transplant. It is caused by the Epstein-Barr virus, but is not harmful by itself.

White patches usually appear on the tongue and sometimes on other places in the mouth. The condition may look like thrush, a type of Candida infection that is also linked to HIV and AIDS in adults.

Symptoms

The most common symptoms of hairy leukoplakia are painless, fuzzy white patches on the side of the tongue.

The skin lesions tend to have the following characteristics:

• Location
  • Usually on the tongue
  • May be on the inside of the cheeks
  • In females, occasionally on the genitals
• Color
  • Usually white or gray
  • May be red (called erythroplakia, a condition that can lead to cancer)
• Texture
  • Thick
  • Slightly raised
  • Hardened surface

Signs and tests

The typical white patch of leukoplakia develops slowly, over weeks to months. The lesion may eventually become rough in texture, and may become sensitive to touch, heat, spicy foods, or other irritation.

A biopsy of the lesion confirms the diagnosis. An examination of the biopsy specimen may find changes that indicate oral cancer.

Treatment

The goal of treatment is to get rid of the lesion. Removing the source of irritation is important and may cause the lesion to disappear.

• Treat dental causes such as rough teeth, irregular denture surface, or fillings as soon as possible.
• Stop smoking or using other tobacco products.
• Do not drink alcohol.

You may need surgery to remove the lesion. The lesion is usually removed in your health care provider's office using local anesthesia.

Leukoplakia on the vulva is treated in the same way as oral lesions.

Expectations (prognosis)

Leukoplakia is usually harmless. Lesions often clear up in a few weeks or months after the source of irritation is removed.

Oral hairy leukoplakia is often a sign of HIV infection and an increased likelihood of developing AIDS, but it is not harmful by itself.

Complications

• Chronic discomfort
• Infection of the lesion
• Oral cancer

Calling your health care provider

Call for an appointment with your health care provider if you have any lesions resembling leukoplakia or hairy leukoplakia.

Prevention

Minimize or stop smoking or using other tobacco products. Do not drink alcohol, or limit your number of alcoholic drinks. Have rough teeth treated and dental appliances repaired promptly.

Safer sexual practices minimize the risk of contracting sexually-transmitted diseases, including HIV.

References

Daniels TE. Diseases of the mouth and salivary glands. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 451.

Posner M. Head and neck cancer. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 200.

Answer 2

Definition

Leukoplakia are patches on the tongue, in the mouth, or on the inside of the cheek that occur in response to long-term irritation. Leukoplakia patches may also develop on the outer female genitals.

Alternative Names

Hairy leukoplakia; Smoker's keratosis; Vulvar leukoplakia

Causes, incidence, and risk factors

Leukoplakia mainly affects the mucus membranes of the mouth. It is thought to be caused by irritation, but the cause is not always known.

Irritation in the mouth may be caused by:

• Rough teeth
• Rough places on dentures, fillings, and crowns
• Smoking or other tobacco use (smoker's keratosis), especially pipes
• Holding chewing tobacco or snuff in your mouth for a long period of time

The disorder is most common in elderly persons.

"Hairy" leukoplakia of the mouth is a different disorder that is seen mostly in HIV-positive people. It may be one of the first signs of HIV infection. It can also appear in other people whose immune system is not working well, such as after a bone marrow transplant. It is caused by the Epstein-Barr virus, but is not harmful by itself. The most common symptoms of hairy leukoplakia are painless, fuzzy white patches on the side of the tongue.

Symptoms

Sores usually develop on the tongue, but they may also appear on the insides of the cheek, or on the outer female genitals. The most common symptoms of hairy leukoplakia are painless, fuzzy white patches on the side of the tongue.

The sores are:

• Usually white or gray
• Sometimes red (called erythroplakia, a condition that can lead to cancer)
• Thick and slightly raised with a hard surface that can't be easily scraped off

Signs and tests

The typical white patch of leukoplakia develops slowly, over weeks to months. The lesion may eventually become rough in texture, and may become sensitive to touch, heat, spicy foods, or other irritation.

A biopsy of the lesion confirms the diagnosis. An examination of the biopsy specimen may find changes that indicate oral cancer.

Treatment

The goal of treatment is to get rid of the lesion. Removing the source of irritation is important and may cause the lesion to disappear.

• Treat dental causes such as rough teeth, irregular denture surface, or fillings as soon as possible.
• Stop smoking or using other tobacco products.
• Do not drink alcohol.

You may need surgery to remove the lesion. The lesion is usually removed in your health care provider's office using local anesthesia.

Leukoplakia on the vulva is treated in the same way as oral lesions.

Expectations (prognosis)

Leukoplakia is usually harmless. Lesions often clear up in a few weeks or months after the source of irritation is removed.

Rarely, it may become cancer.

Calling your health care provider

Call for an appointment with your health care provider if you have any lesions resembling leukoplakia or hairy leukoplakia.

Prevention

Stop smoking or using other tobacco products. Do not drink alcohol, or limit your number of alcoholic drinks. Have rough teeth treated and dental appliances repaired promptly.

References

Sciubba JJ. Oral mucosal lesions. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 91.

Reviewed By

Review Date: 07/20/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.