Leukoplakia

Introduction Leukoplakia refers to a white keratotic disease that occurs in the mucous membranes of the mouth or vulva. Oral mucosal leukoplakia is more common in men than middle-aged men, and vulvar leukoplakia is more common in women after amenorrhea. Clinically, it is characterized by punctate, flaky or stripped grayish or creamy keratotic patches in the lesion, and has a tendency to become squamous cell carcinoma. It is estimated that the malignant rate is about 2%, but the highest is only 4% to 6%. It is advisable to use a combination of local and systemic treatments, and patients with cancer should be removed early.

Cause

(1) Causes of the disease

Smoking is the most important external stimuli, but snuff can induce a special form of leukoplakia. Mechanical stimulation, such as brushing and chewing with a toothless alveolar, can also cause white spots, called rubbing keratinization, rather than mucocele. Syphilis can cause leukoplakia of the tongue and can be complicated by atrophic glossitis. In the so-called pathogenesis of spontaneous leukoplakia, there is no obvious local factor. Mucosal atrophy is an important cause of disease.

(two) pathogenesis

In recent years, it has been suggested that oral leukoplakia is associated with Candida albicans infection, and these lesions should be referred to as chronic proliferative candidiasis or Candida leukoplakia. Hyperkeratosis is a prerequisite for Candida infection, and the oral horn is a predilection site for Candida leukoplakia. A study in the United Kingdom showed that all of the patients with Candida leukoplakia who were investigated had smoked and had dentures day and night. About half of Candida leukoplakia has nodular changes. This may be the cause of up to 45% of epidermal lesions dysplasia. The treatment of Candida leukoplakia with antibiotics lasted for an average of 45 days, and the nodular and partially significant lesions of the lesion disappeared.

Systemic factors include diabetes, endocrine disorders, and vitamin deficiency. It is speculated that leukoplakia is a defensive reaction of the body to chronic stimuli, causing the mucosal stratum corneum to thicken and dense, thereby protecting the submucosal tissue from chronic stimuli.

an examination

1. More common in men over 40 years old. The predilection sites of mucosal leukoplakia are: buccal mucosa, oral mucosa, toothless alveolar, tongue, lip mucosa, hard palate, sublingual area and gingiva. Buccal mucosa and oral horny mucosal lesions often occur symmetrically. Oral leukoplakia is often associated with Candida infection. This area of simple mucosal leukoplakia is rare, often covering the ecdysis. When it occurs in the high-risk part of oral squamous cell carcinoma (bottom of the mouth, outside of the tongue, soft palate), it should be highly valued.

2. The range of mucosal leukoplakia varies in size and is pleomorphic, single or multiple. The damage is light red at the early stage, and the skin lesions may be waxy spots with clear boundaries. It may also have a wide range of skin lesions and white color; the skin lesions may have a villus-like or papillary-like membrane, and the lesions may also have irregular thickening and Nodules; sometimes the performance is net-like, and the adhesion is very tight with the following. Forcibly peeling causes bleeding, the boundary is clear, the quality is hard, it is difficult to push, and the thickening is thick. Repeated trauma can cause ulcers.

3. Usually asymptomatic, but some patients complain of burning or irritation.

4. Although clinical manifestations are not necessarily related to histopathology, the white, punctiform, and hypertrophic nodules on the basis of atrophy are characteristic of epithelial dysplasia of the lesions, indicating a highly malignant tendency. Many mucosal leukoplakia can recover if exogenous stimuli are eliminated. Some long-term skin lesions may not resolve, and late leukoplakia thickening may produce shallow ruptures and small ulcers. Usually no symptoms, or acupuncture or mild pain. Recent studies have shown that 4% to 6% of leukoplakia become malignant tumors

Long-term unhealed leukoplakia should be biopsied to rule out cancer, and histopathological examination is the main basis.

TCM pathogenesis and syndrome differentiation: The oral mucosa has localized white keratinized plaques, the surface is rough and not easy to peel off, the tongue is slightly red, the fur is white, and the pulse string is slow. Syndrome differentiation belongs to the stomach and lung heat, relapsed poisonous evil, caused by stagnation.

Differential diagnosis

Differential diagnosis

Oral mucosal fibrosis: Oral mucosal fibrosis is a collagen-deficient disease that attacks the submucosal layer and often severely restricts mouth movement.

Oral mucosal shedding: Oral mucosal shedding is a general term for all diseases that occur or are reflected in oral mucosal tissues. Common oral mucosal detachment diseases include acute allergic cheilitis, drug-induced mouth, radiation stomatitis and erythema multiforme. Common symptoms of oral mucosal shedding are extensive erosion of the mouth, including buccal, tongue, sputum, gums, mouth, tongue, throat, small tongue, upper and lower lips.

Oral mucosal ulcer: Oral ulcer, also known as "mouth sore", is a superficial ulcer that occurs on the oral mucosa. It can range in size from rice to soybean, round or oval, and the ulcer surface is concave and concave around the mouth. Congestion can cause pain due to irritating food, usually one to two weeks can heal itself.

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