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Leukoedema lesions disappear when the mucosa is stretched, which helps to differentiate it from other white lesions in the mouth. [2] The differential diagnosis is with leukoplakia , oral candidiasis , oral lichen planus , white sponge nevus , morsicatio buccarum , [ 3 ] hereditary benign intraepithelial dyskeratosis and dyskeratosis congenita.
Desquamative gingivitis is a descriptive clinical term, not a diagnosis. [1] Dermatologic conditions cause about 75% of cases of desquamative gingivitis, and over 95% of the dermatologic cases are accounted for by either oral lichen planus or cicatricial pemphigoid. [1]
It is seen in patients using inhaled steroids and smokers, and is usually a kind of chronic atrophic oral candidiasis, but hematinic deficiency and diabetes should be excluded. [3] Median rhomboid glossitis in a child. Note atypical appearance of the lesion, which is more commonly an erythematous, atrophic area of depapillation
Lichen planus may be categorized as affecting mucosal or cutaneous surfaces.. Cutaneous forms are those affecting the skin, scalp, and nails. [10] [11] [12]Mucosal forms are those affecting the lining of the gastrointestinal tract (mouth, pharynx, esophagus, stomach, anus), larynx, and other mucosal surfaces including the genitals, peritoneum, ears, nose, bladder and conjunctiva of the eyes.
Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in confectionery, plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors) Administration of ganglion blockers (e.g., Tubocurarine, Mecamylamine). Oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris; Heredity
Lichen planus: A chronic inflammatory disease with different forms of oral presentations. The most classic appearance of lichen planus is the presence of white streaks in inner cheek, tongue, and gum. Desquamative gingivitis can be seen in patients with lichen planus. Biopsy is done for definitive diagnosis of lichen planus. [18] [23]
Oral candidiasis may develop with long term topical steroid use, and sometimes antimycotics such as miconazole gel or chlorhexidine mouthwash are used to prevent this. Topical ciclosporin is sometimes used. Dapsone is sometimes used as a steroid sparing agent. The dose is often increased very slowly in order to minimize side effects.
[20] [21] The condition resembles oral lichen planus when biopsied. The diagnosis is made by microscopic examination of biopsy tissue: direct immunofluorescence can reveal the presence of antinuclear antibodies specifically directed against the ΔNp63α form of the p63 protein , which is normally expressed within the basal layer of stratified ...
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