Leukoplakia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 28, 2016
StartDiseasesLeukoplakia

Leukoplakia is a condition in which white patches appear on various areas within the mouth. It can less commonly affect other mucosal areas of the body. The patches have been linked to the use of tobacco products.

Contents

Definition & Facts

Leukoplakia is defined by the existence of white lesions or patches on mucous membranes such as that of the mouth. These patches are known as areas of keratosis and are composed of keratin, the same material that makes up hair and fingernails. They cannot be removed non-surgically and can persist for a few weeks to years or even permanently.

In order for a lesion to be considered leukoplakia, it cannot have a known cause. As a result there are several types of syndromes that can fall under the category of leukoplakia. Historically, the term was applied to many diseases that later were found to have verifiable and specific causes, such as syphilitic glossitis and hyperplastic candidiasis, a type of oral candidiadis.

Leukoplakia is premalignant and may develop into squamous cell carcinoma of the mouth. Some resources estimate that 3-17% of people with leukoplakia develop oral cancer within fifteen years of diagnosis.

Symptoms & Complaints

Leukoplakia may present in many different ways. The primary symptom of leukoplakia is hard white patches within the mouth that do not go away. The patches may be smooth or rough and corrugated. They are uneven in shape and slightly raised, and can occasionally sting when in contact with acidic or spicy foods.

Very rarely, these patches may appear in the esophagus or the bladder. Other than the existence of the patches, oral and esophageal leukoplakia usually present with few or no symptoms. In the case of bladder leukoplakia, persons may experience a frequent need to urinate, blood in the urine, and pain in the area of the bladder and during urination.

Causes

Leukoplakia is an idiopathic (meaning "without cause") syndrome. There is not yet a clear reason for the disease's occurrence, but several causative factors have been identified. The clearest link is with tobacco use, including smoking and chewing tobacco, with the latter being more strongly linked. Out of all leukoplakia patients, 80% have a history of using tobacco. Use of paan, a combination of betel leaf and areca nut popular in some Asian countries, is also indicated to be a factor.

Alcohol or mouthwash use in conjunction with a tobacco habit can increase one's chance of developing leukoplakia. However, alcohol or mouthwash by themselves do not appear to have an effect. Sanguinaria, or bloodroot, is used in some toothpastes and mouthwashes and has been strongly linked to leukoplakia.

Frictional trauma in the mouth, such as a rough tooth or dentures, has been known to cause calluses that have a similar appearance to leukoplakia. Other factors that are associated with the occurrence of leukoplakia include deficiencies of iron or some vitamins and ultraviolet radiation exposure. Scientists are currently researching fungal infections and viral infections as possible causes, with Candida yeast and human papilloma virus being strong candidates.

Diagnosis & Tests

A diagnosis of leukoplakia comes only after other syndromes have been ruled out. The patch or patches can be examined by a physician via biopsy to determine any possible cause. There are many reasons for white lesions or patches to develop in the mouth, but if no cause can be identified, then the physician will diagnose it as oral idiopathic leukoplakia.

There are several subcategories of the condition. Homogenous leukoplakia is a corrugated flat-looking patch with a uniform appearance. Non-homogenous leukoplakia is a patch that varies in color and texture throughout, and has a greater chance of becoming malignant or cancerous. Erythroleukoplakia is a patch of speckled white and red that often appears inside the cheek, and erythroplakia is when the patch is completely red.

A few diseases that used to be classified as leukoplakia now have known causes and are not to be confused with idiopathic leukoplakia, Candidal leukoplakia is a historical name for oral candidiasis, which is a white covering on the tongue and is caused by a Candida yeast infection. Oral hairy leukoplakia manifests as corrugated white patches caused by the Epstein-Barr virus in association with human immunodeficiency virus infection. Syphilitic leukoplakia is an open white lesion on the tongue and arises with tertiary syphilis infection.

Treatment & Therapy

Surgical removal is often the first step in treating leukoplakia, especially if growth or change in the lesion has been observed. This involves removing the patch with traditional scalpel techniques, or using more modern surgical procedures such as laser surgery, cryotherapy, or electrocautery. This will not prevent the leukoplakia from reappearing, however, so the patient will be advised to cease activities that increase risk, such as use of tobacco and alcohol.

If the patch is too large to remove or if surgery is otherwise not possible, then the patch will be regularly monitored for signs that it has developed into malignancy. Again, it is recommended that the patient cease smoking and drinking alcohol, as these greatly increase the risk of the area becoming cancerous.

In the case of non-idiopathic leukoplakia, removal of the cause will usually result in the disappearance of the lesion. If it has appeared due to frictional trauma in the mouth, this could mean repairing a broken tooth or replacing dentures. If the patient uses a known precursor substance such as tobacco or sanguinaria, cessation of the substance could also prompt eventual resolution of the leukoplakia.

Prevention & Prophylaxis

The best way to prevent leukoplakia is to refrain from using tobacco or drinking alcohol, or any other substances known to increase its incidence such as sanguinaria or paan.

In general, keeping good oral hygiene will do a lot to prevent leukoplakia-like conditions from developing. Making sure to have any problems with teeth or dentures repaired as soon as possible is an important preventive measure. Regular dentist visits will ensure that cases of leukoplakia can be caught and addressed or monitored early on.

There are currently no medications that can either prevent leukoplakia from appearing or prevent it from becoming malignant. Research is currently being done into whether substances such as antioxidants, vitamins or cell growth inhibitors have any affect.