This document provides descriptions and distinguishing characteristics of various white and red lesions that may appear in the oral cavity. It describes conditions such as leukoplakia, lichen planus, oral thrush, hairy leukoplakia, chemical burns, and more. For each condition, it outlines where in the mouth they typically appear, their appearance (color, texture, etc.), potential causes, how to diagnose, and important histopathological findings. The goal is to differentiate between these various oral lesions based on clinical and microscopic examination.

1. D.D of white lesion:
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Leukodema
White spongy neavus
Heredetary benign epith.dyskeratosis
Darriers disease
oral keratosis
Chemical burns
Oral thrush
Leukoplakia
Hairy leukoplakia
Lichen planus

2. leukodema
 Faint diffuse,filmy
 Numerous folds or
wrinkles
 Can’t be scrapped off
 Disappear & fades
upon stretching

3. White spongy neavus
 Oral mucosa (mainly)
 Nose,pharynx,genital
,rectum
 Bilateral,symmetrical
 spongy,velvety,thick
plaque
 Buccal mucosa
mainly
 May be other non
keratinized mucosa

6. Biopsy
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Hyperkeratosis
Acanthosis
Perinuclear condensation of cytoplasm
Vacuolazation of suprabasal layer

7. Hereditary benign
intraepithelial
dyskeratosis
 Oral lesion
 Eye lesion

8.  Oral lesion:
 Thick & corrugated
 Asymptomatic
 White spongy plaque
 Buccal & labial mucosa mainly
 1st years of life &increase untill teenage

9.  Eye lesion:
 Thick, gelatinous, foamy,opaque plaque
adjacent to cornea
 Seasonal prominence
 May lead to blindness due to corneal
vascularization

10. Darrier disease
hyperkeratotic papules
 Skin lesion:
 Firm harsh
papule,greasy
 Seborrhoeic areas as
Scalp ,forhead
 Skin yellowish brown
or brown

11.  Oral lesion:
 cobblestone papules
 Palate,tongue,buccal
mucosa,pharyngeal
wall
 confluence of papule
form plaque

12.  Nail lesion:
 Broad white
longitudinal band
 Broad red
longitudinal band
 Sandwich of red &
white
• Ear lesion:
 External auditory
meatus blocked by
accumulation of
debris

13. Frictional keratosis
 White rough plaque
 Related to a source of
mechanical irritation

14. Cheek biting
 Chronic irritation as:
Suckling,cheek & lip
biting
 Bilaterally along
occlusal plane

15. Chemical burn
 Transient non
keratotic white plaque
 Irregular in shape
 Covered by
pseudomembrane
 Very painful

16. Aspirin burn

17. Smokless tobacco
induced keratosis
 In the area of
tobacco contact
 Precancerous
 May be wrinkled or
folded
 May be
Accompanied by
gingival recessetion&
perio-destruction

18. Actinic keratosis
 Patient exposed for
sunlight for
prolonged time

19. Acute psdeudo
membranous
candidiasis(oral thrush)
 Painless
 Soft creamy white plaque
 Can’t be easily rubbed or
whiped off leaving
erythematous area or
ulceration
 Range from
Small flecks-wide spread
confluent plaque
 Prodrome of bad taste or
loss of taste sensation

21. Confirmation:
 Gm stained smear
shows candidal
hyphae
 Biopsy:hyperplastic
epithelium
inflammatory
oemda&cells
 PAS shows candidal
hyphae

22. Chronic hyperplasic
candidiasis
(candidal leukoplakia)
 Chronic
 Firm white leathery
plaque
 Cheek,lip,palate,
tongue
 PAS +ve candidal
hyphae

23. leukoplakia
White patch or plaque
 Homogenous
 Nodular
 Verrucous
 Proliferative verrucous

24.  Homogenous leuplakia:
 Well defined white patch
 Slighty elevated
 Fissured,wrinkled,corrug
ated surface
 On palpation
leathery( like dry
cracked mud)

26. Verrucous leukoplakia:
 papillary
 Heavily keratinized
 Increased rate of
malignant
transformation

27. Proliferative verrucous:
 Extensive papillary or
verrucoid white
plaque
 Involve multiple
mucosal site
 May transform into
squamous cell
carcinoma

28. Speckled leukoplakia:
 mixed red & white
 Karatotic white nodule
&erythematousatrophic
area
 High rate of malignant
transformation

30. diagnosis
clinically
 Cannot be stripped or rubbed off
 Loss of elasticity & pliability
Lab investegation:
 Biopsy
*hyperkeratosis
*acanthosis
*chronic inf. Cells
*signs of dysplasia
 Touluidine blue test

31. Oral hairy leukoplakia
 Corrugated white
lesion
 Lateral or ventral
surfaceof tongue
 Immumunodeff pt (HIV)

33. confirm diagnosis by:
Demo of EBV by:
 In situ hyberidization
 E.M
 PCR

34. Lichen planus
 Skin lesions
 Oral lesions:
 Papular(reticular)
 Atrophic
 Bullous erosive

35. Skin lesions:
• Pruiritic
• Polyangular
• Plane topped
• Papules & plaques
• Violaceous
• (wrist,legs,trunk)
• Koebner
phenomenon
• Scalp alopecia

37. Oral lesion:
papular type:
*painless
*Pin head,hyperkeratotic
papule
*fine white lines called
(wickhams stria)
 Discrete
 Linear
 Reticular
 Confluent (plaque)

38. D.D lekoplakia:
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Bilateral
Felxible
Pliable
No signs of dysplasia
Cheek,lips,dorsum of
tongue
Rarely palate & gingiva

39. Immunofourescenct
test

40. D.D of red lesions
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Acute atrophic candidiasis
Denture induced stomatitis
Median rhomboidal glossitis
Erythematous candidiasis
Erythroplakia
Atrophic lichen planus
Angular stomatitis

41. Acute atrophic
candidiasis
 Whole mucosa is red
& sore
 History of prolonged
antibiotic intake
 Xerostomia (sjogren
syndrome)

42. Denture induced
stomatitis
 Sharpely limited to area
occluded by denture
 Associated usually by
angular stomatitis

43. Median rhomboidal
glossitis
 Erythematous
rhomboidal area
 At central area of
dorsum of the tongue

44. Erythematous
candidiasis
 Red patch due to candida albicans
 Infection in H.I.V pt
 Hard palate,soft palate,dorsum of the
tongue

45. Angular stomatitis
 Denture wearer
( loss of V.D)
 Inflamation at the angle
of the mouth

46. erythroplakia
 Bright red velvety
plaque
 Esp:floor of
mouth,soft
palate,ant.tonsillar
pillar
Biopsy:
Severe signs of
dysplasia

47. Atrophic lichen planus
 Irregular red patch
 No change in
flexibility or pliability
 Commonly dorsum of
tongue
 Desquamative
gingivitis
 Reimmision &
exacerbation

48. Bullous erosive lichen
planus
 Severe pain &
burning sensation
 Change in taste

49. Histopathology:
 Hyperkeratosis
 Liguifactive degeneration of basal cell
layer
 Dense subepithelial band of lymphocytic
inf.
 isolated epith.cells have nuclear
fragment(civatte bodies)

50. immunoflourescent
 Shaggy band of
fibrinogen at B.M
zone
 IgM in dermal papilla
in peribasal area

51. Stomatitis nicotina
 White lesion inhard & soft
palate
 Heavy cigarette,pipe,cigar
smoking & reverse
smoking
 Palate grey or white
 Elevated papules with red
centre

53. Lupus erythematosus

56. Immunoflouresecnt
test