Erythroplakia Overview

Erythroplakia

• Defined as a red patch or plaque that lacks a clear clinical or pathological diagnosis.
• Requires exclusion of other oral red lesions; prevalent risk factors include tobacco and alcohol use.
• High potential for malignant transformation, with an estimated 80% risk.
• Less common than leukoplakia but carries a more severe prognosis.
• Prevalence in adults estimated at 0.02% to 0.1%.
• Clinically appears as a well-demarcated red patch, soft or velvety texture, often asymptomatic.
• Any persistent red mucosal lesion should be considered cancerous unless proven otherwise through histology.

Diagnosis and Microscopic Features

• Diagnosis involves the exclusion of other red lesions (e.g., non-specific mucositis, candidiasis, lichen planus, lupus erythematosus).
• Histological evaluation shows atrophic, non-keratinized epithelium.
• Over 90% of cases present with dysplasia, carcinoma in situ, or carcinoma at initial presentation.

Treatment

• Treatment decisions are based on histopathological findings.
• Biopsies for dysplastic lesions and complete excision are essential.
• Aggressive treatment is warranted for squamous cell carcinoma (SCCa).
• Emphasis on tobacco cessation and regular follow-ups.

Biopsy Recommendations

• Excisional biopsy recommended for leukoplakia under 30 mm; larger or suspicious lesions require incisional biopsies from multiple sites.

Oral Lichen Planus

• Multifactorial pathogenesis impacts immune response, causing local epithelial destruction.
• Common causes include erosive and plaque subtypes with potential autoimmune disease association.
• Clinical types include reticular (most common), papular, plaque-like, bullous, atrophic, and ulcerative forms.
• Reticular type often appears bilaterally on buccal mucosa, while plaque-like is frequently seen in smokers.
• Skin lesions include purple, itchy papules, often known as the "4 Ps".

Histopathological Features of Lichen Planus

• Diagnosis requires presence of papules or reticular components.
• Features include hyperkeratosis, hypergranulosis, and necrosis of the basal cell layer.
• Differential diagnosis includes various lichenoid reactions and systemic lupus erythematosus.

Management of Lichen Planus

• Focus on reducing symptoms; topical steroids are the main treatment.
• Second-line therapies include cyclosporine, tacrolimus, and retinoids.
• Emphasis on optimal oral hygiene, especially in the erythematous form.

Drug-Induced Lichenoid Reactions

• Clinical appearances resemble hypersensitivity reactions triggered by certain drugs (e.g., penicillin, NSAIDs).
• Diagnosis can be challenging; improved clarity when reactions arise after new drug administration.
• Management typically involves discontinuation of the drug and symptomatic care with topical steroids.

Reactions to Mechanical Trauma

• Chronic cheek biting results in asymptomatic white keratotic plaque, often bilateral (Morsicatio Buccarum).
• Frictional hyperkeratosis represents a response to repeated minor trauma, detected by a white keratotic line on buccal mucosa.
• Traumatic eosinophilic ulcerations appear as deep, chronic lesions without malignant potential.

White Sponge Nevus

• An autosomal dominant condition characterized by an asymptomatic corrugated surface in the buccal mucosa due to keratin gene mutations.
• Usually begins in adolescence; no treatment required.

Hairy Tongue

• A condition stemming from imbalance in oral flora, often linked to certain medications and poor oral hygiene.
• Management includes improving oral hygiene and tongue cleaning practices.

This quiz explores the clinical definition and implications of erythroplakia, a concerning oral condition characterized by red patches. The risk factors, prevalence, and potential for malignant transformation associated with this condition will also be discussed. Understanding erythroplakia is crucial for early diagnosis and intervention.