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Leukoplakia

Leukoplakia is a chronic inflammation of the mucous membrane with keratinization of the epithelium in the form of white spots observed on the mucous membranes of the oral cavity (tongue, cheeks, lower lip), cervix, vagina , bladder, penis .

leukoplakia

Spots of leukoplakia are flat, smooth, forming a sort of whitish-gray bloom, which cannot be removed by scraping; leukoplakia can also manifest itself in the form of whitish plaques with warty keratinizing growths on the surface - this form is called leukeratosis. Foci of leukoplakia are multiple, their color is not always uniform - in some places whitish-pink, in places grayish-white with a pearl shade. Spots can merge with each other, forming fancy shapes. Subjective sensations are often absent, and patients usually find leukoplakia only when viewed from the mucous membrane. The causes of leukoplakia of the oral mucosa are prolonged irritation with tobacco smoke, which contains tar, nicotine, phenolic products, etc., with alcohol and other chemical irritants; repeated injuries of carious teeth or poorly fitted dentures. Leukoplakia of the oral mucosa is usually observed in people older than 30-40 years, more often in men.

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Leukoplakia of the cervix develops in the menopausal period, usually as a result of chronic inflammation of the mucous membrane of the cervix, with prolapse of the uterus, with avitaminosis A and sometimes observed in newborns . Leukoplakia of the cervix has a long course, is not amenable to treatment with antibiotics and requires surgery.

Leukoplakia of the bladder and urinary tract is less common (see Bladder, leukoplakia).

Leukoplakia is a precancerous condition (especially leukeratosis). The development of cancer on the background of leukoplakia is observed in about 15–20% of cases. The loss of gloss of the white spot, the appearance of roughness, defined by a finger, or the detection of horny growths on the spot, as well as sores, should always be suspected of malignant transformation.

The treatment and prevention of leukoplakia is primarily the elimination of all causes causing constant irritation of the mucous membranes. For treatment should never be used cauterizing agents. When leukoplakia is detected, patients should be referred to a doctor. It is advisable to prescribe vitamins A and B. In the absence of success, surgical treatment is recommended ( electrocoagulation ). With the appearance of cracks, excessive keratinization, compaction of the leukoplakia lesion, it is necessary to perform a biopsy. Patients with leukoplakia should be under medical supervision, according to the manifestation of the disease, at the dentist, gynecologist or urologist.

Leukoplakia (leukoplakia; from Greek leukos - white and plakion - tile, plate) - opalescent or milky-white spots on the mucous membranes next to the skin, such as the lower lip, as well as on the mucous membranes of the cheeks, tongue (Fig. 1), floor of the mouth, clitoris, cervix, on the mucous membrane of the renal pelvis, bladder and urethra, on the foreskin, with vulvar kourose, etc. The size of the spots is 0.5 cm or more. Leukoplakia belongs to the keratoprecancrosis group. Leukoplakia has clear boundaries, rises above the level of the mucous membrane, occurs in two forms: simple and warty - leukeratosis (Fig. 2).

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Smoking, tooth damage, poor dentures, excessive use of alcohol, spices, cold or hot food, vitamin A or complex B, inflammatory processes of the oral cavity, metal bridges, fillings, crowns contribute to the occurrence of this etiological disease.

Simple leukoplakia (L. simplex). The folds of the mucous membrane are smoothed, the surface resembles a mosaic or parquet, the lesion can spread to a significant surface. Removal of white spots by scraping or rubbing fails, forcible intervention is accompanied by superficial bleeding.

Cracks or ulcers that appear during simple leukoplakia are painful, do not heal for a long time, are prone to relapses, and provide the basis for cancer.

Warty leukoplakia (L. verrucosa). The level of the mucous membrane is increased by several millimeters. The color of the affected area varies from pearl white to the color of chalk. In this form of leukoplakia, patients often complain of feeling petrified, burning, crawling, tastelessness, and severe pain, especially of the tongue and lips. Rapid thickening of the hilly region of leukoplakia or the appearance of papillomatous growths, cracks, ulcers may be a sign of incipient cancer transformation, which occurs more often than with simple leukoplakia.

Histopathology. When leukoplakia, as a rule, keratinization of the mucous membrane epithelium is observed. Keratinization has a pathological nature (such as parakeratosis). The epithelium covered with the stratum corneum is considerably thickened; the granular layer expands; epithelial processes penetrate to different depths; later the basal layer of the epithelium is loosened; the border of the epithelium and connective tissue becomes blurred; in the connective tissue, an infiltrate consisting of fibroblasts, lymphocytes, less frequently from plasma cells is observed. On the surface of the warty leukoplaky V-shaped grooves are formed, filled with horny mass. Leukoplakia is sometimes malignant.

In senile keratoma, cutaneous horn, keratoacanthoma, histological signs of initial cancer are often detected in the form of leukoplakia.

Treatment . With simple leukoplakia without signs of further evolution, electrocoagulation is used for therapeutic purposes; in cases of repeated relapses or the presence of clinical signs of epithelial proliferation, radiation treatments are recommended.

See also precancer.