Leukoplakia — the dystrophic change of a mucous membrane which is followed in a varying degree by keratinization of an epithelium; treats a precancer.
The leukoplakia most often develops at the age of 40 — 70. Men are ill twice more often than women.
Allocate 3 clinical kinds of a leukoplakia: • flat; • verrukozny; • erosive and ulcer.
Etiology and pathogeny
Emergence and development of a leukoplakia are promoted by chronic inflammatory or atrophic processes, in particular red flat deprive, a lupus erythematosus, psoriasis, skleratrofichesky deprive, a mnogoformny erythema, syphilis. In some cases the epidermal nevus mucous a mouth independently or as a component of a syndrome of an inborn pachyonychia can be the cause of a leukoplakia. The leukoplakia can be result of a roentgenotherapy, mechanical damages, smoking.
Clinical signs and symptoms
The flat form of a leukoplakia is characterized by emergence on mucous membranes of milky-white spots of various size and a form with a clear boundary which do not tower over their surface (i.e. over a surface of mucous membranes) and are covered with a multilayer flat epithelium with existence of difficult deleted keratinization sites. The Verrukozny form is provided by the blyashkovidny centers with a warty surface and the expressed keratinization, gray-white color, slightly plotnovaty, acting over a surrounding mucous membrane, sometimes coming to light against the centers of a flat leukoplakia.
The erosive and ulcer form of a leukoplakia is characterized by existence of the single or multiple erosion of various size arising usually against the keratosic centers of a flat leukoplakia.
The diagnosis and the recommended clinical trials
The diagnosis is made on the basis of clinical yielded and results of a biopsy. • At a flat form in the centers of defeat the epidermis acanthosis decides on a parakeratosis, in a stroma — hypostasis with availability of the merging perivascular polymorphocellular infiltrates. • At a verrukozny form sharply expressed compact hyperkeratosis, an acanthosis with uneven, reinforced epidermal outgrowths is characteristic. A hyperplasia of a granular layer from 3 — 6 rows of cells with well-marked granularity. In a derma — hypostasis, vasodilatation and perivascular lymphocytic infiltrates. • The erosive and ulcer form is followed by defect of an epithelium at the edges of which find an acanthosis with lengthening of epithelial outgrowths, a parakeratosis and an exocytosis. In a stroma — the expressed inflammatory changes which are followed by a hyperemia, hypostasis and emergence of the diffusion infiltrates consisting of lymphocytes with impurity of plasmocytes and fabric basophiles.
Surgical excision, cryolysis, laser evaporation are shown. At a leukoplakia appoint also GKS for topical administration: Klobetazol, ointment, locally 3 r / days within 1 month, 2 r / days within the 2nd month, 1 r / days within the 3rd month. Also methods of combined local effect by retinoids in combination with administration of interferon are described.