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Leukoplakia

Leukoplakia — the dystrophic change of a mucous membrane which is followed in a varying degree by keratinization of an epithelium; treats a precancer.

Epidemiology

The leukoplakia most often develops at the age of 40 — 70. Men are ill twice more often than women.

Classification

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.

Differential diagnosis

Psoriasis, lupus erythematosus, red flat deprive, AIDS.

General principles of treatment of a leukoplakia

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.

Forecast

Planocellular cancer develops in 2 — 4% of cases.

 
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