Leukoplakia is a precancerous mucous membrane condition -- manifested by white patches -- that develops on the tongue, gums, or the inside of the cheek. Occasionally, patches develop on the female external genitalia. This condition is most common in older men.
Cause of oral leukoplakia
This condition may develop as a response to chronic irritation, for instance dentures, or from smoking or alcohol abuse.
SADJ. 2012. Leukoplakia and erythroplakia of the oral mucosa--a brief overview. Leukoplakia and erythroplakia are the two most common potentially malignant disorders of the oral cavity. The prognosis and overall survival of a patient with oral cancer is dependent on the early detection of any lesion that might identify a patient with higher risk than normal or with early infiltration before metastatic disease. The role of the general dentist cannot be overstressed and the aim of this brief summary is to give the general practitioner an overview on the current concepts relating to these disorders. Leukoplakia and erythroplakia were traditionally known as two "precancerous lesions of the oral mucosa". The term "precancer" defines all lesions classified as such to have a "precancerous nature" implying that all of them will eventually become malignant. Through the years it became known that even clinically normal mucosa may show features of dysplasia and in some instances molecular aberrations of early malignant transformation may be found in the mucosa of a patient without any clinical lesions or dysplasia. The consensus view then was to introduce the term: "potentially malignant disorders" (PMD) reflecting the more generalised mucosal involvement in these patients.
Oral hairy leukoplakia is a white thickening or coating of the lining of the mouth. It looks like white vertical folds or ridges. These ridges are almost always located on the sides of the tongue. Hairy leukoplakia is often a sign of HIV infection and an increased likelihood of developing AIDS. Oral hairy leukoplakia is often one of the first opportunistic infections to occur in HIV-positive people. It can occur at any T-cell count, but it is most common among HIV-positive people with fewer than 300 T-cells. It is also important to note that it can occur in people with healthy immune systems, including those not infected with HIV, such as organ transplant recipients.
Hairy leukoplakia is a condition now thought to be caused by the Epstein-Barr virus (EBV), a member of the herpes virus family which is commonly found in the mouth.
Oral leukoplakia treatment
This condition is usually treated by removing the source of the irritation, for instance stopping tobacco chewing, smoking or correcting dental problems. Leukoplakia patches can be removed by a dentist or oral surgeon using a scalpel, laser or cryoprobe, an extremely cold probe that freezes and destroys cancer cells.
There is an exciting possibility that retinoids — derivatives of vitamin A that are used to treat severe acne and other skin conditions — may be helpful for oral leukoplakia. Natural carotenoids such as beta-carotene, an antioxidant that's converted to vitamin A in your body, may also completely or partially reduce leukoplakic patches. Recent studies indicate that lycopene may be helpful. Lycopene is a carotenoid with a pink/red color found in tomatoes, watermelon, and other fruits. Lycopene is available as a supplement. Perhaps curcumin and other herbs that fight cancer could also play a role.
Efficacy of oral lycopene in the treatment of oral leukoplakia.
Oral Oncology. 2004.
This study evaluates the efficacy of lycopene in the treatment of oral leukoplakia and compares two different doses with a placebo. Fifty-eight clinically and histologically diagnosed patients of oral leukoplakia were selected for the study. They were randomly divided into three groups. Group A: (8 mg lycopene / day), Group B: (4 mg lycopene / day) and Group C (placebo). The duration of the therapy was three months. Outcome was assessed clinically as well as histologically. Post-treatment patients were on follow-up for two months. Student's 't' test was used for statistical evaluation. Clinically the patients in Groups A, B, C had a mean response of 80%, 66% and 12% respectively. Histological evaluation too had similar results. Patients receiving lycopene in both regimes show highly significant difference in response as compared to placebo (Group C). The observed effect of lycopene suggests that it can be effectively and safely used for the management of oral leukoplakia.
Oral Leukoplakia Research
Although leukoplakia responds to some treatments relapses and adverse effects are common.
Evid Based Dentinstry. 2005.
The Cochrane Oral Health Group's Trials Register, Cochrane Central Trials Register, Medline and Embase were searched, as well as the following journals: Cancer, Community Dentistry and Oral Epidemiology, European Journal of Oral Sciences, Journal of Dental Research, Oral Oncology, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. The reference lists of included studies and reviews were checked, and oral medicine experts were contacted through a European mailing list (EURORALMED). Randomised controlled trials (RCT) were included if they had enrolled patients who had a diagnosis of oral leukoplakia and who were undergoing any surgical or medical (topical and systemic) treatment. The primary outcome considered was malignant transformation of leukoplakia demonstrated by histopathological examination. Other outcomes considered were clinical resolution, histological modification and frequency of adverse effects. Data were collected using a specific extraction form. The validity of studies included was assessed by two reviewers, on the basis of the method of allocation concealment, blindness of the study and loss of participants. Data were analysed by calculating relative risk (RR). The possible effectiveness of surgical interventions, including laser therapy and cryotherapy, has never been studied by means of an RCT. Nineteen RCT of nonsurgical interventions were identified: seven were included. Vitamin A and retinoids were tested in five RCT (245 patients); the other drugs tested were bleomycin (one study), mixed tea (one study) and beta-carotene (one study). Malignant transformation was recorded in just two studies. None of the treatments tested showed a benefit compared with placebo. Treatment with beta-carotene and vitamin A or retinoids was associated with significant rates of clinical resolution, compared with placebo or absence of treatment. Whenever reported, a high rate of relapse was a common finding. Side effects of variable severity were often described but interventions were well accepted by patients, since dropout rates were similar between treatment and control. To date there is no evidence of effective treatment in preventing malignant transformation of leukoplakia. Treatments may be effective in the resolution of lesions, but relapses and adverse effects are common.