Author: Dr Amna Bilal

Have you ever encountered white patches or spots on your tongue or inside your cheeks? Leukoplakia, a disorder in which white lesions develop inside the mouth, may be the cause.

You may have leukoplakia, a mouth condition if you’ve observed white patches in your mouth that don’t appear to go away. Leukoplakia is more common in areas of the mouth with mucous membranes, such as the gums, the inside of the cheek, and the tongue. The skin around the mouth becomes thicker as a result of this condition, and white patches start to appear there.

A mouth condition called leukoplakia affects 1% to 2% of people. Most cases involve men over the age of 50, and it typically affects people over the age of 40. Leukoplakia is uncommonly diagnosed in people under the age of 30. Leukoplakia can be challenging for clinicians to identify because some of its symptoms are shared by those of other frequent disorders and diseases of the mouth. However, a proper diagnosis of leukoplakia is required before a biopsy may be performed. Leukoplakia-related lesions can potentially develop malignant cells, resulting in oral and mouth cancer.

Leukoplakia: What is it?
The condition known as leukoplakia manifests as a white or a grey area on the tongue, the inside of the cheek, or the floor of the mouth. It is the mouth’s response to persistent (chronic) mouth mucous membrane irritation. The female genital area can also develop leukoplakia patches, albeit the reason why is unknown. Leukoplakia patches can appear at any time in your life, but older persons are more likely to develop them.

The uncommon leukoplakia known as “hairy” leukoplakia of the mouth, which is brought on by the Epstein-Barr virus, only affects those with HIV, AIDS, or an AIDS-related complex. The tongue and other parts of the mouth can develop white, fuzzy patches. Thrush, an infection brought on by the fungus Candida that typically affects people whose immune systems aren’t functioning properly, can mimic it in appearance.

What are the many forms of leukoplakia?
Leukoplakia can be of various different types:
1. Homogenous leukoplakia:
A lesion that is entirely white and does not contain any red. A homogeneous lesion’s probability of developing mouth or oral cancer is extremely low, and its cells hardly ever exhibit precancerous characteristics.

2. Non-homogenous leukoplakia:
Uneven lesions that are a mixture of white and red in colour. If the red areas are left untreated, they are more likely to develop into precancerous or cancerous lesions. Proliferative verrucous leukoplakia is a rare type of leukoplakia that typically affects older women. This type, which can cause tongue cancer in addition to oral cancer, has lesions all over the mouth as opposed to only the cheeks and tongue.

3. Hairy Leukoplakia:
In this kind of leukoplakia, the lesions are ridged or folded and have fine filaments that resemble hair growing out of them.

What symptoms are present in leukoplakia?
Leukoplakia can develop in areas of the body with mucosal tissue, like the mouth. Unusually shaped patches inside your mouth distinguish the condition. These patches can have a variety of appearances and the following characteristics:

· A thick, firm, elevated surface with a white or grey colour

· Hairy/fuzzy (hairy leukoplakia only)

· Red marks (rare)

· Cancer may be indicated by redness. If you experience red spots or patches, consult a doctor right away. You can develop leukoplakia on your lips, inside of your cheeks, under or on your tongue, and even on your gums. It can take many weeks for the patches to appear. They rarely hurt.

Leukoplakia is a condition that some women can get inside the vagina as well as on the exterior of their genitalia in the vulva area. This is more common among menopausal women. It’s a benign disorder. You should get in touch with your doctor if you have any concerns about anything more serious.

Why does leukoplakia develop?

The following are frequently linked to leukoplakia:

· Heavy smokers

· Using snuff or chewing tobacco

· Chewing betel nut, also known as areca nut, a tropical plant that thrives in regions of east Africa, the Pacific, and Asia.

· Heavy alcohol use

Unknown causes exist in certain leukoplakia cases, this is called idiopathic leukoplakia. The majority of occurrences occur in men aged 50 to 70. Less than 1% of cases involve people younger than 30.

How is leukoplakia identified?
Leukoplakia’s white patches are asymptomatic; therefore, medical professionals frequently discover them for the first time during a normal checkup. Other possible causes of the white spots are evaluated before a diagnosis of leukoplakia is confirmed. These could include internal mouth friction induced by something like dentures, recurrent cheek biting, fungal infection or lichen planus, and so on.

A biopsy (tissue sample) is collected and sent to the lab for analysis if no explanation is determined and the white patches are still present after two to four weeks. Leukoplakia, which carries the risk of developing into cancer, may be confirmed as the cause of the white patch if the biopsy results still do not provide a clear diagnosis. A cancer diagnosis, not a leukoplakia diagnosis, is made if cancer cells are really discovered.

How do you treat leukoplakia?
The primary goal of treatment for leukoplakia is to keep it from progressing to malignancy. Treatment is difficult, though, and outcomes are frequently inconsistent. The lesions may disappear with treatment, but many of them return.

Medical care:
· Stop drinking and using cigarettes.

· Consume plenty of fruits and veggies in your diet.

· Retinoids, which are vitamin A-based medications used to treat psoriasis and acne, are frequently relapsed and have undesirable side effects.

Beta-carotene and vitamin A pills can help reduce white spots, but once the person stops taking them, the patches will return. Beta-carotene is not as good at preventing malignant alterations as supplements containing isotretinoin.

Surgical treatment:
Surgical removal of lesions. However, there is still a 10% to 20% probability of the lesions coming back, as well as a 3% to 12% danger of getting cancer in the areas that have been treated.

Using a laser to remove lesions.

· Photodynamic treatment (use of light-activated cancer drugs).

· Cryotherapy (application of freezing to remove lesions)

· Electrocauterization (application of an electrically heated needle or other device to remove lesions)

Every three to six months, individuals with leukoplakia should visit their physician for follow-up care and, if necessary, biopsies to look for any potential changes in the condition. Even after surgically removing patches, it is advised to have a checkup every six to twelve months since leukoplakia frequently recurs. Treatment areas that have been free of abnormalities for three years may no longer need to be monitored. If leukoplakia reappears the following therapy, you should continue having follow-up exams as long as your doctor advises.