SUPERPLASTICITY
CONTENTS WHITE LESIONS, ACTINIC (SOLAR) CHEILITIS, CANDIDIASIS, EXFOLIATIVE CHEILITIS, FORDYCE’S GRANULES, GEOGRAPHIC TONGUE, HAIRY LEUKOPLAKIA, HAIRY TONGUE, LEUKOEDEMA, LEUKOPLAKIA, LICHENOID DRUG ERUPTIONS, LICHEN PLANUS, MORSICATIO BUCCARUM/LABIORUM (CHEEK AND LIP CHEWING), PROLIFERATIVE VERRUCOUS LEUKOPLAKIA, SMOKELESS TOBACCO KERATOSIS (SNUFF POUCH), SUBMUCOUS FIBROSIS, WHITE SPONGE NEVUS, RED/BLUE LESIONS, ECCHYMOSIS, ERYTHROPLAKIA, FISSURED TONGUE, HEMANGIOMA, HEREDITARY HEMORRHAGIC TELANGIECTASIA (RENDU-OSLER-WEBER SYNDROME), KAPOSI’S SARCOMA, PDQ ORAL DISEASE DIAGNOSIS AND TREATMENT PETECHIAE, PLASMA CELL GINGIVITIS, PYOGENIC GRANULOMA, VARICES, VESICULOBULLOUS DISEASES, EPIDERMOLYSIS BULLOSA, ERYTHEMA MULTIFORME, HAND-FOOT-AND-MOUTH DISEASE, HERPANGINA, HERPETIC STOMATITIS: PRIMARY, IMPETIGO, MUCOUS MEMBRANE PEMPHIGOID, PARANEOPLASTIC PEMPHIGUS, PEMPHIGUS VULGARIS, RECURRENT HERPETIC STOMATITIS: SECONDARY, STEVENS-JOHNSON SYNDROME, VARICELLA AND HERPES ZOSTER, ULCERATIVE CONDITIONS, ACTINOMYCOSIS, ACUTE NECROTIZING ULCERATIVE GINGIVITIS (VINCENT’S INFECTION), APHTHOUS STOMATITIS, BEHÇET’S DISEASE, BLASTOMYCOSIS, CROHN’S DISEASE, HISTOPLASMOSIS, LUPUS ERYTHEMATOSUS, MUCORMYCOSIS (ZYGOMYCOSIS), NEUTROPENIC ULCER, RADIATION-INDUCED MUCOSITIS, SQUAMOUS CELL CARCINOMA, SYPHILIS, TRAUMATIC GRANULOMA (TRAUMATIC EOSINOPHILIC ULCER), TRAUMATIC ULCER, TUBERCULOSIS, WEGENER’S GRANULOMATOSIS, PIGMENTARY DISORDERS, ADDISON’S DISEASE, AMALGAM TATTOO, MELANOACANTHOMA, MUCOSAL MALIGNANT MELANOMA, MUCOSAL MELANOTIC MACULE AND EPHELIDES, MUCOSAL PIGMENTATION: EXTRINSIC (DRUG OR METAL INDUCED), NEVUS, NEVUS OF OTA, PIGMENTATION DISORDERS: DRUG INDUCED, PIGMENTATION DISORDERS: PHYSIOLOGIC, PIGMENTATION DISORDERS: SMOKER’S MELANOSIS, TETRACYCLINE STAINING, VERRUCAL-PAPILLARY LESIONS, CONDYLOMA ACUMINATUM, FOCAL EPITHELIAL HYPERPLASIA, KERATOACANTHOMA, LYMPHANGIOMA, PAPILLARY HYPERPLASIA (PALATAL PAPILLOMATOSIS), PYOSTOMATITIS VEGETANS, SQUAMOUS PAPILLOMA, VERRUCA VULGARIS (ORAL WARTS), VERRUCOUS CARCINOMA, VERRUCOUS HYPERPLASIA, CONNECTIVE TISSUE LESIONS, CEMENTOBLASTOMA, CHEILITIS GLANDULARIS, FIBROMA: TRAUMATIC, FIBROUS DYSPLASIA, FIBROUS HYPERPLASIA: DENTURE-RELATED (EPULIS FISSURATA), FLORID OSSEOUS DYSPLASIA (FLORID CEMENTO-OSSEOUS DYSPLASIA), GARDNER’S SYNDROME, GIANT CELL GRANULOMA, GINGIVAL HYPERPLASIA: GENERALIZED, GRANULAR CELL TUMOR (GRANULAR CELL MYOBLASTOMA), LEUKEMIA, LINGUAL BONE DEFECT (STAFNE BONE CYST; STATIC BONE CYST), LINGUAL THYROID, LIPOMA, MACROGLOSSIA, MASSETERIC HYPERTROPHY, MELKERSSON-ROSENTHAL SYNDROME, MUCOSAL NEUROMA, NEUROFIBROMA, PAGET’S DISEASE, PERIAPICAL CEMENTO-OSSEOUS DYSPLASIA, SCLERODERMA, TORUS: PALATAL AND MANDIBULAR, SALIVARY GLAND DISEASES, MUCOCELE, MUCUS RETENTION CYST, NECROTIZING SIALOMETAPLASIA, RANULA, SIALORRHEA (SIALOSIS), SJÖGREN’S SYNDROME, LYMPHOID LESIONS, BURKITT’S LYMPHOMA, LYMPHOEPITHELIAL CYST, LYMPHOMA, MYELOMA, CYSTS, ANEURYSMAL BONE CYST, CALCIFYING ODONTOGENIC CYST, DENTAL LAMINA CYST (BOHN’S NODULES; GINGIVAL CYST OF NEWBORN), DENTIGEROUS CYST, DERMOID CYST, ERUPTION CYST, GLANDULAR ODONTOGENIC CYST, LATERAL PERIODONTAL CYST, NASOPALATINE DUCT CYST, NEVOID BASAL CELL CARCINOMA SYNDROME, ODONTOGENIC KERATOCYST, PRIMORDIAL CYST, RADICULAR CYST, THYROGLOSSAL DUCT CYST, TRAUMATIC BONE CYST, ODONTOGENIC TUMORS, ADENOMATOID ODONTOGENIC TUMOR, AMELOBLASTIC FIBROMA AND AMELOBLASTIC FIBRO-ODONTOMA, AMELOBLASTOMA, CALCIFYING EPITHELIAL ODONTOGENIC TUMOR, ODONTOGENIC MYXOMA, ODONTOMA, PERIPHERAL ODONTOGENIC FIBROMA, BENIGN NONODONTOGENIC TUMORS, CAROTID BODY TUMOR, EXOSTOSIS, JUVENILE OSSIFYING FIBROMA, LANGERHANS CELL DISEASE (“HISTIOCYTOSIS X,” IDIOPATHIC HISTIOCYTOSIS), OSSIFYING FIBROMA, OSTEOMA, PERIPHERAL OSSIFYING FIBROMA, INFLAMMATORY DISEASES, ANGIOEDEMA, CHEILITIS GRANULOMATOSA, DRUG-INDUCED STOMATITIS (STOMATITIS MEDICAMENTOSA), GARRɒS OSTEOMYELITIS, GINGIVITIS, MEDIAN RHOMBOID GLOSSITIS, OSTEOMYELITIS, OSTEORADIONECROSIS, PERIAPICAL GRANULOMA, SARCOIDOSIS, TOOTH ABNORMALITIES, ABRASION, AMELOGENESIS IMPERFECTA, ATTRITION, BULIMIA, DENTINAL DYSPLASIA, DENTINOGENESIS IMPERFECTA, EROSION, FLUOROSIS: CHRONIC ENDEMIC, FUSION, NATAL TEETH, MALIGNANT NONODONTOGENIC TUMORS, EWING’S SARCOMA, METASTATIC CANCER, OSTEOSARCOMA, METABOLIC AND GENETIC DISORDERS, AMYLOIDOSIS, CHERUBISM, CLEIDOCRANIAL DYSPLASIA, HYPERPARATHYROIDISM, THERAPEUTICS, ACUTE HERPETIC GINGIVOSTOMATITIS, ACUTE NECROTIZING ULCERATIVE GINGIVITIS, HERPES ZOSTER, PEMPHIGOID, RECURRENT APHTHOUS STOMATITIS (APHTHOSIS), RECURRENT HERPES SIMPLEX LABIALIS OR STOMATITIS, ZOSTER, ADDITIONAL READING, PDQ ORAL DISEASE DIAGNOSIS AND TREATMENT WHITE LESIONS ACTINIC (SOLAR) CHEILITIS ETIOLOGY CHRONIC, EXCESSIVE EXPOSURE TO SOLAR RADIATION; ULTRAVIOLET SPECTRUM (RANGING FROM 290 TO 320 NM) MOST DAMAGING FAIR-COMPLEXIONED PEOPLE MORE SEVERELY AFFECTED THAN OTHERS MAY PROGRESS TO CUTANEOUS ACTINIC KERATOSIS AND/OR SQUAMOUS CELL CARCINOMA CLINICAL PRESENTATION VERMILION PORTION OF LOWER LIP PALE IRREGULARLY OPAQUE (KERATOTIC) SURFACE WITH INTERVENING RED (ATROPHIC) ZONES OBFUSCATED TO EFFACED CUTANEOUS-VERMILION BORDER MORE ADVANCED LESIONS ARE SCALY, CRUSTED AND/OR INDURATED PROGRESSION TO CARCINOMA OFTEN HERALDED BY PERSISTENT ULCERATION OR EROSION MICROSCOPIC FINDINGS HYPERKERATOSIS EPITHELIAL ATROPHY VARIABLE DEGREES OF EPITHELIAL DYSPLASIA AMPHOPHILIC TO BASOPHILIC CHANGE IN SUBMUCOSA (ELASTOSIS) TELANGIECTASIA DIAGNOSIS THERMAL/CHEMICAL BURN RULED OUT BY HISTORY CHRONIC ULTRAVIOLET LIGHT EXPOSURE BIOPSY FINDINGS DIFFERENTIAL DIAGNOSIS EXFOLIATIVE CHEILITIS SQUAMOUS CELL CARCINOMA TREATMENT PREVENTION OF FURTHER DAMAGE WITH SUNSCREENS BLOCKING LONG- WAVE ULTRAVIOLET A (UVA) AND SHORT-WAVE ULTRAVIOLET B (UVB) LIGHT BIOPSY OF CLINICALLY SUSPICIOUS AREAS CO2 LASER VERMILIONECTOMY TOPICAL 5-FLUOROURACIL OR VERMILIONECTOMY FOR SEVERE DISEASE EXCISION OR RESECTION-RECONSTRUCTION IF MALIGNANT TRANSFORMATION HAS OCCURRED PROGNOSIS LIFELONG FOLLOW-UP UP TO 10% DEVELOP INTO SQUAMOUS CELL CARCINOMA WHEN CARCINOMA DEVELOPS, GROWTH TENDS TO BE SLOW AND METASTASIS OCCURS LATE; 85 TO 90% LONG-TERM SURVIVAL SUPERPLASTICITY CANDIDIASIS ETIOLOGY INFECTION WITH A FUNGAL ORGANISM OF THE CANDIDA SPECIES, USUALLY CANDIDA ALBICANS ASSOCIATED WITH PREDISPOSING FACTORS: MOST COMMONLY, IMMUNOSUPPRESSION, DIABETES MELLITUS, ANTIBIOTIC USE, OR XERO- STOMIA (DUE TO LACK OF PROTECTIVE EFFECTS OF SALIVA) CLINICAL PRESENTATION ACUTE (THRUSH) PSEUDOMEMBRANOUS PAINFUL WHITE PLAQUES REPRESENTING FUNGAL COLONIES ON INFLAMED MUCOSA ERYTHEMATOUS (ACUTE ATROPHIC): PAINFUL RED PATCHES CAUSED BY ACUTE CANDIDA OVERGROWTH AND SUBSEQUENT STRIPPING OF THOSE COLONIES FROM MUCOSA CHRONIC ATROPHIC (ERYTHEMATOUS): PAINFUL RED PATCHES; ORGANISM DIFFICULT TO IDENTIFY BY CULTURE, SMEAR, AND BIOPSY “DENTURE-SORE MOUTH”: A FORM OF ATROPHIC CANDIDIASIS ASSOCIATED WITH POORLY FITTING DENTURES; MUCOSA IS RED AND PAINFUL ON DENTURE-BEARING SURFACE MEDIAN RHOMBOID GLOSSITIS: A FORM OF HYPERPLASTIC CANDIDIASIS SEEN ON MIDLINE DORSUM OF TONGUE ANTERIOR TO CIRCUMVALLATE PAPILLAE PERLÈCHE: CHRONIC CANDIDA INFECTION OF LABIAL COMMISSURES; OFTEN CO-INFECTED WITH STAPHYLOCOCCUS AUREUS HYPERPLASTIC/CHRONIC HYPERPLASTIC: A FORM OF HYPERKERATOSIS IN WHICH CANDIDA HAS BEEN IDENTIFIED; USUALLY BUCCAL MUCOSA NEAR COMMISSURES; CAUSE AND EFFECT NOT YET PROVEN SYNDROME ASSOCIATED: CHRONIC CANDIDIASIS MAY BE SEEN IN ASSOCIATION WITH ENDOCRINOPATHIES DIAGNOSIS MICROSCOPIC EVALUATION OF LESION SMEARS POTASSIUM HYDROXIDE PREPARATION TO DEMONSTRATE HYPHAE PERIODIC ACID–SCHIFF (PAS) STAIN CULTURE ON PROPER MEDIUM (SABOURAUD’S, CORN MEAL, OR POTATO AGAR) BIOPSY WITH PAS, GOMORI’S METHENAMINE SILVER (GMS), OR OTHER FUNGAL STAIN OF MICROSCOPIC SECTIONS SUPERPLASTICITY DIFFERENTIAL DIAGNOSIS ALLERGIC OR IRRITANT CONTACT STOMATITIS ATROPHIC LICHEN PLANUS TREATMENT TOPICAL OR SYSTEMIC ANTIFUNGAL AGENTS FOR IMMUNOCOMPROMISED PATIENTS: ROUTINE TOPICAL AGENTS AFTER CONTROL OF INFECTION IS ACHIEVED, USUALLY WITH SYSTEMIC AZOLE AGENTS SEE “THERAPEUTICS” SECTION CORRECTION OF PREDISPOSING FACTOR, IF POSSIBLE SOME CASES OF CHRONIC CANDIDIASIS MAY REQUIRE PROLONGED THERAPY (WEEKS TO MONTHS) PROGNOSIS EXCELLENT IN THE IMMUNOCOMPETENT HOST SUPERPLASTICITY EXFOLIATIVE CHEILITIS ETIOLOGY CAUSES MAY BE ATOPIC, CONTACT, FACTITIOUS, INFECTIOUS, SYSTEMIC, OR MEDICATION INDUCED CLINICAL PRESENTATION USUALLY INVOLVES LOWER LIP (IN BOTH GENDERS); CAN INVOLVE BOTH LIPS TENDER OR ASYMPTOMATIC CRUSTS AND IMPACTED SCALE OF VERMILION MINIMAL INFLAMMATION DIAGNOSIS CLINICAL APPEARANCE NONSPECIFIC MICROSCOPY RESULTS DIFFERENTIAL DIAGNOSIS ATOPIC CHEILITIS ACTINIC CHEILITIS CONTACT CHEILITIS TREATMENT DETERMINATION OF CAUSE SUPPORTIVE CARE TOPICAL OR INTRALESIONAL CORTICOSTEROIDS, INCLUDING LIP OINTMENTS/ POMADE (HYPOALLERGENIC) TOPICAL TACROLIMUS OINTMENT PROGNOSIS CHRONIC PSYCHOLOGIC SUPPORT FOR FACTITIAL CHEILITIS