Leukoedema

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  • A blue, grey or white appearance of the mucosa (especially the buccal mucosa)
  • Considered by many to be a variant of normal

Epidemiology[edit]

  • Incidence varies with ethnicities[1]
    • Most common in black adults (90%)
  • More common in smokers[1]
  • ♀ = ♂

Clinical Features[edit]

Leukoedema of buccal mucosa. Image from Huang et al. 2020[2]
  • Diffuse, blue-gray-white, milky opalescent appearance of the mucosa
  • Asymptomatic
  • Usually occurs bilaterally
  • Commonest site is buccal mucosa
    • Can also occur on labial mucosa, palate or floor of mouth
  • The mucosal surface can appear wrinkled and with white streaked lesions
  • Can disappear or become less pronounced on stretching the mucosa
  • Can also occur on the mucosa of the larynx or vagina

Differential Diagnosis[edit]

Aetiology and Pathogenesis[edit]

  • Unknown aetiology[3]
  • Because of how common the lesion is, it is considered by many to be variation of normal
  • Some suggestion that it is an acquired condition caused by local irritation
    • Intracellular edema of the superficial epithelial cells coupled with retention of superficial parakeratin
  • More common in smokers
    • Becomes less pronounced with smoking cessation
    • Smoking cannabis is known to be linked to this condition

Investigations[edit]

  • Usually clinical examination alone is sufficient
  • Biopsy may be needed to rule out differentials
  • Exfoliative cytology (smear) may be helpful

Histopathology[edit]

  • Increased epithelial thickness
  • Elongated rete ridges
  • Parakeratosis and intracellular edema of the spinous layer
  • The cells of the spinous layer are vacuolated, large and possess pyknotic nuclei
  • The superficial squamous cells have a clear, empty cytoplasm
    • Thought to be caused by water within the cells of the spinous layer causing the light to reflect back as whitish

Management[edit]

No treatment needed

Prognosis and Complications[edit]

Benign

Follow-up[edit]

No follow-up needed

References[edit]