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September 3, 2012
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The leukoplakia is a disease at which mucous membranes of a red border of a lip, a mouth or generative organs are surprised. At the same time inflammatory process as response to exogenous chronic irritation develops. Such state is carried to an optional precancer. At development of a leukoplakia there is a process of keratinization and a thickening of a cover epithelium. Leukoplakias appear in the form of changes which have an appearance of whitish-gray plaques or films. The shade of such plaques can sometimes be nacreous. As a rule, it flat, but sometimes can tower a little over normal tissues of a mucous membrane. Most often men after forty-year age suffer from this disease.
Types and reasons of a leukoplakia
Defining a clinical picture of an illness, distinguish several forms of a leukoplakia: verrukozny, flat, erosive, Tappeyner's leukoplakia.
Signs of a flat leukoplakia are the flat centers of a hyperkeratosis having the different form and gray-white color. At a simple leukoplakia the mnogoslony flat epithelium is thickened at the expense of granular and basal layers.
The Verrukozny form of a leukoplakia is shown against a flat form of a disease. Two different types of a verrukozny form of a leukoplakia are possible: blyashechny and warty. The main manifestation of such form is increase in fabric. In this case it is very important to monitor all changes as fast consolidation and intensive keratinization can demonstrate transition of process to a malignant form.
If at the patient the erosive form of a leukoplakia develops, then in this case the periodic homotopic pain will be a characteristic symptom. Multiple or single erosion are shown against a hyperkeratosis. This form of a leukoplakia most often perekholdit in a malignant disease.
Tappeyner's leukoplakia is also called a nicotinic leukokeratosis of the sky. This illness develops at people who smoke throughout long time much. At this form of an illness there is a defeat of a hard and soft palate, the edge of a gum can be also surprised. On this place the mucous membrane becomes grayish-white, on it folds can appear. Against such changes multiple reddish points which look as small small knots are allocated. These are expanded sialadens.
Till today there are no exact data on an etiology of this disease. But in most cases specialists consider development of a leukoplakia as reaction mucous on influence of irritants from the outside. However at the same time influence of internal causes is also not excluded. In this case it is about digestive tract pathologies owing to which there is a decrease in resistance of a mucous membrane to the irritants influencing it. Besides, keratinization can happen as an effect of disturbance of an exchange of vitamin A or a lack of this vitamin B of an organism.
Besides, a certain impact on development of a leukoplakia is exerted by genetic factors. The disease also develops under the influence of external factors – thermal, chemical, mechanical influence. If similar factors are combined, then influence can be especially expressed.
The oral cavity leukoplakia often develops at malicious smokers: continuous existence in an oral cavity of a hot tobacco smoke negatively affects a condition of mucous. Negatively also the injuries arising under the influence of the dentures made of diverse materials influence a condition of an oral cavity.
The leukoplakia of language and red border of lips can arise at traumatization during smoking, continuous cauterization of lips in the course of a cigarette dokurivaniye, owing to unfavorable weather conditions. Sometimes emergence of a leukoplakia is connected with occupational disease. So, influence of products of dry distillation of coal can provoke a leukoplakia.
Thus, internal causes, exogenous factors, and also process of involutional changes of functional and morphological properties of a mucous membrane of genitalias are distinguished from the factors influencing development of a leukoplakia.
Symptoms of a leukoplakia depend on what factor provoked an illness where it is localized defeats, and also from its form. Leukoplakias of a neck of uterus also the area mucous sometimes takes vaginas. Also the vulva leukoplakia can develop. Sometimes distribution of a disease is noted also on a mucous membrane of the cervical channel.
The leukoplakia of an oral cavity is, as a rule, shown on a mucous membrane of cheeks, on an under lip, near mouth corners. The language leukoplakia is less often shown: its back or a lateral surface is surprised.
Leukoplakias develops gradually: from emergence of an illness before its transition to a malignant form there pass several different stages. Initially there comes the predleykoplakichesky stage at which small inflammatory process of a certain site of mucous begins. Further rather fast process of keratinization of this site follows. If development of a leukoplakia continues, then the affected area gradually rises over a healthy mucosal surface of a cover. The verrukozny leukoplakia at which hyperplastic changes are replaced by changes metaplastic is so shown. The subsequent stage of a course of a disease it becomes frequent an erosive form. Therefore, all forms of a leukoplakia make uniform process of pathological changes.
Transition of a disease to a malignant form is possible on each of stages of a course of a disease. Most often malignant processes happen in case of a language leukoplakia.
Oncological changes develop at a leukoplakia individually: if at one patient the disease is transformed to cancer for decades, then at other person it can occur for only a few months.
There are some strong indications testimonial of the fact that process of transition of an illness to a malignant form begins. It is possible to speak about activation of this process if there is an active display of erosion, and also consolidations under one of the parties of the keratosic site appear. The erosive leukoplakia passing into a malignant form bleeds if to injure it. Besides, there is an ulceration, papillary growths on an erosion surface are formed, the sizes of an affected area increase. It should be noted also the fact that at early stages of process of transition of a disease to a malignant form such signs can not be shown. Therefore the centers of a verrukozny and erosive leukoplakia should be deleted as soon as possible, at the same time conducting histologic research.
Specialists note that now the leukoplakia of a bladder meets rather seldom. However, the tendency to more frequent manifestation of this form of a leukoplakia nevertheless exists in recent years. At development of this form of a disease there is a defeat of an epithelium of a mucous membrane of a bladder under the influence of a chronic inflammation. As a result on a mucous membrane there are plaques which rise over normal sites of mucous. Emergence of a chronic inflammation of a bladder, in turn, develops under influence of either pathogenic, or opportunistic microflora. Therefore, there are all bases to speak about communication of a leukoplakia with sexually transmitted infections. More often the leukoplakia of a bladder is shown at women as there is a communication of a disease with an erosion of a neck of uterus, a vagina epithelium dysplasia, chronic adnexites.
However analyses of urine at the same time do not confirm the expressed changes of inflammatory character. Except the general analysis of urine at diagnosis of a disease it is important to carry out urine crops, the analysis of urine across Nechiporenko, the general and biochemical blood analysis. Besides, the patient should carry out diagnosis of urogenital diseases. Sometimes carrying out a biopsy of a bladder and a tsistoskopiya is required. Researches allow to define existence of a leukoplakia of a bladder by a tsistoskopiya precisely. Such research is conducted by survey with use of a tsistouretroskop – the special endoscopic device.
Diagnosis of a leukoplakia
Establishment of the diagnosis is made on the basis of survey of generative organs, other places affected with a disease and also clinical data which if necessary are confirmed by histologic research. It is also important to differentiate a disease with the illnesses having a similar clinical picture: by a lupus erythematosus, red flat it is deprived, syphilitic papules, and also with certain forms of candidiasis.
In the course of diagnosis it is important to define features of a disease: whether the simple leukoplakia develops, or the basal and cellular hyperactivity and atypia of cells takes place.
Treatment of a leukoplakia
If the leukoplakia with signs of a basal and cellular hyperactivity and atypia is diagnosed for the patient, then treatment of a disease assumes excision of an affected area. The modern medicine offers use of laser therapy for this purpose. If the leukoplakia of a neck of uterus is diagnosed for the patient, then for selection of the correct tactics of treatment the condition of an endotserviks surely is defined. In most cases treatment of a leukoplakia of a neck of uterus is reduced to coagulation use (that is cauterizations) an affected area. For this purpose use the surgical laser, and also a radio wave. Such procedure should be made surely for 5-7 days of a monthly cycle.
Therapy of a disease with use of chemicals is less preferable to cauterization as at the same time there is a traumatizing a neck of uterus. As a result, elasticity of a neck of uterus considerably decreases, and there are various complications. If the infection was diagnosed for the woman, then before therapy of a leukoplakia it is necessary to carry out treatment of an infectious disease. Otherwise the risk of defective healing of the cauterized or excised site increases.
After carrying out treatment the woman has to refuse completely the sexual intercourses for 4-6 weeks. During this time tissue of a neck of uterus will be able fully to be recovered. For one year after carrying out this procedure the patient has to pass routine inspections once in three months
After treatment of a leukoplakia most use of hormonal contraceptives is considered a procedure of choice of contraception. And here spermitsida should not be used up to full healing of fabrics as influence of chemicals provokes corrosion of a mucous membrane which was already exposed to a certain mechanical influence. Also it is not desirable to use cervical caps and diaphragms: from barrier methods of protection against unplanned pregnancy only the condom is allowed.
Sometimes at development of a simple leukoplakia the doctor does not practice any interventions, stopping only on ensuring continuous supervision over the patient and kolposkopichesky control. At a simple leukoplakia of a vulva use of local means with the moderate content of estrogen is recommended to patients of advanced age.
If the patient is disturbed by a severe itch, then it is possible to apply hydrocortisone ointment, and also to practice sedentary bathtubs. But at the same time doctors do not recommend to practice national methods of treatment, for example, to use oil of a dogrose, a sea-buckthorn for tampons. Such methods can activate development of pathological cells.
Treatment of a leukoplakia of a bladder is initially reduced to careful therapy of all urological and gynecologic diseases which accompany this illness. Therefore the integrated approach to treatment including a course of antibiotics, process of instillation of drugs in a bladder, ozonotherapy, acupuncture, physical therapy practices. If necessary coagulation of affected areas is made.
The doctor can sometimes make the decision on carrying out a cystectomy.
Treatment of a leukoplakia of a mouth assumes use of Solutio oleosa of vitamins, stimulators of immunity, fortifying means.
Treatment of a leukoplakia of Tappeyner occurs after the person completely refuses smoking.
Prevention of a leukoplakia
To avoid a disease of a leukoplakia, it is necessary to pay special attention to rules of hygiene. In particular, it is important to make sanitation of an oral cavity, to provide rational prosthetics. Refusal of tobacco smoking will protect from risk of manifestation of a leukoplakia of Tappeyner.
Besides, it is important to reveal and treat timely diseases, sexually transmitted, to adjust hormonal failures in a female organism, not to allow disbolism and deterioration in protective functions of an organism.