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Oral leukoplakia

Leukoplakia is a common condition (<1%) of the mouth that involves the formation of white leathery spots on the mucous membranes of the tongue and inside of the mouth. It is not a specific disease entity and is diagnosed by exclusion of diseases that may cause similar white lesions like candidiasis or lichen planus. more...

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Leukoplakia is common in adults, mostly in the 50-70 years age group. The cause in most cases is unknown, but many are related to tobacco use and chronic irritation. A small proportion of cases, particularly those involving the floor of the mouth or the undersurface of the tongue is associated with a risk of cancer.

The so-called hairy leukoplakia associated with HIV infection and other diseases of severe immune deficiency does not have risks for cancer.

The treatment of leukoplakia mainly involves avoidance of predisposing factors like smoking, tobacco and betel chewing, alcohol,and removal of chronic irritants like sharp edges of teeth. In suspicious cases, a biopsy is also taken, and surgical excision done if pre-cancerous changes or frank cancer is detected.


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Treatment of oral leukoplakia - with isotretinoin
From Nutrition Research Newsletter, 4/1/93

High dose therapy with the vitamin A analogue isotretinoin has been shown to inhibit the progression of precancerous oral leukoplakias into oral cancer. The use of this drug is limited, however, by its toxicity. The trial described here was designed to determine whether a lower, less toxic dose of isotretinoin would be effective in the treatment of leukoplakia. The efficacy of [beta]-carotene was also evaluated. This agent was chosen for study because epidemiologic data have suggested that it may have a protective effect against oral cancer, and because it is essentially non-toxic.

Seventy patients with oral leukoplakia received three months of high-dose (1.5 mg/kg body weight/day) isotretinoin therapy. Patients with positive responses to this treatment were then randomly assigned to nine months of treatment with either low-dose isotretinoin (0.5 mg/kg/day) or [beta]-carotene (30 mg/day).

Low-dose isotretinoin was significantly more effective than [beta]-carotene in inhibiting the progression of oral leukoplakia. Only 8% of the patients in the isotretinoin group showed progression of their disease, as compared with 55% of the [beta]-carotene group. Both agents were well tolerated.

The findings of this study indicate that, when preceded by high-dose isotretinoin therapy, low-dose isotretinoin therapy is more effective than [beta]-carotene in the treatment of oral leukoplakia.

Scott M Lippman et al, Comparison of Low-Dose Isotretinoin with Beta Carotene To Prevent Oral Carcinogenesis, New England J Medicine 328(1):15-20 (7 Jan 1993) [Reprints: Scott M Lippman, MD, Department of Medical Oncology, Box 80, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston TX 770301]

See also William J Richtsmeier, Biologic Modifiers and Chemoprevention of Cancer of the Oral Cavity [Editorial], New England J Medicine 328(1):58-59 (7 Jan 1993)

COPYRIGHT 1993 Frost & Sullivan
COPYRIGHT 2004 Gale Group

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