eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Leukoplakia, Oral: Treatment & Medication

Author: Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL,DSc, DChD, DMed(HC), Dr hc., Professor, Director of Special Projects, Eastman Dental Institute for Oral Health Care Sciences; Professor, Special Needs Dentistry, University College; Professor, Oral Medicine, Pathology and Microbiology, University of London
Contributor Information and Disclosures

Updated: Oct 17, 2008

Treatment

Medical Care

The objective of care is to detect and to prevent malignant change. The presence of the white plaque alone does not require treatment.

  • Several management regimens have been suggested; however, no large trials have shown a definitive, reliable treatment. No evidence base exists on which to reliably recommend treatment. Indeed, current evidence suggests that no treatment is of reliable benefit.
  • Possible courses of action include the following:
    • Wait and watch
    • Medical therapies (eg, anti-inflammatory agents, vitamins, cytotoxic agents)9
    • Surgical removal (eg, scalpel, laser, cryoprobe, electrosurgery, photodynamic therapy)
  • Patients should avoid any causal factor, such as use of tobacco and alcohol. Leukoplakias can regress under these circumstances.
  • Any degree of dysplasia in a lesion at a high-risk site must be taken seriously and the lesion should be removed.
  • Occasionally, patients are treated by photodynamic therapy or topical cytotoxic agents.
  • Patients should be examined regularly, probably at 3- to 6-month intervals.

Surgical Care

Management of leukoplakias is far from satisfactory, and no large trials offer guidance as to the most reliable treatment. Surgical removal of leukoplakia seems one reasonable option. Some experts surgically remove these lesions with scalpel, laser, or cryoprobe. Laser excision is preferred to fulguration.10,11 Others point out the possible aggravation of dysplasia caused by such operative intervention and that surgical removal of aneuploidic lesions does not improve mortality rates.12

The Medscape Dermatologic Surgery Resource Center may be of interest.

Diet

A diet rich in fresh fruits and vegetables may help prevent cancer.

Medication

Retinoids are currently being investigated as a possible treatment modality. They appear to be very effective but can have severe adverse effects on liver function and may cause teratogenicity. Their beneficial effect appears to last only during the treatment.

Retinoids

These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration. They modulate keratinocyte differentiation. They have been shown to reduce the risk of skin cancer formation in patients who have undergone renal transplantation.


Isotretinoin (Accutane)

Oral agent that treats serious dermatologic conditions. Synthetic 13-cis isomer of the naturally occurring tretinoin (trans- retinoic acid). Both agents are structurally related to vitamin A. In acne, its activity includes reduction in sebaceous gland activity, modification of keratinocytic adhesion, and anti-inflammatory actions.
If used to treat acne, at least 8 wk should be allowed between courses of treatment if re-treatment is indicated (because of possible continued improvement).
Prescriber and patient must enroll in FDA-sponsored iPledge system to receive this medication. Difficult to prescribe for off-label use (nonacne), especially because iPledge system does not allow use beyond 5- to 6-mo period.

Adult

500 mcg/kg PO qd with food for 4 wk

Pediatric

Not established

Toxicity may occur with vitamin A coadministration; pseudotumor cerebri or papilledema may occur when coadministered with tetracyclines; may reduce plasma levels of carbamazepine; alcohol may increase toxicity; topical agents that are drying and/or irritating may potentiate cutaneous adverse effects

Documented hypersensitivity; pregnancy and breastfeeding

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

If possible, avoid in women of childbearing age; if used (only for severe acne), the patient must be using 2 forms of birth control 1 mo before, during, and 1 mo after treatment (blood donors taking this drug should not donate blood during treatment and for 1 mo after this treatment has been stopped); may decrease night vision; hepatitis may occur; occasionally, exaggerated healing response of acne lesions (excessive granulation with crusting) may occur; transient exacerbation of acne may occur during initial period of treatment requiring reduction of dose and/or systemic corticosteroids; patients with diabetes may experience problems in controlling blood sugar and plasma triglyceride concentrations while on isotretinoin; caution in patients with preexisting or family history of hypertriglyceridemia
Avoid exposure to UV light or sunlight until tolerance has been achieved; with prolonged use (especially in treatment for disorders of cornification), skeletal abnormalities, including diffuse interstitial skeletal hyperostosis in adults and premature closure of the epiphyses in children, may occur; rarely, depression and attempts of suicide have occurred while taking this drug; laboratory monitoring includes CBC count, fasting blood lipids, hepatic function tests, and bhCG (for pregnancy); comprehensive metabolic panel/SMA-12 and blood sugar level have also been suggested

More on Leukoplakia, Oral

Overview: Leukoplakia, Oral
Differential Diagnoses & Workup: Leukoplakia, Oral
Treatment & Medication: Leukoplakia, Oral
Follow-up: Leukoplakia, Oral
Multimedia: Leukoplakia, Oral
References
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References

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Further Reading

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Keywords

oral leukoplakia, leukoplakia, oral cancer, mouth cancer, smokeless tobacco, keratosis,

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Contributor Information and Disclosures

Author

Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL,DSc, DChD, DMed(HC), Dr hc., Professor, Director of Special Projects, Eastman Dental Institute for Oral Health Care Sciences; Professor, Special Needs Dentistry, University College; Professor, Oral Medicine, Pathology and Microbiology, University of London
Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL,DSc, DChD, DMed(HC), Dr hc. is a member of the following medical societies: Academy of Medical Science, British Society for Oral Medicine, International Association for Dental Research, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Medical Editor

David P Fivenson, MD, Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan
David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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