erythroplakia

With progression in science and technology, there have been plenty of discoveries mounting up to a plethora of oral lesions that have become very common in today’s population.

Ranging from a white patch on the oral tissue to a red lesion or even a combination of the two; it is essential to get such conditions identified and diagnosed by professional means.

Many oral conditions though visible due to color change are often symptomless and thus are ignored by the patient.

But no matter what the color of an oral patch may be; it can prove to be a precancerous lesion or even a variant of a significant oral cancer.

Sometimes even the slightest change in a benign oral lesion may progress to become precancerous if left undiagnosed and unmonitored.

One such oral condition is Erythroplakia, a red velvety patch which is not associated with any other oral condition.

Erythroplakia is a rare lesion that constitutes of abnormal cells which have a high chance of turning it into a precancerous condition. It is often found on the tongue or the floor of the mouth.

In this article, we will cover more about this rare oral lesion, the various forms of Erythroplakia and its diagnosis and treatment.

What is Erythroplakia?

Erythroplakia is clinically defined as a red velvety lesion that occurs most commonly on the tongue and the floor of the mouth.

It cannot be classified clinically and pathologically as any other oral condition. (1) Erythroplakia is a collection of abnormal cells that have a high tendency to turn malignant over time.

The lesion is usually flat or macular and sometimes might even occur in the form of an ulcer or show specks of white spots around it.

It affects mostly an age group of above 50 years and is more prevalent among people with the habit of smoking tobacco and drinking alcohol. (2)

What causes Erythroplakia?

The following factors predominantly cause Erythroplakia:

  • Use of both smokeless and smoking tobacco. For example, use of cigar, cigarettes or a habit of chewing tobacco
  • The habit of drinking alcohol can increase the risk of malignancy in this condition (3)
  • Untreated ill-fitting dentures or broken teeth can irritate the oral tissues and lead to the formation of non-healing ulcers
  • Any trauma to the oral tissues, especially the tongue and the floor of the mouth
  • Progression with age – most commonly in people above 50 years of age
  • In rare cases, the persistence of viral infections, for example, the Human Papilloma Virus (HPV 16) has shown increased contribution.

Whatever the cause may be, if detected early, Erythroplakia can be treated appropriately by modifying lifestyle and avoiding certain habits in addition to a professional treatment.

Signs and symptoms

Often Erythroplakia presents as a painless lesion over a small area of the oral cavity, but a patient may experience pain when oral bacteria or virus infect the lesion.

Clinically Erythroplakia presents as a red flat or slightly raised velvety lesion that often bleeds when scraped from the site.

Familiar sites in the oral cavity include the lateral borders of the tongue, the floor of the mouth and sometimes even the back of the throat. (4)

Some variants of Erythroplakia may occur in the form of ulcers or may show white spots in and around the red lesion. These white spots form due to keratinization of the surrounding tissue.

What can you do?

If the cause of formation is trauma to the oral tissues or broken teeth, treating the cause can relieve the irritation and allow the lesion to heal and disappear within ten days.

It is thus imperative to keep a check on the changes in the oral conditions and inform a dentist about any symptoms.

Maintain good oral hygiene and keep the concerned area clean using a non-alcohol containing mouthwash or a mouthwash recommended by the dentist.

How is Erythroplakia clinically diagnosed?

A full mouth examination should include both the hard and soft tissues of the oral cavity. The primary motive is to detect the lesion in its earliest stage.

Medical history plays a crucial role in this case. A review of the lifestyle, habits gives a dentist a good background of the possible causes.

Any areas of concern are scrutinized by the dentist to check the color, surface texture and the extent of the lesion. X-rays and CT scans also aid in dental examination.

When identified, a biopsy is taken from the lesion under local anesthesia. A biopsy consists of a small portion of the affected area along with the surrounding healthy tissue.

The sample is then tested in a pathology lab to confirm the diagnosis. This takes a few days to prove the result. Based on the biopsy report, the lesion is classified and treated appropriately.

What is the treatment for Erythroplakia?

If the biopsy shows a positive result for Erythroplakia, the dentist may perform or may refer you to an oral surgeon for the excision of the lesion.

An excision involves complete removal of the lesion along with its surrounding healthy tissue. A circumcision can be done surgically or even with the help of lasers.

A clinical study shows that Lasers are useful in excising erythroplakia and associated dysplasia. (5)

Although erythroplakia is treatable, it has a high chance of recurrence. So, a follow-up appointment and regular surveillance are mandatory to eliminate the chances of relapse.

At this point, cessation of all the habits and guidance for lifestyle modification is essential to maintain proper hygiene.

Over to you

Any oral lesion is a predisposition of an underlying condition. Keep a check on any changes happening in the oral cavity and try to detect it at an early stage.

Though self-monitoring is good, regular visits to a dentist will ensure a great result. Improve your dietary and oral habits to protect your mouth from any such oral conditions.

Notify the dentist about any symptoms that you experience. Erythroplakia though is just a precancerous lesion and often benign.

If you do not take proper care, then It has a very high chance of turning malignant.