Upload
roja-lakshmi
View
226
Download
0
Embed Size (px)
Citation preview
7/30/2019 Asif 2
1/30
USE OF ANTI OXIDANTS INTREATMENT OF
LEUKOPLAKIA
ASIF
7/30/2019 Asif 2
2/30
INTRODUCTION Leukoplakia is a white lesion of the oral mucosa
particularly those that appear leathery and cannotbe dislodged easily
A white patch or plaque that cannot be
characterized clinically or pathologically as anyother disease- WHO collaboration (1978)
At an international seminar on oral leukoplakia
and an associated lesion related tobacco habitheld in Malrno Sweedan in 1983 the proposal was
made to modify the WHO collaborating reference
center definition for leukoplakia to read
7/30/2019 Asif 2
3/30
Leukoplakia is a whitish patch or plaque that cannot
be characterized clinically or pathologically as any
other disease and is not associated with any physical
or chemical causative agent except the use of
tobacco
Total life time risk of malignant transformation isestimated to be 4-6% (Leurman H etal 1995)
Lesions of the tongue and floor of the mouth
account for more than 90% of cases that showdysplasia or carcinoma (Waldron etal 1975)
7/30/2019 Asif 2
4/30
ETIOLOGY A number of locally acting etiological agents
including tobacco, alcohol,candidiasis habe beenimplicated as causative factors
True leukoplakia is often related to tobacco usage(Axell T etal 1996)
More than 80% of the leukoplakia are smokers,development of leukoplakia in smokers also dependson dose, duration of use as shown by heavy smokers
having a more frequent incidence of lesion thanlight smokers
Cessation of smoking often results in partial to totalresolution of leukoplakia
7/30/2019 Asif 2
5/30
Candidia aibicans is frequently found in histological
section of leukoplakia and is consistently (60% of
cases) identified in nodular leukoplakia but rarely inhomogenous leukoplakia (3%) term candidia
leukoplakia and hyper plastic candidiasis have been
used to describe such lesions (Cawson etal 1988)
Sun light is well known to be an etiologic factor for
the formation of leukoplakia of vermilion border of
the lower lip
7/30/2019 Asif 2
6/30
CLINICAL FEATURES
Majority of leukoplakia are a symptomatic Development of carcinoma from leukoplakia has
been reported to occur in 4-17.5% of patients withmean observation period ranging from 3.7 11.7yrs
(Silverman etal 1984)
Buccal mucosa are most frequently affected (Silverman etal1984)
More commonly found in men, occurs in adultsolder than 50yrs of age prevalence increase rapidlywith age especially for males and 8% of men olderthan 70yrs of age are affected
7/30/2019 Asif 2
7/30
TYPES
HOMOGENOUS LEUKOPLAKIA:
It has well defined patch, localized orextensive that is slightly elevated and that has afissured wrinkled or corrugated surface on palpation
these lesions may feel leathery to dry cracked mud-like
NODULAR OR SPECKLED LEUKOPLAKIA
It is a mixed red and white lesion in which whitekeratotic white nodules or patches are distributedover an atrophic erythematous back ground. Thistype of leukoplakia is associated with high
malignant transformation rate
7/30/2019 Asif 2
8/30
VERRUCOUS LEUKOPLAKIA
Thick white lesion with papillary surface in the oral
cavity. These lesions are usually heavily keratinizedand are most often seen in older age group
PROLIFERATIVE VERRUCOUS
LEUKOPLAKIA:
They are verrucoid white plaques that tend to be
slowly involve multiple mucosal sites in the oral
cavity PVL has a very high risk of transformation to
dysplasia, squamous cell carcinoma or verrucous
carcinoma
7/30/2019 Asif 2
9/30
HISTO PATHOLOGY
Benign form of leukoplakia are characterized byvariable patterns of hyperkeratosis and chronic
inflammation
Waldron and Shafer in a land mark study of over3,000 cases of leukoplakia, found that 80% of the
lesions represented benign hyperkeratosis with or
with out thickened spinous layer(acanthosis)
About 17% of the leukoplakia shows dysplastic
changes in the basal or parabasal zones of the
epithelium
7/30/2019 Asif 2
10/30
DIFFERENTIAL DIAGNOSIS
Lichen planus Leukoedema
Lupus erythematosis
White sponge nevus
Verruca vulgaris
Hairy leukoplakia
Cheek biting
7/30/2019 Asif 2
11/30
MANAGEMENT BY ANTI
OXIDANTS
Antioxidants are the products which are derivedmainly from green or colored vegetables foodgrains, animal fats and also from some spices likecucuramin (turmeric) or garlic
The function of anti oxidants is to remove the freeoxygen radical from the body and as a resultprevents the cell damage or undergoing any
carcinomatous changes Beta carotene, retinoic acid, ascorbic acid and
alpha tocopherol are examples of anti oxidants
7/30/2019 Asif 2
12/30
BETA CAROTENE
It is primarily found in the green vegetables, the deeperthe color of vegetable or fruit greater the carotenecontent
Approx 16% of the ingested beta carotene is transformedin to retinol with in the intestinal mucosa by a two stepprocess that converts 6micro grams of BC into 1mm ofretinol
Fate of beta carotene after it reaches liver
Very small amount can be converted in to retinol It can be incorporated in to very low densit lipo protein
cholesterol
Can be stored in liver
7/30/2019 Asif 2
13/30
RELATION SHIP TO HUMAN
CANCER
In dietary studies low beta carotene intake has beenassociated with an increased risk of lung,
laryngeal, gastric, ovarian, breast, cervical and oral
cancer Several studies have shown that a low intake of
fruits and vegetables which are the primary source
of beta carotene is also related to generalizedincreased cancer risk and mortality
7/30/2019 Asif 2
14/30
THERAUPETIC USE
OF ORAL
LEUKOPLAKIA
7/30/2019 Asif 2
15/30
RETINOL AND RETINOIDS
Vitamin A also known as retinol, is an alcohol that
can be converted in to aldehyde or retinoic acid
Retinol is found in dairy products, eggs and meats
Silverman etal showed that doses exceeding300,000 IU/day of vitamin A ester for more than
3mths can exceed liver storage capacity and cause
side effects that include rashes, dry skin and pruritis
Of more than 1500 synthetic analogues of vitamin A
13-cRA (isotretinoin) has generated the most
interest
7/30/2019 Asif 2
16/30
RELATIONSHIP TO HUMAN
CANCER
The first study that associated Vitamin A deficiency with
cancer appear in 1941
Low intake of Vitamin A has been linked with an
increased risk of developing cancer of the lung, colon,breast, pharynx, larynx and bladder
The theories proposed to explain Vitamin A include
Deficiency of Vitamin A disturbs normal epithelial growth Tumor surveillance is dependent on levels of vitA
Vitamin A directly influences gene expression
7/30/2019 Asif 2
17/30
THERAPEUTIC USE
OF ORAL
LEUKOPLAKIA
7/30/2019 Asif 2
18/30
ASCORBIC ACID
Ascorbic acid commonly known as Vitamin C, isfound in citrus fruits, cruciferous vegetables
The (RDA) recommended daily allowance range
from 60mg/day for non smokers to 100mg/dayfor smokers
It is because they have a decreased concentrationof A.A in their serum and leukocytes
It is reported that many people ingest more than1gmof ascorbic acid per day with out anyapparent ill effects
RELATIONSHIP WITH
7/30/2019 Asif 2
19/30
RELATIONSHIP WITH
HUMAN CANCER
Numerous studies have shown that a low intake
of AA is associated with increased of cancer of
the stomach, esophagus, oral cavity
The protective effect of dietary AA is more
attributable to intake from fruits compared with
vegetables
Low serum level of AA have been associatedwith an increased risk of cancer, especially of the
stomach
7/30/2019 Asif 2
20/30
ALPHA-TOCOPHEROL
The most active and common form of Vitamin E
Found in plant oils, wheat germ and green leafy
vegetables
The RDA for adult males is 10mg/day, and theaverage daily intake for adult males in USA is
11mg/day
The absorption of AT ranges from 20% to 80%,and the efficiency decreases as the intake exceeds
30mg/day
7/30/2019 Asif 2
21/30
RELATIONSHIP TO HUMAN
CANCER
The patients with low serum level of AT had a
relative risk of > 2.0 for gastrointestinal cancers
The role of AT in cancer risk reduction is unclear,
but the proposed mechanism includes
The control of free radical damage
Blockade of chemical reactions by mutagens orcarcinogens
Enhancement of detoxification
Enhanced immune response
7/30/2019 Asif 2
22/30
ANTI OXIDANT
COMBINATIONS
THERAPEUTIC USE FORLEUKOPLAKIA
7/30/2019 Asif 2
23/30
CONCLUSION
The use of anti oxidant supplements has shownsome promise but the predictability of success
remains uncertain and long term results are un
availableBefore the decision to use any antioxidant is made
it is critical to obtain a histopathologic diagnosis of
the lesion
7/30/2019 Asif 2
24/30
THANK YOU
7/30/2019 Asif 2
25/30
7/30/2019 Asif 2
26/30
7/30/2019 Asif 2
27/30
7/30/2019 Asif 2
28/30
7/30/2019 Asif 2
29/30
7/30/2019 Asif 2
30/30