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CASE REPORT
Unilateral leukoedema- case report
Shady A.M. Negm
ABSTRACT
Leukoedema is a common developmental alteration of the oral mucosa which appears to be a simple variation of
normal anatomy which is presents most typically as an asymptomatic, bilateral, whitish gray, semitransparent macule of
the buccal mucosa. This paper report a case of unilateral Leukoedema in a 40-year man presented as a discoloration in
the inner surface of right cheek.
Keywords: Leukoedema; Cheek;White Discolouration

Conclusion
In conclusion leukoedema appears as a filmy, opaque, and
white to slate gray discoloration of mucosa, chiefly buccal mucosa. It is important that to distinguish Leukoedema from leukoplakia, as leukoplakia can be pre-cancerous condition and
should be biopsied for accurate diagnosis.
Authors Affiliations
Shady A.M. Negm BDS, Pharos University, Alexandria, Egypt,
Diploma of Clinical Implant, Seville University, Spain, Professional Diploma of Infection Control from Oxford College, UK.
References
1.Gnepp DR. Diagnostic Surgical Pathology of the Head and
Neck: Expert Consult-Online and Print: Elsevier Health Sciences; 2009.
2.Bhattacharyya I, Cohen D, Silverman Jr S. Red and white lesions of the oral mucosa. Greenberg Ms, Gllick M Burkets Oral
medicine: diagnosis and treatment 10th ed Hamilton, Ontario:
Bc Decker. 2003:85-125.
3.Pindborg J, Chawla T, Misra R, Nagpaul R, Gupta V. Frequency
of Oral Carcinoma, Leukoplakia, Leukokeratosis, Leukoedema,
Submucous Fibrosis, and Lichen Planus in 10,000 Indians in
Lucknow, Uttar Pradesh, India Preliminary Report. Journal of

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2013 Volume 5 Issue 3

Discussion
Leukoedema is persistent, and is most common in individuals with dark skin. The etiology of this condition is unknown.3
Clinical examination readily differentiates leukoedema from
leukoplakia since there is no loss of pliability or flexibility of
the involved tissues.4,5 In addition, the tissues affected by leukoedema manifest an edematous state. Leukoedema is distinguished from lichen planus by stretching the buccal mucosa.4,6 Areas exhibiting leukoedema will either disappear or
persist upon stretching, whereas lesions of lichen planus will
become more pronounced. Leukoedema should also be differentiated from white sponge nevus and habitual cheek-biting (pathomimia morsicatio buccarum).4,7,8 White sponge nevus is a relatively uncommon lesion, and the buccal mucosa

Leucoedema is characterized by a variable intracellular edema of the superficial half of the epithelium.1 The vacuolated
cells are large and often have pyknotic nuclei. They may extend to the basal layer and may cluster into inverted wedgeshaped regions separated by normal spinous epithelial cells.2
The epithelium is hyperplastic and rete ridges are often broad
and elongated. Parakeratosis is commonly seen but is not pronounced unless there has been chronic trauma.3 Intracellular
edema is characteristic of several other oral lesions, many of
which may be found on the buccal mucosa: smokeless tobacco keratosis, frictional keratosis (chronic cheek bite keratosis),
white sponge nevus and Witkops disease.1

Case Report
A 40-year-old male patient was visited for routine dental examination to our clinic and on check up a discoloration in his
right inner cheek was noticed. The vitals were measured. Pulse
rate 56 beats /minute, Respiratory rate 19 cycles/min, body
temperatures 37.50C and blood pressure 140/90 mm of Hg.
Differential diagnosis of white sponge nevus, leukoedema,
leukoplakia and lichen planus were proposed. Leukoedema
presents most typically as an asymptomatic, bilateral, whitish
gray, semitransparent macule of the buccal mucosa as seen in
Figures 1 and 2. Based on clinical features a provisional diagnosis of leukodema was made and which were confirmed by
biopsy. No treatment is necessary for leucoedema. It has no
malignant potential and does not change significantly after
25-30 years of patient age.

appears thickened and folded.4,9 Superficial erosions that alternate with irregular white flakes are present in lesions of habitual cheek-biting whereas areas of leukoedema are usually
smooth and grayish-white in coloration.4

I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S

Introduction
Leukoedema is a common developmental alteration of the
oral mucosa, which appears to be a simple variation of normal
anatomy.1,2 When the mildest cases are included, it is seen in
almost 90% of adult blacks and half of adult whites, although
it presents as a much less pronounced alteration in whites
(prevalence rate: 3/1,000 white adults).1 Tobacco smoking and
chewing has been shown to enhance the whiteness and size
of the lesion but most cases are so subtle that they are not
formally diagnosed. Similar mucosal changes have been reported on vaginal and laryngeal mucosa.1,2 This paper report a
case of unilateral Leukoedema in a 40-year man presented as
a discoloration in the inner surface of right cheek.

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P-ISSN: 2231-2285

Negm et al
cutaneous pathology. 1983;10(4):238-56.
8.Duncan SC, Su W. Leukoedema of the oral mucosa: possibly
an acquired white sponge nevus. Archives of dermatology.
1980;116(8):906-8.

Figure 1. Leukodema in the right cheek of the pateint ,Figure 2.

Inner left cheek of the patient without any apparent lesion.
Dental Research. 1965;44(3):615.

5.Hammer JE, Mekta FS, Pindborg JJ, DK D. An epidemiologic

and histopathologic study of leukoedema among 50915 rural
Indian villagers. Oral Surgery, Oral Medicine, Oral Pathology.
1971;32:58-63.
6.Crawley EP, DA K. Lichen planus. Oral Surg Oral Med Oral
Pathol. 1952;5:1069-76.

How to cite this artice

Negm S AM.Unilateral leucoedema- case report. Int. J. Dent.Clinics. 2013;5(3): 21-22.
Address for Correspondence
Shady A.M. Negm
Bachelors Degree School of Dentistry, Pharos University,
Alexandria, Egypt.
Diploma of Clinical Implant from Seville University, Spain
Professional Diploma of Infection Control from Oxford
College, UK.
Email: smngm@msn.com

7.Bnaczy J. Oral leukoplakia and other white lesions of the

oral mucosa related to dermatological disorders. Journal of

I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S

2013 Volume 5 Issue 3

4.Martin JL. Leukoedema: a review of the literature. Journal of

the National Medical Association. 1992;84(11):938-40.

9.Martin JL, Crump EP. Leukoedema of the buccal mucosa in

Negro children and youth. Oral Surgery, Oral Medicine, Oral
Pathology. 1972;34(1):49-58.

Source of Support: Nil

Conflict of Interest: None Declared

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