White callus disease, anal intraepithelial neoplasia, perianal intraepithelial neoplasia, AIN, PAIN.

Leukoplakia is the name given to certain pathological changes in the mucous membrane, which usually occur in the mouth. They are manifested by conspicuous white spots, for example on the tongue or in the palate. Only rarely do they form outside the oral cavity.

The white changes in the mucosa cannot be wiped off. Leukoplakia is also called white callus disease. It may occur with or without pain. Most often the manifestations are harmless, but not infrequently leukoplakia can develop into a dangerous cancer.

Overview: What is leukoplakia?

In leukoplakia (white callus disease), keratinization of cell surfaces takes place. Affected are various outer cell layers that have a flat, plate-like shape and are interconnected. A grouping of such cells is called “squamous epithelium”. From the Greek words for plate (“plakos”) and white (“leukos”) arose the medical name leukoplakia.

If you discover persistent white patches on your tongue, the inside of your cheeks, the roof of your mouth or even on your lips, these are signs of leukoplakia. At least if you do not have any other disease that could cause such spots as a concomitant. In addition to leukoplakia affecting the oral area (it is called oral leukoplakia), in rarer cases there are also leukoplakias affecting the genital or anal area.

For a leukoplakia of the anal mucosa, a separate diagnostic term has now become established in medicine: anal intraepithelial neoplasia (abbreviated AIN) or perianal intraepithelial neoplasia (PAIN). A neoplasia is a new formation or cell proliferation. “Perianal” means around the anus.

Leukoplakia – frequency and age

Among the sufferers of leukoplakia, there are about three times as many male patients and female patients. It is estimated that approximately 0.7 percent of women and 2.3 percent of men are affected by white callus disease. For Switzerland, this means that about 30,000 women and about 95,000 men have leukoplakia.

Leukoplakia occurs predominantly in middle and older age, rarely before the age of 40.

Illustration tongue with white coating

Leukoplakia: causes and risk factors

There are many causes of leukoplakia in the mouth. They all have in common that they cause the top tissue layer of the mucosa to become keratinized. The moist environment in the oral cavity causes the keratinized cells to swell, which eventually turns them white.

The following factors can promote the development of white callus disease (leukoplakia):

  • Repeated and prolonged mechanical irritation. Possible causes include braces, protruding teeth and ill-fitting dentures. Nails held between the lips (during craftsmen’s work) in larger numbers can also cause leukoplakia in the long term.
  • Poor oral hygiene and caries are also risk factors.
  • If you are a smoker, the risk of developing leukoplakia is particularly high.
  • Alcohol consumed regularly and in larger quantities can also promote leukoplakia.
  • Unhealthy diet is also a risk factor. Especially if it leads to a deficiency of B vitamins, iron or vitamin A.
  • Infections triggered by viruses or fungi can also cause leukoplakia.

In some cases, however, none of the above triggers can be found. If this is the case with you, you suffer from a so-called idiopathic leukoplakia. In medicine, the term “idiopathic” means that there is no identifiable cause for a disease.

Symptoms: Leukoplakia

If you suffer from leukoplakia, your mucosa has small or large white patches in the affected areas (usually in the mouth). They often show up in larger numbers and in different places. Such patches of white callus disease do not itch. Often they do not produce other complaints. However, there are different forms of the disease, some of which may be associated with complications.

The following forms of leukoplakia can be distinguished:

  • If the coloration of the mucosa is consistently white, with a smooth surface and a sharp border, it is called simple leukoplakia. It is also called leukoplakia simplex or homogeneous leukoplakia.
  • If the surface is rough, wart-like and you notice a burning sensation or pain, it is a verrucous (warty) leukoplakia. It belongs to the so-called inhomogeneous (not evenly structured) leukoplakia.
  • If red and white discolorations occur that are irregularly limited, you are suffering from erosive leukoplakia. Over time, more and more red areas form on the mucous membranes, so that the white discolorations fade into the background. This form of white callus disease also belongs to the inhomogeneous leukoplakias.

Special form: Hairy leukoplakia

When whitish changes resembling hairs appear on the side of the tongue, it is called hairy leukoplakia. This rare special form of white callus disease can occur in people with HIV (AIDS) who had once been infected with the Epstein-Barr virus in the past. This virus causes glandular fever. Its accompanying symptoms are often fever, sore throat, lassitude, swollen lymph nodes in the neck and enlargement of the spleen. Sometimes, however, there are no symptoms at all.

Leukoplakia: diagnosis with us

If you suspect you have leukoplakia, you should see us. However, you may not notice the symptoms of your white callus disease at first. Often, the whitish changes of the mucous membranes are only discovered by the dentist during a routine check-up.

If the white spots cannot be wiped away, it is reasonable to assume that it is leukoplakia. However, you will receive the final diagnosis only after visiting us. We need to clarify whether the whitish changes in the mucosa are not from a disease other than leukoplakia. White callus disease, for example, can be confused at first glance with the fungal disease thrush and with a form of nodular lichen (lichen ruber planus).

To make a definite diagnosis, we will take some cells from your mucosa (we will make a smear), or we will take a tissue sample (we will make a biopsy). Analysis of the cells under the microscope reveals whether leukoplakia is present.

Leukoplakia: prevention, early detection, prognosis

When you stand in front of the mirror and take a look at your oral cavity, your mucous membranes ideally present themselves in reddish hues. White, non-wipeable stains that indicate leukoplakia are not always immediately recognizable. They may also appear on the edges of the tongue or in areas of the cheeks that are not immediately visible.

You can prevent white callus disease to some extent by avoiding risk factors and maintaining a healthy lifestyle. What you can do:

  • Brush your teeth thoroughly at least twice a day, preferably with an electric toothbrush. Do not forget any tooth and clean the interdental spaces with interdental brushes or dental floss. In this way, you remove the deposits even in hard-to-reach places. Also, remember to visit your dentist at least once a year to have your gums and teeth checked.
  • Smoking and heavy alcohol consumption increase the risk of leukoplakia. So keep moderation or do without altogether.
  • Eat a healthy and balanced diet to avoid nutrient deficiencies, which are also considered a risk factor for white callus disease.
  • Be careful not to expose your mouth to the same stimulus in the same place over and over again. This could be cigarettes or tobacco pipes, for example, or, if you often do manual labor, nails held with your lips.
  • If you are wearing dentures and notice that they do not fit perfectly, do not accept this, but consult your dentist.

Course and prognosis

Simple leukoplakia (also called homogeneous leukoplakia or leukoplakia simplex) is usually harmless. However, if it is not treated, there is a high risk that the disease will develop into a tumor. Medical experts estimate that up to 30 percent of untreated leukoplakias can become malignant. In these cases, a so-called squamous cell carcinoma develops. White callus disease is thus one of the most common precancerous lesions of the oral cavity.

Even if leukoplakia is treated, the risk of its recurrence is high. Therefore, even after therapy, you should take care to avoid the risk factors and thus prevent a new outbreak of the disease. Have your oral cavity checked regularly so that you can initiate re-treatment at an early stage if necessary.

Leukoplakia: effective treatment

To effectively treat your leukoplakia, we need to know the cause of the condition. If this consists of a mechanical irritation of the mucosa, it is often sufficient to remove the causative trigger (for example, a slipping denture). Diet-related mucosal damage can also usually be remedied by appropriate remedies (for example, by changing food choices). If the trigger is known, treatment starts at the appropriate site. Once the source of interference is removed, white callus disease usually disappears on its own.

It becomes more difficult if the cause is unknown or the leukoplakia persists after several weeks despite medical treatment. We then perform a minor surgical procedure to remove the discolored mucosal areas. We can remove the keratinized cells with a laser or with heat, or we eliminate them by icing them.