[061021] Frictional Keratosis.pptx

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1. Frictional Keratosis Selviana Rizky Pramitha 022118026301 Fatimah Fauzi Basalamah 022118026303 Frictional Keratosis Frictional Keratosis

2. White lesion with roughened surface due to chronic mechanical irritation (Myers and Curran, 2014; Neville et al., 2016) Definition Increased cornification on the surface of epithelial layer (O’Toole, 2013; Sonar et al., 2018) Resulted from parallel force between two materials with sliding motion along the surface (Walker, 2007; O’Toole, 2013; Ling, Sany and Moebs , 2016) 2

3. 1,4% 1 of 70 subjects 21-40 y.o age group 47,73% 63 of 176 cases 3,28% 76 of 310 cases 46 – 60 y.o age group 1,3% 1 of 75 subjects 70-80 y.o age group Epidemiology Scully, 2013; Vijayabala et al., 2016; Krishnaa and Chaudhary, 2020; Kuzio et al., 2020; Rohini et al., 2020; Shayeb et al., 2020 3 >

4. Etiology & Predisposing Factors Mignogna et al., 2011; Ongole dan Praveen, 2013; Neville et al., 2016; Khaled, 2017; Lazos et al., 2017; Odell, 2017; Mersil dan Sari, 2019; Kuzio et al., 2020 4

5. Etiopathogenesis 5 Mechanical load > shear strength (0.5 to 1.3 times of tensile strength) Keratinocyte injury release of intracellular organelles Intracellular organelles act as DAMPs activates TLR and NLR Production of Reactive Oxygen Species ROS binding KEAP1 Nrf2 release to activate Antioxidant Response Elements (AREs) (esp. Spprd2 and Lec1 ↑ LEC Protein to bind Keratin Intermediate Filament and Cornified Envelop Cytoskeleton breakdown that turn cell into corneocyte 3,81 MPa in gingiva, 1,70 MPa in hard palate and 1,54 MPa in buccal mucosa ↑ Cornification

6. Gambar 1. Diagram membram mukosa , struktur dan fungsi KEAP1-Nrf2, disregulasi sitoskeletal akibat defisiensi KEAP1 (Kumar, 2015; Belleza et al., 2018; Deo dan Desmukh , 2018; Ishitsuka , Ogawa and Roop , 2020) 6

7. A complaint of white patch or plaque with roughened surface in which patient has a history of contact with causative agent Diagnosis Family history and drug consumption should be collected Relevant information of onset , localization , duration , and previous therapy is important to distinguish with other white lesion 7 Mignona et al., 2011; Mersil dan Sari, 2019; Kuzio et al., 2020

8. Early lesion appear as pale, translucent and diffuse with surrounding mucosa Prolonged lesion presents with denser white plaque and irregular surface ( Cardessa dan Slootweg , 2006; Odell, 2017; Mersil dan Sari, 2019) 8 Supporting Examination Clinical Examination

9. Supporting Examination Microscopic examination Hyperkeratosis appear as thick orthokeratin layer ( white column ) Prominent granular cell ( yellow column) Biopsy is considered for persistent lesion with prolonged period or existence of risk factors (e. g. smoking or alcohol consumption) Supporting Examination 9 Cardesa dan Slootweg , 2006; Ongole dan Praveen, 2013; Myers dan Curran, 2014 Cawson and Odell, 2017; Khaled et al., 2017; Kuzio et al., 2020

10. No irritant adjacent to lesion HPA: Presence of dysplasia (Myers dan Curran, 2014; Carrard and Van Der Waal, 2018; Kuzio et al., 2020) Differential Diagnosis 10 Candidal Leukoplakia Oral Hairy Leukoplakia

11. Concurrently with other part of mucosa Reticula or papula may be observed following the plaque Often bilateral HPA: Infiltrate in subepithelial area ( Neville et al., 2016; Kuzio et al., 2020 ) 11 Candidal Leukoplakia Oral Lichen Planus (Plaque Type)

12. Frequently on the anterior part of buccal mucosa HPA: parakeratosis with intraepithelial inflammation and candida hyphae ( Scully, 2013; Neville et al., 2016 ) 12 Candidal Leukoplakia Candidal Leukoplakia

13. Elimination of causative agent if it is possible to be identified Cessation of existing habit that contributes to the manifestation (Scully, 2013; Glick, 2015; Mersil and Sari, 2019) Treatment 13 Patient should be informed the benign nature of the lesion and it will regress spontaneously once the irritant and contributing habit have been removed (Myers dan Curran, 2014; Mersil and Sari, 2019)

14. Lesion is benign in nature and regressed within two weeks ( Ongole and Praveen, 2013; Cardesa and Slootweg , 2016; Odell, 2017; Mersil and Sari, 2019) Prognosis Dysplasia may be present in patient with smoking habits ( Kuzio et al., 2020) 14

15. Kuzio M., Wapniarska K., Danilewics M., Lewkowicz N. (2020) ‘Oral epithelial dysplasia and oral cancer prevalence in routine white lesion biopsies – a 6-year retrospective study’, Journal of Pre-Clinical and Clinical Research, 14(3), pp. 63–68. doi : 10.26444/ jpccr /125393. Mersil S., Sari L. H. (2019) ‘Frictional Keratosis ”Mimicking” Leukoplakia ’, Jurnal Ilmiah dan Teknologi Kedokteran Gigi, 15(1), p. 16. doi : 10.32509/jitekgi.v15i1.786. Mignona M. D., Fortuna G., Leuci S., Adamo D., Siano M., Makary C., Cafiero C. (2011) ‘Frictional keratoses on the facial attached gingiva are rare clinical findings and do not belong to the category of leukoplakia ’, Journal of Oral and Maxillofacial Surgery, 69(5), pp. 1367–1374. doi : 10.1016/j.joms.2010.05.087. Müller, S. (2019) ‘Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa’, Head and Neck Pathology, 13(1), pp. 16–24. doi : 10.1007/s12105-018-0986-3. Myers S. L., Curran A. E. (2014) General and Oral Pathology for Dental Hygiene Practice. USA, F. A. Davis Company, pp. 40. References 15

16. Neville B. W., Damm D. D., Allen C. M., Chi A. C. (2016) Oral and Maxillofacial Pathology , Fourth Edition. Missouri: Elsevier. Pp. 260-262. Odell, E. W. (2017) Essentials of Oral Pathology and Oral Medicine . China: Elsevier. pp. 292. Ongole , R., Praveen, B. N. (2013) Textbook of Oral Medicine Oral Diagnosis and Oral Radiology. India: Elsevier. pp. 134. Patterson J. W., Hosler G. A. (2016) Weedon's Skin Pathology Fourth Edition. China, Elsevier, pp. 282. Scully C. (2013) Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment Third Edition. China, Elsevier, pp. 44. Vijayabala G. S., Mohanavalli S., Gunasekar C., Janagarathinam V. A., Kumar S. S., Kumar U. R. (2016) ‘Prevalence of oral mucosal abnormalities in dental patients in Tamil Nadu’, World Journal of Dentistry, 7(4), pp. 186–188. doi : 10.5005/jp-journals-10015-1393. 16

17. Thanks