20 November 2024
: Case report 
Innovative Combination of Tetracycline Rinse and CO₂ Laser Ablation for Treating White Sponge Nevus in Adolescents: A Case Study
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Karolina Spodzieja
1ABEF, Piotr Sobiech1AD, Dorota Olczak-Kowalczyk 1ACD*
DOI: 10.12659/AJCR.944795
Am J Case Rep 2024; 25:e944795
Table 1. Differential diagnosis – conditions similar to WSN.
| Oral condition | Clinical appearance | Treatment |
|---|---|---|
| Frictional keratosis | Corrugated, grey or white lesion with smooth or rough surface, due to constant rubbing of oral mucosa, usually located on the buccal mucosa | Removal of intraoral irritant resolve the lesion |
| Leukoedema | Benign white lesion found bilaterally or unilaterally on buccal or labial mucosa due to smoking, local irritation | No treatment needed |
| Linea alba | Distinct white linear area on the buccal mucosa in the plane of occlusion, sometimes also on the lateral side of the tongue due to biting of the oral mucosa | No treatment needed |
| Pseudomembranous candidiasis | Opportunistic fungal infection caused by , superficial white coatings on mucous membranes that can be wiped off, can be located on buccal and labial mucosa, palate, and tongue | Gentian violet/topical use of nystatin or systemically: fluconazole/ketoconazole/ itraconazole for patients with risk of systemic infections |
| Proliferative verrucous Leukoplakia | White, thickened plaques with irregular, rough surface showing presence of verrucous or wartlike areas, most often located on gingiva, buccal mucosa, alveolar ridge | Surgery, laser ablation, radiation |
| Hereditary benign intraepithelial dyskeratosis (HBID) | Corrugated white plaques of the buccal and labial mucosa, ocular lesions resulting in bloodshot appearance | No treatment needed |
| Heck’s disease (focal epithelial hyperplasia) | Multiple whitish soft papular or nodular elevated lesions in the oral cavity which disappear when mucosa is stretched | Local cryotherapy using liquid nitrogen application, cauterization, surgical resection, ablative laser treatment |
| Pachyonychia congenita | White, opaque thickenings present on buccal mucosa or tongue, cheilitis, hyperkeratosis of palms and soles, dystrophic changes in fingernails and toenails | No effective treatment for oral lesions |
| Darier disease | Oral mucosa may show multiple white papules in the buccal mucosa and hard palate, erythematous cutaneous papules | Oral antibiotics, acyclovir, antimicrobial mouth rinses to prevent from secondary infection |
| Lichen planus | White, grey, thread-like papules forming lacy, reticular patches or present as a plaque-like lesion, symmetrically o buccal mucosa, tongue, lips, palate. Oral lesions appear before cutaneous lesions | Observation, for more severe cases cryotherapy, laser ablation, surgery |
| Squamous cell carcinoma | White lesion with uneven surface and borders, may exhibit ulceration, usually located on the lateral border of the tongue, may appear also on the soft palate, mouth floor, buccal mucosa | Surgical excision of the lesion |
| Dyskeratosis congenita | Plaque-like leukoplakia present on the surface of the tongue with atrophy of the papilla or on buccal mucosa; skin pigmentation, nails changes | No treatment needed |
| Syphilis (secondary) | White patches similar to leukoplakia located on the tongue or oral mucosa | Antibiotics: penicillin, doxycycline, azithromycin |
| Lupus erythematosus | Non-wear off white lesion with irregular shape located on buccal mucosa or soft palate | Topical corticosteroids, sometimes systemic agents such as corticosteroids or immunosuppressants |