Tobacco pouch keratosis | Snuff dipper lesion




Tobacco pouch keratosis is also called snuff pouch, spit tobacco keratosis.




Etiopathogenesis:-

 Nicotine : The compound N-nitroso-nor-nicotine (NNN), which is derived partly from bacterial action on nicotine during the curing process, is contributed but the action of salivary nitrites when  tobacco is held in the mouth.

Clinical features:-

Location:- It occurs in mucosal surface, where snuff is habitually held
Gingiva and periodontal tissue : Painless loss of the gingival and periodontal tissue in the area of tobacco contact.
Teeth :-

Smokeless tobacco keratosis: It is white plaque present in the mucosa where chewing tobacco is kept. It is thin, gr or gray-white translucent lesion. Margin of the lesion blends gradually into the surrounding mucosa. The appearance of lesion depends upon hours of daily use and use of different tobacco leaves.

Snuff pouch, tobacco pouch: Mucosa is soft, velvety touch feel on palpation and stretching of mucosa reveal distinct pouch. Stretched mucosa appears fissured and ripped in sand on a beach after an ebbing tide.

Malignant transformation: Verrucous carcinoma has been reported to occur from snuff dipper lesion. This is also called as snuff dippers cancer.

Management:-


Stoppage of habit: Maximum lesion is regressed following the cessation of habit

Biopsy: Any lesion which remains after 6 months of quitting the habit, should be sent for biopsy.


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