Content area
Full text
Abstract
Betel quid lichenoid lesion (BQLL) refers to a specific entity of oral mucosal lesion associated exclusively with quid chewing habit which mimics oral lichen planus (OLP) clinically but lacks the crisscrossing pattern of striae commonly noted in OLP. This lesion may be misdiagnosed as OLP or lichened contact reaction or other quid-associated oral mucosal lesions; however, BQLL should be considered as a separate entity. There is a scarcity of case reports pertaining to this entity; although few prevalence studies have been reported. The prevalence rate of BQLL among quid chewers was found to be 9.5% in a north Indian population in 2015 which was higher than that reported in 1980 (0.7%). This shows the increasing trend of this lesion possibly due to the easy availability of quid in recent times. Hence, it is essential for oral physicians to have a sound knowledge of this entity, and it should be considered in the differential diagnosis.
Keywords: Betel quid lichened lesion, gutkha lichen, lichen planus-like lesion, oral lichen planus, quid
Introduction
Quid is defined as "a substance, or mixture of substances, placed in the mouth or chewed and remaining in contact with the mucosa, usually containing one or both of the two basic ingredients, tobacco or areca nut, in raw or any manufactured or processed form." The term "betel quid" refers to a specific variety of quid that includes betel leaf.[1] The term paan masala denotes a dry powdered mixture composed of areca nut, lime, catechu, and some other ingredients without a betel leaf; the same ingredients with tobacco are called gutkha.12]
An oral lichenoid lesion induced by quid has been reported exclusively among quid users. It clinically resembles oral lichen planus (OLP) but with some differences.[3] The main difference is the presence of fine, white, wavy, and parallel lines that do not overlap or crisscross, are non-elevated, and in some instances radiate from a central erythematous area.[3] Some cases may also resemble a plaque like or a papular variety of lichen planus.[4] This is considered to be a Type IV contact hypersensitivity-type lesion and may be unilateral in nature.[5] The lesion generally always occurs on the buccal mucosa, tongue, and mandibular vestibule; locations directly opposing the quid.[6] This lesion was initially referred to as...