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August 1981

Leukoedema, Reactive Hyperkeratosis, or Cheek Biting

Author Affiliations

Sydney, Australia

Arch Dermatol. 1981;117(8):454. doi:10.1001/archderm.1981.01650080006010

To the Editor.—  I found the article by Duncan and Su on leukoedema of the oral mucosa of great value and interest. This is a condition that seems to occur frequently in mental patients. It has to be distinguished from the other types of white keratotic lesions of the oral mucosa. This is done very well in the article quoted, which contains a helpful differential diagnostic table. However, the illustrations of the condition published by these authors are, I would say, the exact replicas of the clinical appearance and of the histologic picture of cheek biting as seen in the articles of Kocsard et al1 and Obermayer.2 In the differential diagnostic discussion of their case, Duncan and Su dismiss the diagnosis of cheek biting because "lesions secondary to cheek-biting are usually limited to the occlusal planes, and careful history taking will disclose its origin." This limitation of the

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