Tobacco Pouch Keratosis - A Common but of Ten Missed Oral Lesion

Aim: As a reference for cases related to smokeless tobacco use, its management and also states about the importance of proper and early diagnosis of tobacco pouch keratosis.

Presentation of Case: A 45 year old male complained of a rough surface with burning sensation occasionally in the mucosa of the lower front teeth region. The patient gave a positive history of using smokeless tobacco mixed with areca nuts, four times a day for the past seven years. A greyish white mucosal thickening was evident in the mandibular right and left buccal vestibule, labial vestibule with surface ulcerations from 35 to 45 region. The lesions had ill-defined borders. It had a wrinkled, corrugated surface texture. On palpation the lesion had a rough and leathery consistency.

Discussion: Smokeless tobacco usage is on an alarming rise in the Indian subcontinent. Some use it as an alternative for smoking and others use it along with smoking tobacco without realizing that smokeless tobacco also has equal potential to cause oral and systemic effects. One of the most common lesion which occurs due to use of smokeless tobacco is tobacco pouch keratosis. This paper presents a case report and a review about the prevalence, etiology, clinical features, pathogenesis, harmful effects, management and prevention of tobacco pouch keratosis.

Conclusion: Based on the clinical examination the lesion was diagnosed as tobacco pouch keratosis. Non-invasive procedures like habit cessation, counselling, early diagnosis may prevent the prognosis of the lesion and also decrease financial burden of the patient.