White sponge nevus (WSN) is a rare, benign genetic disorder characterized by distinctive white or gray mucosal lesions, most commonly affecting the oral cavity. Inherited in an autosomal dominant pattern, WSN results from mutations in keratin genes-primarily KRT4 and KRT13. These mutations lead to the development of thick, spongy plaques in the oral mucosa, with extraoral involvement more commonly associated with KRT13 mutations. The condition typically manifests in early childhood, presenting as painless, persistent white plaques. Diagnosis is usually based on clinical evaluation, although histopathological examination can provide confirmation. WSN is generally asymptomatic and does not require treatment; however, its cosmetic appearance may cause psychological discomfort. Although malignant transformation is rare, certain antimicrobial therapies have shown promise in symptom management. This report describes a case of WSN in a 23-year-old Iranian woman, detailing the clinical presentation, diagnostic process, and potential treatment strategies. Despite its benign nature, further research into the pathogenesis and therapeutic options is essential to improve patient care and quality of life.

The Figures were published in the incorrect order with incorrect captions. Below are the corrected versions. Reference: Karolina Spodzieja, Piotr Sobiech, Dorota Olczak-Kowalczyk. Innovative Combination of Tetracycline Rinse and CO₂ Laser Ablation for Treating White Sponge Nevus in Adolescents: A Case Study. Am J Case Rep 2024; 25:e944795. DOI: 10.12659/AJCR.944795.

BACKGROUND White sponge nevus (WSN) is rare, hereditary oral mucosa disorder. This condition usually presents as asymptomatic white coatings on mucous membranes that vary in intensity and thickness. Changes are usually observed on the oral cavity mucosa, and other mucosal sites of involvement include nasal, esophageal, and anogenital. In most cases this condition is considered benign since the plaques cause no pain, with no risk of malignant transformation. Thorough clinical and histopathological examination is indicated to exclude other similar conditions and to avoid unnecessary treatment. CASE REPORT We present a new case of white sponge nevus in a 13-year-old Polish girl with history of familial involvement. The patient had been treated with low-dosage tetracycline rinse (0.25%) for 3 months, and slight reduction in lesions was observed. Laser, ablation was performed with a CO₂ laser, the lesions recurred after half a year. It is the first published case report of WSN lesions on the oral mucosa treated with CO₂ laser. The patient remains under observation. CONCLUSIONS Because therapeutic options recommended in the literature provide only partial improvement or are unsuccessful, further research is still needed to develop treatment methods for patients with WSN. CO₂ laser ablation, although promising, cannot be regarded as an effective treatment method for white sponge nevus.

White Sponge Nevus (WSN) is traditionally considered a benign genetic disorder affecting the oral mucosa, primarily caused by pathogenic mutations in keratin 4 (KRT4) or keratin 13 (KRT13). Despite its benign nature, recent evidence has begun to question the malignant potential of WSN. We report a case involving a 70-year-old man who presented with a white lesion on the right floor of his mouth. Initial diagnostic evaluations confirmed the lesion as WSN. Over a one-year follow-up, the lesion underwent malignant transformation, evolving into local epithelial moderate-to-severe dysplasia. Exome sequencing identified a novel insertion mutation in exon 1 of the KRT4 gene, resulting in a deletion-insertion amino acid mutation involving glycine. Single-cell RNA sequencing further revealed altered epithelial proliferation and differentiation dynamics within the lesion. This case not only expands the known genetic spectrum of KRT4 mutations associated with WSN but also provides preliminary evidence suggesting the malignant potential of WSN. The novel pathogenic mutation in KRT4 is postulated to alter epithelial proliferation and differentiation, thereby raising concerns about the malignant transformation of WSN. Further studies are warranted to confirm these findings.

White sponge nevus is a rare genetic autosomal dominant disorder characterized by irregular patches of thick, white diffuse plaques, which mainly affects the oral mucosa and, very rarely, the skin or mucosa of the nose, esophagus, and anogenital region. We present a case of oral white sponge nevus in a 62-year-old woman, the differential diagnosis of which was of particular interest due to other similar white oral lesions, some of which are potentially malignant. The lesions were verified histologically. However, no treatment was performed due to the benign and asymptomatic nature of the lesions.