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Gardner NJ. PFAPA syndrome in children. JAAPA 2023; 36:1-5. [PMID: 37751263 DOI: 10.1097/01.jaa.0000977712.81696.b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
ABSTRACT Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is, as the name implies, characterized by an extremely regular cycle of fevers that is accompanied by one or more other symptoms such as oral ulcers, pharyngitis, adenitis, tonsillitis, sore throat, cervical adenopathy, and headache. Originally known as Marshall syndrome, PFAPA is most commonly identified in children younger than age 5 years; however, adults may also present with the disease, though they may report additional symptoms. PFAPA is now understood to be a diagnosis of exclusion. Laboratory studies are typically unremarkable except for increases in acute phase reactants such as C-reactive protein. Treatment is primarily supportive and most frequently uses systemic steroids to suppress the inflammatory response. Acute flares are self-limited, and the syndrome typically resolves on its own as the child reaches age 7 or 8 years.
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Affiliation(s)
- Nathan J Gardner
- Nathan J. Gardner is an assistant professor and director of the PA program at Albany Medical College in Albany, N.Y. and works clinically in physical medicine and rehabilitation at Sunnyview Rehabilitation Hospital in Schenectady, N.Y. The author has disclosed no potential conflicts of interest, financial or otherwise
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2
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Vaezi Moghaddam A, Mortazavi SA, Kobarfard F, Bafkary R, Darbasizadeh B. Synthesis and functionalization of mucoadhesive mesoporous silica particles containing diphenhydramine for treatment of aphthous ulcers. BIOIMPACTS : BI 2023; 13:456-466. [PMID: 38022378 PMCID: PMC10676526 DOI: 10.34172/bi.2023.27548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/15/2022] [Accepted: 11/19/2022] [Indexed: 12/01/2023]
Abstract
Introduction Medications used to treat oral ulcers include corticosteroids, anesthetics, and antihistamines. These can be used as gels, mouthwashes, pastes, ointments, etc. Diphenhydramine hydrochloride (DPH) has local anesthetic properties that can help treat the aphthae. One of the drawbacks of the delivery to the transmucosal is the quick turnaround time of the gel, a mucous form that is located on the epithelial film surface. Methods Therefore, it seems that the preparation of a carrier that has the characteristics of adhesive mucus can increase the duration of drug retention on the mucous surface. To solve this problem, mesoporous silica nanoparticles (MSNPs) were synthesized and functionalized with amino and thiol groups and suggested as a system of drug delivery. The properties and structure of MSNPs were investigated by dynamic light scattering (DLS), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS), thermal gravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), and nitrogen adsorption-desorption isotherms (BET). Results Our outcomes indicated that the average sizes of bare MSNPs (MSN), amino modified MSNPs (MSN-NH2), and thiol modified MSNPs (MSN-SH) were obtained to be 611, 655, and 655 nm respectively and the average pore size of MSN, MSN-NH2, and MSN-SH were about 2.42 nm, 2.42 nm, and 2.44 nm, respectively, according to the BJH (Barrett-Joyner-Halenda) pore size distribution. The release kinetics and release of DPH from mesoporous silica carriers were evaluated. Conclusion Eventually, the mucoadhesive study and DPH-loaded particles were investigated. Also, the MSN-SH exhibited a high mucoadhesive capacity for buccal mucosa compared with MSN-NH2 and MSN.
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Affiliation(s)
- Azadeh Vaezi Moghaddam
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Mortazavi
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Kobarfard
- Department of Medicinal Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Bafkary
- Department of Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Darbasizadeh
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ali K, Raja M, Osman S, Zulfiqar G, Janjua O. Recognition and management of drug-associated oral ulceration: a review. Br Dent J 2022; 233:564-568. [PMID: 36241814 DOI: 10.1038/s41415-022-5032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022]
Abstract
The number of people who are using prescribed medications is on the rise, largely due to an ageing population in the UK, but also because of early diagnosis and prompt medical management of a variety of conditions. Systemic medications may contribute to the development of oral side effects and translate into an increasing number of patients presenting in general dental practice settings. The aim of this paper is to provide an outline of oral side effects of systemic medications followed by a review of drug-associated oral ulcers (DAOUs). The paper also provides recommendations for early recognition and management of DAOUs in general dental practice settings, including referral to general medical practitioners and specialists in oral medicine.
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Affiliation(s)
- Kamran Ali
- Professor of Oral Surgery, Qatar University College of Dental Medicine, Qatar; Honorary Professor of Dental Education, Plymouth University, UK.
| | | | - Safa Osman
- Research Assistant, Qatar University, Qatar
| | - Gulraiz Zulfiqar
- Associate Professor, Oral and Maxillofacial Surgery, Jinnah Hospital Lahore, Pakistan
| | - Omer Janjua
- Professor, Oral and Maxillofacial Surgery, Faisalabad Medical University, Faisalabad, Pakistan
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4
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Ossama M, Lamie C, Tarek M, Wagdy HA, Attia DA, Elmazar MM. Management of recurrent aphthous ulcers exploiting polymer-based Muco-adhesive sponges : in-vitro and in-vivo evaluation. Drug Deliv 2021; 28:87-99. [PMID: 33342321 PMCID: PMC7758044 DOI: 10.1080/10717544.2020.1858999] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recurrent aphthous ulcer (RAU) is a well-known painful, inflammatory disease with uncertain etiology for which local symptomatic therapy is only available. The aim of this study was to formulate and characterize muco-adhesive sponges containing a mixture of tenoxicam and miconazole nitrate to manage pain, inflammation and avoid candida infection that may accompany RAU due to poor oral hygiene. Two polymers at different concentrations were used to prepare sponges applying simple freeze-drying. Medicated chitosan (2%) sponges (mC2) showed acceptable physical appearance, surface pH (6.3 ± 0.042), porosity (25.7% ± 1.8), swelling index (5.7 ± 0.11), in-vivo and ex-vivo muco-adhesion time (115 min.±0.813 and 155 min.±1.537, respectively), ex-vivo muco-adhesion force (0.09 N ± 0.002) and scanning electron microscope (SEM) images. For concurrent clear-cut determination of tenoxicam and miconazole nitrate from mC2, a new UPLC method was developed and validated. mC2 sponges exhibited superior in-vitro drug release profiles where ∼100% of tenoxicam released within 5 min for fast pain relief with a more prolonged miconazole nitrate release. Furthermore, in-vivo animal study revealed that mC2 caused a significant decrease in the acetic acid-induced ulcer size in rats after 6 days of treatment (p < .0001) compared to negative and positive controls. Additionally, histopathological examination showed faster healing with complete restoration of the normal oral histology in rats. The present study concludes that chitosan sponge loaded with a combination of tenoxicam and miconazole nitrate could improve healing of RAU cases.
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Affiliation(s)
- Muhammed Ossama
- Department of Pharmaceutics and Pharmaceutical Technology, The British University in Egypt (BUE), Cairo, Egypt
| | - Caroline Lamie
- Department of Pharmaceutics and Pharmaceutical Technology, The British University in Egypt (BUE), Cairo, Egypt
| | - Mohamed Tarek
- Department of Pharmaceutical Chemistry, The British University in Egypt (BUE), Cairo, Egypt
| | - Hebatallah A Wagdy
- Department of Pharmaceutical Chemistry, The British University in Egypt (BUE), Cairo, Egypt
| | - Dalia A Attia
- Department of Pharmaceutics and Pharmaceutical Technology, The British University in Egypt (BUE), Cairo, Egypt
| | - Mohamed M Elmazar
- Department of Pharmacology and Biochemistry, The British University in Egypt (BUE), Cairo, Egypt
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Deng F, Thompson LDR, Lai J. Unexpected Reason for Non-healing Oral Ulcers: Syphilis. Head Neck Pathol 2021; 16:544-549. [PMID: 34342809 PMCID: PMC9187837 DOI: 10.1007/s12105-021-01348-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/11/2021] [Indexed: 02/05/2023]
Abstract
Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum and characterized by a complex and variable clinical presentation. Cases of unexpected oral syphilis presenting as non-healing ulcers are uncommonly reported. We report 3 cases (one female and two males, aged 35, 35, and 56 years, respectively) in which patients presented with non-healing oral ulcers. Biopsies revealed surface ulceration and a significant neutrophilic infiltrate rather than the more conventional plasma cell infiltrate seen with most reported syphilis infections, potentially leading to an inaccurate diagnosis. Treponema pallidum immunohistochemistry highlighted spirochetes within the epithelium, with additional diagnostic confirmation by serum T. pallidum particle agglutination assay. Sexual history documentation by the clinician with nonspecific oral ulcers is paramount to aiding diagnosis and leading to proper management. Further, it is important to perform immunohistochemistry for T. pallidum in oral biopsies from non-healing ulcers, especially when clinical history raises the differential diagnosis or when other clinical manifestations may support this consideration.
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Affiliation(s)
- Frank Deng
- Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Lester D. R. Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, CA USA
| | - Jinping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, 95825 Sacramento, CA USA
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Alvarez-Payares JC, Ramírez-Urrea S, Correa-Parra L, Salazar-Uribe D, Velásquez-López M. Mucocutaneous Manifestations of Inflammatory Bowel Disease. Cureus 2021; 13:e17191. [PMID: 34548985 PMCID: PMC8439267 DOI: 10.7759/cureus.17191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and incurable disease, of unknown etiology, associated with an unregulated immune response to environmental triggers in a genetically predisposed host. IBD affects mainly the gastrointestinal (GI) tract and includes Crohn's disease (CD) and ulcerative colitis (UC). However, a large percentage of patients may present with extraintestinal manifestations, including mucocutaneous ones (which are the most common) and dermatologic findings, such as erythema nodosum, pyoderma gangrenosum, and aphthous stomatitis (which are the most frequently occurring). According to pathophysiologic mechanisms, mucocutaneous manifestations of IBD are classified into five categories, namely, specific manifestations, associated manifestations, reactive manifestations, adverse effects of IBD therapy, and malabsorption manifestations. Recognizing such manifestations should not be performed only by a dermatologist but also other specialties such as internal medicine, gastroenterology, among others. This is because these manifestations can present before the IBD diagnosis, even in the absence of GI symptoms. Therefore, these skin lesions could be a fundamental tool for the earlier diagnosis of IBD. This review provides a comprehensive overview of the most common cutaneous manifestations of IBD with a focus on their epidemiology, diagnostic criteria, clinical presentation, and available medical treatment.
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Coşkunmeriç N, Üstündağ Okur N, Okur ME, Ayla Ş, Yoltaş A, Karavana SY. Promising nanogels loaded with usnic acid for oral ulcer treatment: development, characterization, and in vivo evaluation in rabbits. Pharm Dev Technol 2021; 26:431-443. [PMID: 33567946 DOI: 10.1080/10837450.2021.1885441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study aimed to present an effective formulation targeting oral ulcers that will remain in the application site for a longer period, reducing the frequency of administration. As a candidate formulation, usnic acid (UA) was loaded into the optimum nanogels. The characterization studies included physical, rheological, and bioadhesive properties as well as in vitro release and ex vivo studies. The rheological results revealed that the nanogels present pseudoplastic flow behavior. In vitro drug release showed a prolonged pattern. In further, the chosen UA nanogels showed very low percentages of penetration and permeation. F13, which showed the highest release, suitable bioadhesive properties (0.475 ± 0.033 N/cm2) and eligible particle size (250.22 ± 4.11 nm), PDI (0.089 ± 0.052), and zeta potential (20.56 ± 0.330 mV) values were chosen for in vivo experiments. The selected UA nanogels showed effective antimicrobial activity against Bacillus Cereus and great in vivo wound healing properties. The results indicated that suitable UA nanogels with desired properties could be prepared. The therapeutic potential of the nanogels for oral ulcers was assessed using an animal model and the histopathological findings suggested that the optimized formulation is a good choice for oral ulcer treatment. Nonetheless, further research is recommended to support its efficacy by applying pharmacodynamic and pharmacokinetic studies in human individuals.
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Affiliation(s)
- Nesrin Coşkunmeriç
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Ege University, Bornova, Izmir, Turkey
| | - Neslihan Üstündağ Okur
- Faculty of Pharmacy, Department of Pharmaceutical Technology, University of Health Sciences, Uskudar, Istanbul, Turkey
| | - Mehmet Evren Okur
- Faculty of Pharmacy, Department of Pharmacology, University of Health Sciences, Uskudar, Istanbul, Turkey
| | - Şule Ayla
- School of Medicine, Department of Histology and Embryology, Istanbul Medipol University, Beykoz, Istanbul, Turkey
| | - Ayşegül Yoltaş
- Faculty of Science, Department of Biology, Fundamental and Industrial Microbiology Division, Ege University, Bornova, Izmir, Turkey
| | - Sinem Yaprak Karavana
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Ege University, Bornova, Izmir, Turkey
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Antonelli E, Bassotti G, Tramontana M, Hansel K, Stingeni L, Ardizzone S, Genovese G, Marzano AV, Maconi G. Dermatological Manifestations in Inflammatory Bowel Diseases. J Clin Med 2021; 10:jcm10020364. [PMID: 33477990 PMCID: PMC7835974 DOI: 10.3390/jcm10020364] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) may be associated with extra-intestinal manifestations. Among these, mucocutaneous manifestations are relatively frequent, often difficult to diagnose and treat, and may complicate the course of the underlying disease. In the present review, a summary of the most relevant literature on the dermatologic manifestations occurring in patients with inflammatory bowel diseases has been reviewed. The following dermatological manifestations associated with IBDs have been identified: (i) specific manifestations with the same histological features of the underlying IBD (occurring only in Crohn's disease); (ii) cutaneous disorders associated with IBDs (such as aphthous stomatitis, erythema nodosum, psoriasis, epidermolysis bullosa acquisita); (iii) reactive mucocutaneous manifestations of IBDs (such as pyoderma gangrenosum, Sweet's syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis-pyostomatitis vegetans, etc.); (iv) mucocutaneous conditions secondary to treatment (including injection site reactions, infusion reactions, paradoxical reactions, eczematous and psoriasis-like reactions, cutaneous infections, and cutaneous malignancies); (v) manifestations due to nutritional malabsorption (such as stomatitis, glossitis, angular cheilitis, pellagra, scurvy, purpura, acrodermatitis enteropathica, phrynoderma, seborrheic-type dermatitis, hair and nail abnormalities). An accurate dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance.
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Affiliation(s)
| | - Gabrio Bassotti
- Gastroenterology Section, Perugia General Hospital, 06156 Perugia, Italy;
- Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy
- Correspondence:
| | - Marta Tramontana
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
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Ali NS, Billings ML, Tollefson MM, Davis DMR, Hand JL. Oral erosions associated with surreptitious marijuana vaping in an adolescent boy. Pediatr Dermatol 2020; 37:347-349. [PMID: 31967343 DOI: 10.1111/pde.14101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 15-year-old boy presented with painful ulcerations affecting the oral mucosa that were eventually attributed to marijuana vaping. In this case report, we highlight cannabis vaping as a potential cause of oral erosions due to injury and chronic inflammation of the oral mucosa.
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Affiliation(s)
- Nora S Ali
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Marcie L Billings
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Dawn M R Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Hand
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota.,Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota
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10
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Topical oral wound healing potential of anthocyanin complex: animal and clinical studies. Ther Deliv 2018; 9:359-374. [DOI: 10.4155/tde-2017-0123] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: An anthocyanin complex (AC), combined Zea mays and Clitoria ternatea extracts, was evaluated for topical oral wound healing in rats and a clinical trial in orthodontic patients. Methods/results: AC enhanced anthocyanin permeation in vitro. In rats, 10% w/w of AC in a mucoadhesive gel (AG) reduced erythema and sizes of oral wounds after topical applications at higher extent than its placebo gel. Acute orthodontic wounds in 68 volunteers were randomly assigned to topically receive either AG or placebo gel and double-blind assessed. Wound size reduction and wound closure enhancement were obvious in AG-treated group on day 3 (p < 0.05). Conclusion: At 10% w/w, AC promoted wound closure and possessed a potential in healing stimulation of acute oral wounds.
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Rogers RS, Fazel N. Oral dermatology: Part II. Clin Dermatol 2017; 35:419-420. [PMID: 28916022 DOI: 10.1016/j.clindermatol.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Roy S Rogers
- Department of Dermatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259
| | - Nasim Fazel
- Department of Dermatology, University of California at Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 98516.
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12
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Affiliation(s)
- Roy S Rogers
- Department of Dermatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259
| | - Nasim Fazel
- Department of Dermatology, University of California at Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816.
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Abstract
Recurrent aphthous stomatitis (RAS) is the most common acute oral ulcerative condition in North America. RAS is divided into a mild, common form, simple aphthosis, and a severe, less common form, complex aphthosis. Aphthosis is a reactive condition. The lesions of RAS can represent the mucosal manifestation of a variety of conditions. These include conditions with oral and genital aphthae such as ulcus vulvae acutum, reactive nonsexually related acute genital ulcers, and Behçet disease. The mouth is the beginning of the gastrointestinal (GI) tract, and the lesions of RAS can be a manifestation of GI diseases such as gluten-sensitive enteropathy, ulcerative colitis, and Crohn disease. Complex aphthosis may also have correctable causes. The clinician should seek these in a careful evaluation. Successful management of both simple and complex aphthosis depends on accurate diagnosis, proper classification, recognition of provocative factors, and the identification of associated diseases. The outlook for patients with both simple and complex aphthosis is positive.
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Affiliation(s)
- Ricky Z Cui
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Alison J Bruce
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
| | - Roy S Rogers
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ
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