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Babic V, Petitpain N, Guy C, Trechot P, Bursztejn AC, Faillie JL, Vial T, Schmutz JL, Gillet P. Nicorandil-induced ulcerations: a 10-year observational study of all cases spontaneously reported to the French pharmacovigilance network. Int Wound J 2018; 15:508-518. [PMID: 29767853 PMCID: PMC7949779 DOI: 10.1111/iwj.12845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/01/2017] [Indexed: 11/26/2022] Open
Abstract
Nicorandil-induced ulcers remain often poorly recognised, with a late diagnosis and an inadequate management. We aimed to provide a clinical overview of the 148 spontaneously reported cases of nicorandil-induced ulcers to the French pharmacovigilance network between 2005 and 2014 and to complete this picture with worldwide published cases over the same period. Spontaneously reported nicorandil-induced ulcers were mainly mucosal (oral and anal) with a previous trauma in 23·0% of patients, revealed by a severe complication in 12·8% of cases. The mean cumulative dose of nicorandil was higher in serious cases. The median delay between the start of nicorandil use and the onset of the ulcer was 23·4 months, and after the ulcer was diagnosed, the median time to incriminate nicorandil was still 3·3 months, being shorter for mucosal ulcerations than for cutaneous ulcerations (5·2 versus 14·0 months, P = 0·001). The anatomic distribution in the 199 published cases differed slightly, but delays were similar. The hypothesis of mechanism becomes more precise, leaving no doubt about the necessity to discontinue the treatment. Practitioners need to be aware that nicorandil-induced ulcers can occur in many locations, possibly multiple and complicated, and should be simply managed by discontinuing treatment with no further reintroduction of nicorandil.
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Affiliation(s)
- Valérie Babic
- Department of DermatologyUniversity HospitalVandoeuvre‐les‐NancyFrance
| | - Nadine Petitpain
- Regional Center of PharmacovigilanceUniversity HospitalNancyFrance
| | - Claire Guy
- Regional Center of PharmacovigilanceUniversity HospitalSaint‐EtienneFrance
| | - Philippe Trechot
- Regional Center of PharmacovigilanceUniversity HospitalNancyFrance
| | | | - Jean Luc Faillie
- Regional Center of Pharmacovigilance, Department of Medical Pharmacology and Toxicology, CHU MontpellierUniversity of MontpellierMontpellierFrance
| | - Thierry Vial
- Regional Center of PharmacovigilanceUniversity HospitalLyonFrance
| | - Jean Luc Schmutz
- Department of DermatologyUniversity HospitalVandoeuvre‐les‐NancyFrance
| | - Pierre Gillet
- Regional Center of PharmacovigilanceUniversity HospitalNancyFrance
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Abstract
A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.
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Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral Health Care Sciences, University College, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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Pisano U, Deosaran J, Leslie SJ, Rushworth GF, Stewart D, Ford I, Watson AJM. Nicorandil, Gastrointestinal Adverse Drug Reactions and Ulcerations: A Systematic Review. Adv Ther 2016; 33:320-44. [PMID: 26861848 DOI: 10.1007/s12325-016-0294-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nicorandil is a popular anti-anginal drug in Europe and Japan. Apart from some common adverse drug reactions (ADR), its safety is satisfactory. Several reports have suggested a link between nicorandil, gastrointestinal (GI) ulceration and fistulas. The review aims to critically appraise, synthesize and present the available evidence of all known GI ADR per anatomical location. METHODS The study complied with the PRISMA statement. Literature and pharmacovigilance databases were used to provide rate and/or calculate parameters (median age, median dose, history of symptoms, length of therapy and healing time after withdrawal of the drug). Differences in distribution of quantitative variables were analyzed via Mann-Whitney test. Correlation between quantitative variables was assessed with a Spearman's correlation coefficient. A p value <0.05 was significant. RESULTS Oral ulcerations occur in 0.2% of the subjects, anal ulcerations are present between 0.07% and 0.37% of patients. Oral and distal GI involvements are the most common ADR (28-29% and 27-31% of all GI ADR, respectively). The hepatobiliary system, the pancreas and salivary glands are not affected by nicorandil exposure. The time to develop oral ulcerations is 74 weeks among people on <30 mg/day compared to only 7.5 weeks in individuals on higher regimens (p = 0.47). There is a significant correlation between dose and ulcer healing time (Spearman's 0.525, p < 0.001). CONCLUSIONS Ulcerative disease is a very commonly reported GI ADR. A delayed ulcerative tendency supports the hypothesis of an ulcerogenic metabolite. Nicorandil seems to act as a cause of the ulcerations, but appears to also work in synergy with other promoting factors. Whether the action of the metabolites relies on a specific mechanism or a simple chemical ulceration is still to be established.
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Affiliation(s)
- Umberto Pisano
- Department of General Surgery, Raigmore Hospital, Inverness, UK.
| | | | | | | | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Campolmi N, Guy C, Cinotti E, Forest F, Gain P, Philippe-Zech C, Gauthier AS, Thuret G. Corneal perforation: another side effect of nicorandil. Cutan Ocul Toxicol 2013; 33:96-8. [DOI: 10.3109/15569527.2013.812105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nicorandil-induced oral ulceration: report of 3 cases and review of the Japanese literature. ACTA ACUST UNITED AC 2011; 112:754-9. [DOI: 10.1016/j.tripleo.2011.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/16/2011] [Accepted: 05/24/2011] [Indexed: 11/23/2022]
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[Ulcers following therapy with hydroxyurea. Three case reports and review of the literature]. Hautarzt 2010; 61:598-602. [PMID: 19763519 DOI: 10.1007/s00105-009-1794-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hydroxyurea is frequently used for therapy of myeloproliferative disorders. One cutaneous side-effect is painful, therapy-resistant ulcers which have bizarre configurations and occur at atypical sites for venous ulcers. Improvement or healing often first occurs when hydroxyurea is discontinued. We report on one patient with essential thrombocythemia and two with polycythemia vera, who developed such ulcers during hydroxyurea therapy. In one case, the ulcers developed shortly after hydroxyurea was started. In addition we give a short overview of the current literature.
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Baker RP, Al-Kubati W, Atuf M, Phillips RKS. Nicorandil-induced severe perianal ulceration. Tech Coloproctol 2007; 11:343-5. [PMID: 18060591 DOI: 10.1007/s10151-007-0378-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 09/18/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nicorandil is a potassium channel activator used in the prevention and long-term treatment of angina pectoris. It is widely prescribed and its use is supported by data from powerful randomised controlled trials. The colorectal community is becoming increasingly aware of a subgroup of patients with anal ulceration and other gastrointestinal manifestations of nicorandil use. METHODS This study is a retrospective review of patients identified as having nicorandil-induced perianal ulceration. We report our experience of 11 patients. RESULTS All eleven patients experienced severe debilitating ulceration of the perianal area and perineum. Multiple therapies were tried unsuccessfully before the association with nicorandil was recognised. Upon recognition of the association of nicorandil with these ulcers, the therapy was stopped resulting in resolution of the perianal symptoms. CONCLUSIONS Nicorandil is a rare cause of severe perianal ulceration. This association should be recognised as these ulcers are resistant to other forms of treatment but heal well on ceasing nicorandil use.
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Affiliation(s)
- R P Baker
- Department of Coloproctology, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, UK.
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11
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Abstract
This leading article refers to the paper by Abdelrazeq AS, Owen C, Smith L, McAdam JG, Pearson HJ, Leveson SH. Nicorandil-associated para-stomal ulceration: case series Eur J Gastroenterol Hepatol 2006; 18:1293-1295. We apologise to all concerned for the dissociation between the two papers, which was due to an administrative error. Nicorandil is used widely in patients with coronary artery disease. Nicorandil is well tolerated with only minor side effects. Nicorandil's association with oral, anal, gastrointestinal ulceration, and more recently para-stomal ulceration has been reported. Medical awareness of nicorandil association with ulcerations should be high to help avoid unnecessary and harmful treatment as only cessation of the drug would heal the ulceration. Nicorandil is an antianginal drug used for the treatment of symptomatic coronary artery disease. It is characterized by an arterial and venous vasodilator effect with dual mechanism of action. Nicorandil is not a first-line agent in the management of angina but it is used in combination with other antianginal medications in stable and unstable angina. It is generally well tolerated with minor side effects such as headache, nausea, flushing and dizziness. The association of nicorandil with mouth and anal ulcers as well as the association with ulceration throughout the gastrointestinal tract has been reported, and recently, an association with para-stomal ulceration has also been described. Medical awareness of the association of nicorandil with ulceration in any part of the gastrointestinal tract should be highlighted among all medical professionals to help avoid delays in withdrawing the treatment and to avoid unnecessary and sometimes invasive and costly interventions.
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Rival AL, Allombert-Blaise C, Ly A, Grandjean JP, Faure M, Claudy A. [Nicorandil-associated anal ulceration]. Ann Dermatol Venereol 2007; 133:781-3. [PMID: 17072194 DOI: 10.1016/s0151-9638(06)71043-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nicorandil is a potassium-channel activator used in the treatment of angina pectoris. The first cases of anal ulcerations induced by nicorandil were published in 2002. CASE REPORT A 71-year-old man presented with a 2-year history of anal ulcerations occurring within a few months of initiation of treatment with Nicorandil. Histological tests on a biopsy sample showed granulation tissue with non-specific chronic inflammation. Nicorandil was stopped and this resulted in complete healing of the ulcers after three months. DISCUSSION Nicorandil can induce chronic and extensive anal ulcerations. The pathogenesis is unknown. Patients are usually treated with high doses of nicorandil. Dermatologists should be aware of this rare side-effect which heals after withdrawal of the drug.
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Affiliation(s)
- A-L Rival
- Service de Dermatologie, Hôpital Edouard Herriot, place d'Arsonval, 69437 Lyon Cedex 03
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Abstract
Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is a common condition which is characterized by multiple recurrent small, round or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors typically presenting first in childhood or adolescence. RAS occurs worldwide although it appears most common in the developed world. The aetiology of RAS is not entirely clear. Despite many studies trying to identify a causal microorganism, RAS does not appear to be infectious. A genetic predisposition is present, as shown by strong associations with genotypes of IL-1beta; IL-6 in RAS patients, and a positive family history in about one-third of patients with RAS. Haematinic deficiency is found in up to 20% of patients. Cessation of smoking may precipitate or exacerbate RAS in some cases. Ulcers similar to RAS may be seen in human immunodeficiency virus disease and some other immune defects, and drugs, especially non-steroidal anti-inflammatory drugs and nicorandil may produce lesions clinically similar to RAS. Topical corticosteroids can often control RAS. However, the treatment of RAS remains unsatisfactory, as most therapies only reduce the severity of the ulceration and do not stop recurrence.
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Affiliation(s)
- S Jurge
- Oral Medicine, Eastman Dental Institute, University College London, UK
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Schmid JP, Schroeder V. Nicorandil – Review of Pharmacological Properties and Clinical Applications. ACTA ACUST UNITED AC 2005. [DOI: 10.1159/000089603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Webster K, Godbold P. Nicorandil induced oral ulceration. Br Dent J 2005; 198:619-21. [PMID: 15920586 DOI: 10.1038/sj.bdj.4812350] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 11/15/2004] [Indexed: 11/08/2022]
Abstract
Oral ulceration has many different causes. The association between Nicorandil and oral ulceration is not a new phenomenon. There have been several previous case reports regarding a possible association although none in publications for general dental practice. In this report we have a case series of seven patients and we compared our findings with those in the current literature.
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Affiliation(s)
- K Webster
- Department of Maxillofacial Surgery, University Hospital Birmingham Foundation Trust, Edgbaston, Birmingham B15 2TH, UK.
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Lin SS, Chou MY, Ho CC, Kao CT, Tsai CH, Wang L, Yang CC. Study of the viral infections and cytokines associated with recurrent aphthous ulceration. Microbes Infect 2005; 7:635-44. [PMID: 15840465 DOI: 10.1016/j.micinf.2004.12.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Revised: 12/24/2004] [Accepted: 12/28/2004] [Indexed: 11/29/2022]
Abstract
Mouth ulcers are one of the most common oral complaints. However, the association between oral ulceration and viruses and cytokines is uncertain. We detected the presence of human papilloma virus (HPV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV)-1, HSV-2 and human herpesvirus (HHV)-8 DNA in oral tissues by polymerase chain reaction (PCR) and Southern hybridization techniques, and quantified the serum levels of cytokines including interleukin (IL)-2, IL-4, granulocyte-macrophage colony-stimulating factor (GM-CSF), soluble Fas (sFas) and the Fas ligand (FasL) by enzyme-linked immunosorbent assay (ELISA) for 67 recurrent aphthous ulcer (RAU) patients and 72 normal individuals. Seven patient specimens were excluded from the study due to the negative PCR results for the beta-globin used as the internal control. Among the 32 (53.3%) virus-positive results from 60 patients' samples, 8 (13.3%) HPV, 4 (6.7%) HSV-1, 11 (18.3%) CMV, 9 (15.0%) EBV, and 16 (26.7%) HHV-8 samples proved to be positive. No HSV-2-positive samples were found. The percentage of single-virus infection (56.3%) was significantly greater than that of double-virus co-infection (31.3%) and the percentage of double-virus co-infection was significantly greater than the percentage of triple-virus co-infection (12.5%) (P < 0.05). In the 72 normal oral-tissue specimens, no viral DNA was detected. The mean serum cytokine level for patients was significantly (P < 0.05) greater than for controls for most of the separate age groups. The mean serum cytokine concentrations for the patient group demonstrated a diffuse pattern covering a wide range of serum concentrations, a very different result from the compact serum concentration pattern and lower mean serum cytokine concentrations revealed by the normal group. Overall association between viruses and recurrent aphthous ulceration is HHV-8 > CMV > EBV > HPV > HSV-1, regarding the frequency of prevalence (P < 0.05).
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Affiliation(s)
- Shih-Shen Lin
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
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Simpson D, Wellington K. Nicorandil: a review of its use in the management of stable angina pectoris, including high-risk patients. Drugs 2004; 64:1941-55. [PMID: 15329045 DOI: 10.2165/00003495-200464170-00012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Nicorandil (Adancor, Angicor, Dancor, Nikoril [Europe], Ikorel [Europe and Oceania], Sigmart [Japan, Korea and Taiwan]) is an adenosine triphosphate (ATP)-sensitive potassium (KATP) channel agonist with nitrate-like properties used in the management of stable angina pectoris. With well established monotherapeutic antianginal activity and a beneficial effect (when added to optimal antianginal therapy) on clinical outcomes in high-risk patients with stable angina, twice-daily oral nicorandil is a useful alternative or addition to other antianginal therapy.
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Affiliation(s)
- Dene Simpson
- Adis International Limited, Auckland, New Zealand.
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Abstract
Four patients with nicorandil induced ulceration are described, and the literature on the subject is reviewed. Nicorandil induced ulcers are very painful and distressing for patients. Clinically they appear as large, deep, persistent ulcers that have punched out edges. They are poorly responsive to topical steroids and usually require alteration of nicorandil treatment. The ulceration tends to occur at high doses of nicorandil and all four cases reported here were on doses of 40 mg per day or greater. In these situations reduction of nicorandil dose may be sufficient to promote ulcer healing and prevent further recurrence. However, nicorandil induced ulcers have been reported at doses as low as 10 mg daily and complete cessation of nicorandil may be required.
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Affiliation(s)
- C M Healy
- Department of Oral Medicine, Dublin Dental Hospital, Lincoln Place, Dublin 2, Republic of Ireland.
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FUTATSUYAMA M, ISHIHARA H, HIGO J, KIDOU M, ONO T. A Case of Oral Ulcerations Induced by Nicorandil. ACTA ACUST UNITED AC 2004. [DOI: 10.2336/nishinihonhifu.66.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Boulinguez S, Sommet A, Bédane C, Viraben R, Bonnetblanc JM. Oral nicorandil-induced lesions are not aphthous ulcers. J Oral Pathol Med 2003; 32:482-5. [PMID: 12901730 DOI: 10.1034/j.1600-0714.2003.00166.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES (i) To accurately define these lesions determining whether oral nicorandil-induced lesions are aphthous ulcers; (ii) To determine clinical characteristics of oral nicorandil-induced lesions. MATERIALS AND METHODS Two slide conferences were held. A total of 60 dermatologists assigned diagnosis and clinical criteria to 11 photographs of oral nicorandil-induced lesions. Two slides were randomly selected and duplicated to be used as control. The panel of slides included independent lesions and photographs of different lesions of the same patient. Statistical analysis used chi2-test, estimation of the percentage interobserver agreement, and kappa-values. RESULTS The diagnosis of non-aphthous ulcer (71.8%) was significantly held in comparison with the diagnosis of oral aphthous ulcer (28.2%; P<0.001). To differentiate aphthous ulcer from non-aphthous ulcer, physicians significantly used three clinical criteria. The diagnosis of non-aphthous ulcer were significantly associated with the absence of yellow-based ulceration (P<0.001), with the linear shape (P=0.006) and the absence of inflammatory halo (P=0.003). CONCLUSION Oral nicorandil-induced lesions are not aphthous ulcers. We propose that at this stage of our knowledge, oral nicorandil-induced ulcer is the most suitable terminology.
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Affiliation(s)
- S Boulinguez
- Department of Dermatology, University Hospital Dupuytren, Limoges, France.
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Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc 2003; 134:200-7. [PMID: 12636124 DOI: 10.14219/jada.archive.2003.0134] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis, or RAS, is a common oral disorder of uncertain etiopathogenesis for which symptomatic therapy only is available. This article reviews the current data on the etiopathogenesis, diagnosis and management of RAS in a primary care setting. METHODS The authors reviewed publications on Medline from 1995 through 2000, the period since the last major reviews were published. RESULTS RAS may have an immunogenetic background owing to cross-reactivity with Streptococcus sanguis or heat shock protein. Predisposing factors seen in a minority include haematinic (iron, folate or vitamin B12) deficiency, stress, food allergies and HIV infection. While topical corticosteroids remain the mainstay for therapy, a number of other immunomodulatory modalities now are available. CONCLUSIONS There is still no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore therapy can attempt only to suppress symptoms rather than to address the basic issues of susceptibility and prevention. CLINICAL IMPLICATIONS In the majority of patients, symptomatic relief of RAS can be achieved with topical corticosteroids alone, with other immunomodulatory topical agents or by combination therapy.
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Affiliation(s)
- Crispian Scully
- Eastman Dental Institute for Oral Health Care Sciences, University of London, England.
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Scully C, Azul AM, Crighton A, Felix D, Field A, Porter SR. Nicorandil can induce severe oral ulceration. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:189-93. [PMID: 11174596 DOI: 10.1067/moe.2001.110306] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To increase physicians' and dentists' awareness that nicorandil is a potential inducer of severe mouth ulceration. STUDY DESIGN Nine new cases of ulceration from 3 European countries were included in this study. RESULTS Oral ulceration developed within 9 months of beginning nicorandil therapy, and ulcers resolved within 1 month of withdrawal of the drug. No lesions developed on other epithelia. CONCLUSIONS A number of drugs used in the care of patients with cardiovascular disease can cause oral adverse effects. Nicorandil, a new potassium-channel activator used in some countries to treat angina pectoris, precipitates persistent ulcerative stomatitis in some patients.
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Affiliation(s)
- C Scully
- Department of Oral Medicine, Eastman Dental Institute of Oral Health Care Sciences, University College London, England.
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Boulinguez S, Reix S, Bedane C, Debrock C, Bouyssou-Gauthier ML, Sparsa A, Le Brun V, De Vencay P, Bernard P, Bonnetblanc JM. Role of drug exposure in aphthous ulcers: a case-control study. Br J Dermatol 2000; 143:1261-5. [PMID: 11122030 DOI: 10.1046/j.1365-2133.2000.03898.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Drug-induced aphthous ulcers have been the subject of several isolated and heterogeneous case reports for the last three decades. OBJECTIVES To perform a case-control study to evaluate the risks linked to drug exposure in aphthous ulcers. METHODS Eighty patients with typical clinical patterns of aphthous ulcers and 152 control patients who had had consultations for skin tumours were studied. A standardized questionnaire, concerning clinical features, life-style and medications taken during the last month, was completed for each patient. RESULTS Case patients had a much higher intake of medications than control patients, respectively, 5.1 and 2. 8 medications per patient (P < 0.0001). Multivariate paired analysis showed an association between aphthous ulcers and two classes of drugs: non-steroidal anti-inflammatory drugs (P < 0.001) and beta-blockers (P = 0.002). Smoking could have a protective effect against aphthous ulcers (P < 0.001). CONCLUSIONS Previous case reports and the results of this study suggest a real link between beta-blockers and aphthous ulcers. Our study did not confirm a role of other drugs but a few interesting case reports with positive reintroduction have to be considered. These results could be beneficial for patients, as healing may occur when the incriminated drug is discontinued.
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Affiliation(s)
- S Boulinguez
- Department of Dermatology and Institute of Epidemiology and Tropical Neurology, University Hospital Dupuytren, 2 Avenue Martin-Luther-King, 87042 Limoges cedex, France
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Shotts RH, Scully C, Avery CM, Porter SR. Nicorandil-induced severe oral ulceration: a newly recognized drug reaction. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:706-7. [PMID: 10397662 DOI: 10.1016/s1079-2104(99)70165-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Nicorandil, a potassium-channel activator used for the long-term treatment of ischemic heart disease, has been recently implicated as having a drug side effect of recurrent aphthous stomatitis. Three patients are reported with drug-induced aphthouslike ulceration secondary to nicorandil.
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Affiliation(s)
- R H Shotts
- Department of Oral Medicine, Eastman Dental Institute of Oral Health Care Sciences, University of London, United Kingdom
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