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Soto AP, Meyer SL. Oral Implications of Polypharmacy in Older Adults. Clin Geriatr Med 2023; 39:273-293. [PMID: 37045533 DOI: 10.1016/j.cger.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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Affiliation(s)
- Annetty P Soto
- Division of General Dentistry, Department of Restorative Dental Sciences, University of Florida College of Dentistry, 1395 Center Drive, PO Box 100415, Gainesville, FL 32610-0415, USA.
| | - Sarah L Meyer
- University of Florida Health Science Center Libraries, 1600 Southwest Archer Road, PO Box 100206, Gainesville, FL 32610, USA
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Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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Abstract
Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely hyposalivation, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, reactive keratosis, dysesthesia, osteonecrosis, infection, angioedema, and malignancy.
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Affiliation(s)
- Anna Yuan
- Division of Oral Medicine, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA.
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
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Sánchez-Bernal J, Conejero C, Conejero R. Recurrent Aphthous Stomatitis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:471-480. [PMID: 32451064 DOI: 10.1016/j.ad.2019.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/17/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
Recurrent aphthous stomatitis is a chronic inflammatory disease of the oral mucosa. It is characterized by painful mouth ulcers that cannot be explained by an underlying disease. Recurrent oral mucosal ulcers require a proper differential diagnosis to rule out other possible causes before recurrent aphthous stomatitis is diagnosed. The condition is common, with prevalence rates ranging from 5 to 60% in different series. Its pathogenesis is unknown, but multiple factors are considered to play a part. There are no standardized treatments for this condition and none of the treatments are curative. The goal of any treatment should be to alleviate pain, reduce the duration of ulcers, and prevent recurrence.
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Affiliation(s)
- J Sánchez-Bernal
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - C Conejero
- Unidad de Dermatología, Centro Médico Millenium, Zaragoza, España
| | - R Conejero
- Departamento de Dermatología, Hospital Royo Villanova, Zaragoza, España.
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Teoh L, Moses G, McCullough MJ. A review and guide to drug-associated oral adverse effects-Oral mucosal and lichenoid reactions. Part 2. J Oral Pathol Med 2019; 48:637-646. [PMID: 31241804 DOI: 10.1111/jop.12910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/02/2023]
Abstract
Dental practitioners and other health professionals commonly encounter and manage adverse medicine effects that manifest in the orofacial region. Numerous medicines are associated with a variety of oral adverse effects. However, due to lack of awareness and training, these side effects are not always associated with medicine use and are underreported to pharmacovigilance agencies by dentists and other health professionals. This article aims to inform health professionals about the various oral adverse effects that can occur and the most commonly implicated drugs to improve the management, recognition and reporting of adverse drug effects. This article follows on from Part 1; however, the focus here is on lichenoid reactions and oral mucosal disorders including oral aphthous-like ulceration, mucositis and bullous disorders such as drug-induced pemphigus, pemphigoid, Stevens-Johnson syndrome and toxic epidermal necrolysis.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Geraldine Moses
- School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
| | - Michael J McCullough
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
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Moghadam ET, Tafazoli A. Azithromycin-induced Aphthous Stomatitis: A Case Series. ACTA ACUST UNITED AC 2019; 14:242-246. [PMID: 30827258 DOI: 10.2174/1574884714666190301153040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/02/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Azithromycin is one of the most popular antibiotics in current clinical practice. This medication generally considered to be safe and well-tolerated in different demographic populations. Like any other drug, azithromycin use is not without risk and adverse effects. In recent years, cardiovascular accidents have been announced as its major and most important side effect. But azithromycin use can be accompanied with less recognized complications which are significantly discomforting. In this article, we presented a neglected adverse effect of azithromycin in medical literature which is aphthous stomatitis. METHODS We detected three cases with this complication in our center during a one-year period. All the accessible clinical data were recorded and PubMed database was explored to assess the relevant literature. RESULTS The patients had aphthous stomatitis within 24 hours of the first dose which was healed in about 2 to 3 weeks. Naranjo scoring system showed a probable stage for this adverse drug reaction. There was no such a report in our database search process. CONCLUSION It could be stated that aphthous stomatitis is an important adverse effect of azithromycin that can affect the patient's quality of life during therapy and in the majority of cases, it can be neglected by healthcare practitioners.
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Affiliation(s)
- Ehsan T Moghadam
- Orthodontics Department, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ali Tafazoli
- Clinical Pharmacy Department, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zare Bidoki A, Massoud A, Najafi S, Mohammadzadeh M, Rezaei N. Autosomal dominant deficiency of the interleukin-17F in recurrent aphthous stomatitis: Possible novel mutation in a new entity. Gene 2018; 654:64-68. [DOI: 10.1016/j.gene.2018.02.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/24/2017] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
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Systemic and environmental risk factors for recurrent aphthous stomatitis in a Polish cohort of patients. Postepy Dermatol Alergol 2018; 36:196-201. [PMID: 31320854 PMCID: PMC6627261 DOI: 10.5114/ada.2018.74638] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Recurrent aphthous stomatitis (RAS) is a common oral mucosal disease without a clearly defined etiology. Aim To analyze the influence of systemic diseases, medications, smoking and a family history of RAS on the prevalence and the course of the condition in Polish patients with RAS. Material and methods Seventy-eight patients with RAS and 72 subjects without a history of RAS were enrolled in the study. All participants underwent a detailed oral examination and a full blood count. The results were statistically analyzed with Statistica 10 (StatSoft, Krakow, Poland) with Mann-Whitney, Kruskal-Wallis, χ2 and Fisher tests, with p < 0.05 considered as the significance level. Results The most common systemic conditions observed in patients with RAS were hypertension, allergies and anemia. Both HT and anemia were prevalent in the RAS group. A positive RAS family history occurred more frequently in the study group than in controls. However, no association was found between smoking and RAS prevalence, although a higher percentage of smokers was observed in the RAS subgroup with a low frequency of RAS episodes. Conclusions The potential role of hypertension and anemia as modifiers of the immune reaction in RAS has been implied in this study but confirmation of this association requires further studies on a larger sample of patients. However, there appears to be no correlation between smoking and the occurrence of RAS. The positive family history observed in this study in the majority of RAS patients confirms the genetic background of the condition.
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Aphthous stomatitis. Ann Allergy Asthma Immunol 2017; 117:341-343. [PMID: 27742082 DOI: 10.1016/j.anai.2016.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/29/2016] [Accepted: 07/05/2016] [Indexed: 11/24/2022]
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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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Torpet LA, Kragelund C, Reibel J, Nauntofte B. Oral Adverse Drug Reactions to Cardiovascular Drugs. ACTA ACUST UNITED AC 2016; 15:28-46. [PMID: 14761898 DOI: 10.1177/154411130401500104] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A great many cardiovascular drugs (CVDs) have the potential to induce adverse reactions in the mouth. The prevalence of such reactions is not known, however, since many are asymptomatic and therefore are believed to go unreported. As more drugs are marketed and the population includes an increasing number of elderly, the number of drug prescriptions is also expected to increase. Accordingly, it can be predicted that the occurrence of adverse drug reactions (ADRs), including the oral ones (ODRs), will continue to increase. ODRs affect the oral mucous membrane, saliva production, and taste. The pathogenesis of these reactions, especially the mucosal ones, is largely unknown and appears to involve complex interactions among the drug in question, other medications, the patient’s underlying disease, genetics, and life-style factors. Along this line, there is a growing interest in the association between pharmacogenetic polymorphism and ADRs. Research focusing on polymorphism of the cytochrome P450 system (CYPs) has become increasingly important and has highlighted the intra- and inter-individual responses to drug exposure. This system has recently been suggested to be an underlying candidate regarding the pathogenesis of ADRs in the oral mucous membrane. This review focuses on those CVDs reported to induce ODRs. In addition, it will provide data on specific drugs or drug classes, and outline and discuss recent research on possible mechanisms linking ADRs to drug metabolism patterns. Abbreviations used will be as follows: ACEI, ACE inhibitor; ADR, adverse drug reaction; ANA, antinuclear antigen; ARB, angiotensin II receptor blocker; BAB, beta-adrenergic blocker; CCB, calcium-channel blocker; CDR, cutaneous drug reaction; CVD, cardiovascular drug; CYP, cytochrome P450 enzyme; EM, erythema multiforme; FDE, fixed drug eruption; I, inhibitor of CYP isoform activity; HMG-CoA, hydroxymethyl-glutaryl coenzyme A; NAT, N-acetyltransferase; ODR, oral drug reaction; RDM, reactive drug metabolite; S, substrate for CYP isoform; SJS, Stevens-Johnson syndrome; SLE, systemic lupus erythematosus; and TEN, toxic epidermal necrolysis.
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Affiliation(s)
- Lis Andersen Torpet
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, 20 Norre Allé, DK-2200 Copenhagen N, Denmark
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[Chronic or recurrent ulceration of the tongue]. Ann Dermatol Venereol 2016; 143:297-308; quiz 295-6, 309-10. [PMID: 27038855 DOI: 10.1016/j.annder.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/31/2016] [Accepted: 02/04/2016] [Indexed: 11/23/2022]
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Vaillant L, Samimi M. [Aphthous ulcers and oral ulcerations]. Presse Med 2016; 45:215-26. [PMID: 26880080 DOI: 10.1016/j.lpm.2016.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 02/07/2023] Open
Abstract
Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting with oral bullous or vesiculous lesions orulcerations and erosions can be mistaken for aphthous ulcers. Currently, treatment of aphthous ulcers is palliative and symptomatic. Topical treatments (topical anesthetics, topical steroids and sucralfate) are the first line therapy. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year. RAS is often idiopathic but can be associated with gastro-intestinal diseases (i.e. celiac disease, inflammatory bowel diseases), nutritional deficiencies (iron, folates...), immune disorders (HIV infection, neutropenia) and rare syndromes. Behçet's disease is a chronic, inflammatory, disease whose main clinical feature is recurrent bipolar aphthosis. Colchicine associated with topical treatments constitutes a suitable treatment of most RAS. Thalidomide is the most effective treatment of RAS but its use is limited by frequent adverse effects. Oral ulcers can be related to a wide range of conditions that constitute the differential diagnoses of aphthous ulcers. Oral ulcers are classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers (mainly due to postherpetic erythema multiforme) and chronic ulcers (with slow onset and insidious progression). Acute oral ulcers are due to trauma, bacterial infections (including acute necrotizing ulcerative gingivitis), deep fungal infection, gastro-intestinal (namely inflammatory bowel disease) or systemic diseases. Chronic oral ulcers may be drug-induced, or due to benign or malignant tumors. Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma. A solitary palatal ulcer can be related with necrotizing sialometaplasia.
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Affiliation(s)
- Loïc Vaillant
- CHRU de Tours, université François-Rabelais de Tours, hôpital Trousseau, Inserm U 930, service de dermatologie, 37044 Tours cedex 01, France.
| | - Mahtab Samimi
- CHRU de Tours, université François-Rabelais de Tours, hôpital Trousseau, Inra, service de dermatologie, 37044 Tours cedex 01, France
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Balakumar P, Kavitha M, Nanditha S. Cardiovascular drugs-induced oral toxicities: A murky area to be revisited and illuminated. Pharmacol Res 2015; 102:81-9. [DOI: 10.1016/j.phrs.2015.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/22/2015] [Accepted: 09/08/2015] [Indexed: 12/20/2022]
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Deen K, Curchin C, Wu J. Successful treatment of recurrent aphthous ulcers with nicotine lozenges in a lifelong non-smoker. Australas J Dermatol 2015; 56:143-4. [DOI: 10.1111/ajd.12261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kristyn Deen
- Department of Dermatology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Claudia Curchin
- Department of Dermatology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Jason Wu
- Department of Dermatology; Princess Alexandra Hospital; Brisbane Queensland Australia
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Adverse drug events in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:35-47. [PMID: 25442252 DOI: 10.1016/j.oooo.2014.09.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/18/2014] [Accepted: 09/10/2014] [Indexed: 01/19/2023]
Abstract
Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and the new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. Some examples include osteonecrosis, seen with not only bisphosphonates but also antiangiogenic agents, and the distinctive ulcers caused by mammalian target of rapamycin inhibitors. As newer therapeutic agents are approved, it is likely that more adverse drug events will be encountered. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely, xerostomia, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, white lesions, dysesthesia, osteonecrosis, infection, angioedema, and malignancy. Oral health care providers should be familiar with such events, as they will encounter them in their practice.
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Abstract
Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease affecting the oral mucosa. RAS occurs mostly in healthy individuals and has an atypical clinical presentation in immunocompromised individuals. The etiology of RAS is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS using topical and systemic therapies is based on severity of symptoms and the frequency, size, and number of lesions. The goals of therapy are to decrease pain and ulcer size, promote healing, and decrease the frequency of recurrence.
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Affiliation(s)
- Sunday O Akintoye
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Martin S Greenberg
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA
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Hill SC, Stavrakoglou A, Coutts IR. Nicotine replacement therapy as a treatment for complex aphthosis. J DERMATOL TREAT 2010; 21:317-8. [PMID: 19821785 DOI: 10.3109/09546630903271563] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Complex aphthosis, the occurrence of recurrent oral and genital aphthous ulceration without manifestations of systemic disease, is relatively uncommon and of unknown aetiology. We describe a case of complex aphthosis which began within weeks of stopping smoking. After failing to respond to conventional agents, the patient was successfully treated with nicotine lozenges. Recurrent aphthous stomatitis (RAS) is known to be less common in smokers and there have been previous reports of nicotine being used as successful treatments for RAS and Behçet's disease. We discuss the mechanisms of action of nicotine whereby nicotine could influence the natural history of aphthous ulceration. We recommend considering its use when conventional management has failed, particularly in ex-smokers.
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Affiliation(s)
- Samantha C Hill
- The Tudor Centre for Sexual Health, The Hillingdon Hospital, Uxbridge, Middlesex, UK.
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van de Nieuwenhof HP, van der Vleuten CJ, de Hullu JA, Dukel L. Never forget medication as a cause: vaginal ulceration caused by nicorandil. Am J Obstet Gynecol 2009; 201:e5-6. [PMID: 19608146 DOI: 10.1016/j.ajog.2009.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/08/2009] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
Abstract
A patient was referred to our vulvar outpatient clinic because of a vaginal ulceration that persisted for 3 years and that had been unresponsive to any prescribed therapy. After a possible association was found with nicorandil therapy, this medication was stopped. Thereafter, the ulceration fully healed within 6 months.
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Çağlayan F, Miloglu, Altun O, Erel, Yılmaz AB. Oxidative stress and myeloperoxidase levels in saliva of patients with recurrent aphthous stomatitis. Oral Dis 2008; 14:700-4. [DOI: 10.1111/j.1601-0825.2008.01466.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karincaoglu Y, Batcioglu K, Erdem T, Esrefoglu M, Genc M. The levels of plasma and salivary antioxidants in the patient with recurrent aphthous stomatitis. J Oral Pathol Med 2005; 34:7-12. [PMID: 15610400 DOI: 10.1111/j.1600-0714.2004.00253.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite plenty of research, the cause of recurrent aphthous stomatitis (RAS) remains obscure. It has been proposed that, the aetiological factors such as local trauma, smoking, vitamin deficiencies and viral infections lead to aphthae formation via final common pathway based on increased oxidative stress. The aim of this investigation was to evaluate the antioxidant enzyme superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSHPx) alterations in plasma and saliva, and in addition uric acid (UA) in saliva, in patients with RAS and healthy controls. METHODS Thirty-two patients with RAS and 30 healthy controls were included into the study. The SOD, CAT, GSHPx and UA levels were measured in plasma and saliva in study and control groups. RESULTS In the RAS group, although the mean SOD (P<0.001) and CAT (P<0.05) levels of plasma were lower, GSHPx (P<0.001) levels were higher than control group. The salivary concentrations of the SOD (P<0.001), CAT (P<0.05) and GSHPx (P<0.001) in RAS group were entirely opposite to plasma concentrations. UA were not significant between RAS group and controls. CONCLUSION Since we found salivary SOD and CAT levels were high whereas plasma levels were low, it has been thought that, salivary defence mechanisms via antioxidant agents may be stimulated against to the ulcerous lesion. We consider that the organism might mobilize the antioxidant potential to the sites where they were needed. At this point, decrease of SOD and CAT levels in the plasma may be related to this shift. It is also thought that GSHPx secretion in the saliva may also be increased but the increase in its turnover may be responsible for the diminished activity.
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Affiliation(s)
- Yelda Karincaoglu
- Department of Dermatology, Inonu University, Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey.
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Letsinger JA, McCarty MA, Jorizzo JL. Complex aphthosis: A large case series with evaluation algorithm and therapeutic ladder from topicals to thalidomide. J Am Acad Dermatol 2005; 52:500-8. [PMID: 15761429 DOI: 10.1016/j.jaad.2004.10.863] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis is a common problem with 20% to 50% of the population having experienced simple aphthous lesions (ie, canker sores). Complex aphthosis is the diagnosis given to patients with almost constant >3 oral aphthae or recurrent oral and genital aphthae in the absence of Behcet's disease. METHODS Eighty-one patients were referred to the Wake Forest University School of Medicine, Department of Dermatology from 1995 to 2001 with the diagnosis of presumptive Behcet's disease. After exclusion of patients with simple recurrent aphthous stomatitis or non-aphthous oral disease, 64 patients remained. Ten of the patients met criteria for Behcet's disease. The remaining 54 patients were evaluated and treated as patients with the diagnosis of complex aphthosis. RESULTS The 54 patients with complex aphthosis became the subject of this study. Twelve patients had secondary complex aphthosis with 10/12 having inflammatory bowel disease. The remaining 42 patients had primary (ie, idiopathic) complex aphthosis. The therapeutic ladder for these patients ranged from topical therapy through oral colchicine and combination oral colchicine and oral dapsone therapy to oral thalidomide therapy. CONCLUSION Complex aphthosis is an important condition to distinguish from Behcet's disease. Appropriate patient evaluation algorithms and treatment therapeutic ladders are proposed.
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Affiliation(s)
- Julie Anne Letsinger
- Department of Dermatology at University of California, San Fransico, CA 94118, USA.
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Abstract
The cause of recurrent aphthous stomatitis (RAS) remains unknown despite considerable research. This article reviews the evidence for current theories regarding this disorder, including possible suspected relationships with microbial and immunologic factors, and presents medical diseases that mimic RAS lesions in certain patients. Topical management of the common form of minor RAS is described along with systemic therapy currently available to patients with severe forms of this disease.
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Affiliation(s)
- Sunday O Akintoye
- The Robert Schnatter Center, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA
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Natah SS, Konttinen YT, Enattah NS, Ashammakhi N, Sharkey KA, Häyrinen-Immonen R. Recurrent aphthous ulcers today: a review of the growing knowledge. Int J Oral Maxillofac Surg 2004; 33:221-34. [PMID: 15287304 DOI: 10.1006/ijom.2002.0446] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recurrent aphthous ulcers represent a very common but poorly understood mucosal disorder. They occur in men and women of all ages, races and geographic regions. It is estimated that at least 1 in 5 individuals has at least once been afflicted with aphthous ulcers. The condition is classified as minor, major, and herpetiform on the basis of ulcer size and number. Attacks may be precipitated by local trauma, stress, food intake, drugs, hormonal changes and vitamin and trace element deficiencies. Local and systemic conditions, and genetic, immunological and microbial factors all may play a role in the pathogenesis of recurrent aphthous ulceration (RAU). However, to date, no principal cause has been discovered. Since the aetiology is unknown, diagnosis is entirely based on history and clinical criteria and no laboratory procedures exist to confirm the diagnosis. Although RAU may be a marker of an underlying systemic illness such as coeliac disease, or may present as one of the features of Behcet's disease, in most cases no additional body systems are affected, and patients remain otherwise fit and well. Different aetiologies and mechanisms might be operative in the aetiopathogenesis of aphthous ulceration, but pain, recurrence, self-limitation of the condition, and destruction of the epithelium seem to be the ultimate outcomes. There is no curative therapy to prevent the recurrence of ulcers, and all available treatment modalities can only reduce the frequency or severity of the lesions.
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Affiliation(s)
- S S Natah
- Gastrointestinal Research Group, Department of Physiology & Biophysics, University of Calgary, AB, Canada;
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Femiano F, Gombos F, Scully C. Recurrent aphthous stomatitis unresponsive to topical corticosteroids: a study of the comparative therapeutic effects of systemic prednisone and systemic sulodexide. Int J Dermatol 2003; 42:394-7. [PMID: 12755982 DOI: 10.1046/j.1365-4362.2003.01853.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is a common oral condition, the etiology of which remains largely unclear. Numerous therapeutic protocols have been tried. Apart from immunomodulators, no therapy is unequivocally effective, and many systemic therapies have potential adverse effects. OBJECTIVE To compare, in patients with frequent RAS unresponsive to conventional therapies, the therapeutic effectiveness of systemic prednisone with that of systemic sulodexide, a low-molecular-weight heparin with immunosuppressive activity but few adverse effects. METHODS The study involved a group of 30 patients suffering from frequent minor RAS over >or= 4 months unresponsive to topical corticosteroids. Patients were randomly assigned to one of three study groups: blind therapy with systemic sulodexide or systemic prednisone and control (no treatment). The outcomes were assessed blind on the basis of the days to recovery from pain and days to recovery from ulceration (epithelialization) during the first month of therapy; the number of aphthae appearing during the second month of therapy; and the number of aphthae appearing in the 2 months after the end of the 2-month treatment cycle. RESULTS AND CONCLUSIONS The effectiveness of systemic sulodexide was almost comparable with that of systemic prednisone in patients with frequent RAS, without significant adverse effects.
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Affiliation(s)
- Felice Femiano
- Stomatology Clinic, II University of Medicines and Surgery, Naples, Italy.
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