T-lymphocyte subsets in oral mucosa of patients with recurrent aphthous ulceration

Revisited and innovative perspectives of oral ulcer: from biological specificity to local treatment

Mouth ulcers, a highly prevalent ailment affecting the oral mucosa, leading to pain and discomfort, significantly impacting the patient's daily life. The development of innovative approaches for oral ulcer treatment is of great importance. Moreover, a deeper and more comprehensive understanding of mouth ulcers will facilitate the development of innovative therapeutic strategies. The oral environment possesses distinct traits as it serves as the gateway to the digestive and respiratory systems. The permeability of various epithelial layers can influence drug absorption. Moreover, oral mucosal injuries exhibit distinct healing patterns compared to cutaneous lesions, influenced by various inherent and extrinsic factors. Furthermore, the moist and dynamic oral environment, influenced by saliva and daily physiological functions like chewing and speaking, presents additional challenges in local therapy. Also, suitable mucosal adhesion materials are crucial to alleviate pain and promote healing process. To this end, the review comprehensively examines the anatomical and structural aspects of the oral cavity, elucidates the healing mechanisms of oral ulcers, explores the factors contributing to scar-free healing in the oral mucosa, and investigates the application of mucosal adhesive materials as drug delivery systems. This endeavor seeks to offer novel insights and perspectives for the treatment of oral ulcers.

Review of oral ulcerative lesions in COVID-19 patients: A comprehensive study of 51 cases

Numerous oral manifestations of COVID-19 have been reported in the literatures. Common oral lesions in COVID-19 patients included ulcerations, xerostomia, dysgeusia, gingival inflammation, and erythema. Among them, oral ulceration is the most frequent finding and is present as various but distinct patterns. Thus, we conducted a comprehensive review of 51 COVID-19 patients with oral ulcerative lesions to further analyze the various oral ulcerative lesions in COVID-19 patients. There were a median age of 41.4 years and a slight female predilection in these patients. Most oral lesions manifested as an aphtha-like ulceration but lack of an evidence of recurrent aphthous stomatitis. Some of them were present as herpetiform ulcerations without HSV infection. Widespread ulcerations accompanied with necrosis were observed in the more severe and immunosuppressed older patients. Although some reported patients were asymptomatic, most of them had systemic symptoms concurring or slightly preceding the oral ulcerative lesions and the latency from the onset of systemic symptoms to oral ulcerative lesions were under 10 days, suggesting that oral ulceration was one of the early symptoms of COVID-19. Therefore, the oral ulcerative lesions may be considered as oral markers for early diagnosis of the underlying COVID-19 infection in the asymptomatic patients.

Assessment of Oral Mucosal Integrity Status in Patients with Recurrent Aphthous Stomatitis

Background:

Recurrent aphthous stomatitis represents one of the most common oral pathoses with multifactorial etiology. Decrease in mucosal barrier resistance is believed to be one of the etiologies in its pathogenesis. This study was conducted to assess the oral mucosal integrity status by evaluating the salivary albumin level in patients with aphthous stomatitis.

Materials and Methods:

Thirty patients diagnosed with aphthous stomatitis were selected as case group. Equal number of age- and sex-matched healthy individuals formed the control group. Salivary albumin level was estimated during active and quiescent stage of the disease in both case group and control group.

Result:

Mean salivary albumin level for the case group during the active and quiescent stage was 0.070 g/dL (SD = 0.037) and 0.004 g/dL (SD = 0.007) (SPSS, version 7.0), respectively, and that for the control group was 0.027 g/dL (SD =0.042). Statistically significant difference was found on comparison of the mean salivary albumin level between the case group during active and quiescent stage and the normal controls using Mann–Whitney U test. No statistically significant difference in salivary albumin level was seen between the quiescent stage in case group and the normal controls.

Conclusion:

Increase in salivary albumin level at the time of disease presentation could be attributed to the leakage of albumin through the ulcerated mucosa. Absence of significant elevation in the salivary albumin level after the resolution of the aphthous ulcer apparently indicates inherently a healthy mucosal barrier in majority of the patients.

Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial

PURPOSE

This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS.

METHODS

An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset.

RESULTS

The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5%). Dapsone was prescribed for a total of nine patients, of whom eight (89%) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90%), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60%), of whom one patient showed complete remission.

CONCLUSION

The therapeutic methods used in this trial provided significant symptom relief. Patients experienced relapses of the lesions; however, this occurred after withdrawal of their medication during the follow-up period.

Serotonin transporter gene polymorphism (5-HTTLPR) in patients with recurrent aphthous stomatitis

BACKGROUND

Considerable evidence indicates that serotonergic mechanisms, particularly the serotonin transporter (5-HTT) may be involved in psychological alterations. Recent findings have demonstrated that depression and stress are influenced by polymorphism of the promoter region of 5-HTT (5-HTTLPR) and that the short allele (S) is associated with reduced transcriptional efficiency resulting in reduced serotonin expression and uptake. As psychological and genetic factors have been implicated in the pathogenesis of recurrent aphthous stomatitis (RAS), the purpose of the present study was to investigate 5-HTTLPR polymorphism in patients with RAS compared with control subjects.

METHODS

Sixty-nine consecutive subjects affected by minor and major forms of RAS and 70 healthy volunteers were genotyped at 5-HTTLPR. The chi-square test was used for statistical analysis.

RESULTS

A significant increase in the genotype of SS (P = 0.05) and of the allele S (P = 0.04) in the group of RAS were observed.

CONCLUSION

Our findings demonstrate that RAS patients have a tendency to show polymorphism associated with anxiety-related traits.

Amlexanox for the Treatment of Recurrent Aphthous Ulcers

Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease in humans, estimated to affect between 5% and 50% of the general population. The minor manifestation of the condition is the most common and is characterised by small, shallow, round or oval lesions that are surrounded by a raised erythematous halo and are covered by a grey-white pseudomembrane. Appropriate management of patients with this condition is largely symptomatic and should focus on reducing ulcer duration, relieving pain and reducing or preventing ulcer recurrence. Amlexanox is a novel anti-inflammatory and anti-allergic agent that has been evaluated for the treatment of RAU in a series of robust clinical trials. After a 100mg dose of 5% amlexanox topical paste, applied directly to the lesion, the maximum serum concentration of the drug was 120 ng/mL, which was achieved 2.4 hours after application. Steady-state concentrations were achieved within 1 week of starting four times daily dosing and there was no evidence of accumulation. In terms of efficacy, application of 5% amlexanox topical paste was shown to consistently and significantly accelerate complete ulcer healing and the time to resolution of pain across four large efficacy studies. Significantly more patients had completely healed ulcers from day 3 (compared with no treatment) and day 4 (compared with vehicle). Healing was mirrored by an improvement in pain: significantly more patients had complete resolution of pain from day 2 (compared with no treatment) and day 3 (compared with vehicle). Overall, amlexanox was well tolerated, with a low frequency of adverse effects. In the oral application studies, adverse effects that were considered by investigators to be potentially related to the study treatment occurred in 2.4% and 2.1% of 5% amlexanox and vehicle recipients, respectively. These effects were mainly local and were all classed as mild to moderate in severity, with the exception of one case of severe stinging in the vehicle treatment group. Furthermore, the incidence of dermal irritation and sensitisation was very low with amlexanox. These findings suggest that 5% amlexanox topical paste is a useful and well tolerated therapeutic option for the treatment of RAU.

Antigen-induced chemokine activation in mouse buccal epithelium

The oral mucosa is an active though poorly understood immunological site. Using an experimental animal system involving antigen priming into the oral mucosa of transgenic mice expressing T cell receptor (TCR) for a peptide antigen of hen-egg lysozyme (HEL), the expression of six chemokine receptors and seven chemokine ligands were studied before and after antigen exposure. Within 24h of local antigen priming, the expression of three chemokine receptor genes (CCR3, CCR5, and CCR7) and three chemokine ligand genes (CCL12, CCL19, and CCL25) were significantly upregulated. These included chemokines known to be responsible for the trafficking of T cells and other leukocytes into tissue sites. Additionally, expression of the chemokine ligand gene, CCL25 (thymus-expressed chemokine [TECK]), which has been linked to T cell migration and/or local T cell development in the intestine, was also markedly elevated in buccal epithelia after antigen exposure. These findings define a process of selective activation of proinflammatory chemokines and/or their receptors following local antigen exposure, and they provide the first evidence, indicating that this may be accompanied by in situ development of T cells in oral tissues.

Helicobacter pylori DNA in recurrent aphthous stomatitis

BACKGROUND

Considering not only the fact that recurrent aphthous stomatitis (RAS) and stomach ulcers are immunologically mediated ulcers associated with Helicobacter pylori, but also the recent evidence that anaemia can be associated with both diseases, and the discovery of H. pylori in the oral mucosa led us to hypothesize that this bacteria may be related to RAS pathogenesis.

METHODS

Thirty-six consecutive subjects affected by minor and major forms of RAS and 48 healthy volunteers were included in the present study. The nested polymerase chain reaction (PCR) technique was used to detect the presence of H. pylori in the oral lesion, the normal contralateral mucosa of patients affected by RAS and the oral mucosa of control subjects. The chi2- and Fisher's tests were used for statistical analysis.

RESULTS

No association between RAS lesions and H. pylori was observed. However, 14 out of 36 (38.9%) of the patients with RAS were found to show the presence of H. pylori DNA in the lesion and/or contralateral mucosa. Sixteen out of 48 (33.3%) of the patients without RAS (control subjects) were positive (P > 0.05).

CONCLUSION

The present study does not give support to the assumption that H. pylori could be involved in RAS development.

Management strategies for HIV-associated aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disorder found in men and women of all ages, races, and geographic regions. There are three forms of the lesions (minor, major, and herpetiform), with major aphthous ulcers causing significant pain and potential for scarring. In HIV-infected individuals, these ulcers occur more frequently, last longer, and produce more painful symptoms than in immunocompetent persons. In addition, they may be associated with similar ulcerations involving the esophagus, rectum, anus, and genitals. The diagnosis of HIV-induced RAS requires a careful history of the condition, and a thorough extra- and intra-oral examination. Oral mucosal biopsies are required for non-healing ulcers in order to exclude the possibility of deep fungal infections, viral infections, and neoplasms. The cause of the ulcers in HIV-positive persons has not been elucidated--local diseases, genetic, immunologic, and infectious factors all probably play a role. The goals of current treatments are to promote ulcer healing, to reduce ulcer duration and pain while maintaining nutritional intake, and to prevent or diminish the frequency of recurrence. Initial therapy for infrequent RAS recurrences includes over-the-counter topical protective and analgesic products. Initial therapy for frequent RAS outbreaks requires topical anesthetics, binding agents, and corticosteroids. Major RAS and non-healing minor or herpetiform RAS may require intralesional corticosteroids and systemic prednisone. Second-line immunomodulators for frequent and non-healing ulcers includes thalidomide and other immunomodulators.

Increase of RM3/1-positive macrophages in radiation-induced oral mucositis

The purpose of this study was to describe the distribution patterns of various leukocyte subpopulations in the oral mucosa during the course of radiotherapy and to determine whether there are dose-dependent alterations, or any correlation between the clinical stages and the population density of specific leukocytes. The distribution and density of various leukocytes in oral mucosa in 13 head and neck cancer patients were immunohistochemically analysed before radiotherapy at 30 and 60 Gy and compared with the clinical degree of oral mucositis. Antibodies were used which characterized different subtypes of macrophages (27E10, 25F9, RM3/1) and recognized epitopes of granulocytes (CD15) and T cells (CD3, CD4, CD8). The study showed that whereas macrophages reactive with RM3/1 increased significantly at 30 Gy (p<0.01) and showed a further increase at 60 Gy (p<0.01), no significant alterations could be detected in the density of macrophages which stained positively for 27E10 or 25F9. Moreover, the percentage of macrophages reactive with RM3/1 showed a non-linear correlation with the clinical mucositis score (p<0.05). No significant alterations were detected in the percentage of T cells and granulocytes, compared with the values before radiotherapy. In conclusion, radiation-induced mucositis is characterized by features of an intermediate stage of an inflammatory response, suggesting active involvement of down-regulatory macrophages in its pathogenesis.

Aphthous ulcers: a difficult clinical entity

Recurrent aphthous ulcers (RAU) are the most common oral ulcerative disease, affecting 10% to 20% of the population. There are 3 clinical subtypes-minor, major, and herpetiform. Minor aphthous ulcers are the most common subtype, representing 80% to 90% of all recurrent aphthous ulcers. Clinically, RAU present as extremely painful, shallow ulcerations with an erythematous halo on unattached oral mucosa. The primary differential diagnosis is oral herpes simplex. The etiology of RAU is unknown. Topical corticosteroids are the mainstay of therapy.

Recurrent aphthous stomatitis and smoking

BACKGROUND

Several studies have reported cigarette smoking to have a beneficial protective effect on recurrent aphthous stomatitis (RAS). In this study, we evaluated once again the incidence of smoking in RAS patients compared with controls. This study differs from most previous ones in that the patients were diagnosed by direct observation of active lesions by a dermatologist.

METHODS

Thirty-four patients with RAS who were seen at the dermatology clinic during a period of 2 years were compared with 115 outpatients with other skin diseases and 20 healthy hospital personnel who had no history of aphthae, with regard to their smoking habits.

RESULTS

Among the 34 patients with RAS, 8.8% were active smokers compared with a significantly higher percentage (25.2%) among the control subjects.

CONCLUSIONS

In agreement with others, we found a negative epidemiologic association between smoking and RAS. This finding can be used to clarify the cause and pathogenesis of the disease, and possibly to identify better treatment or preventive options than those currently available.

Examination of the oral mucosa and peripheral blood cells of patients with recurrent aphthous ulceration for human herpesvirus DNA

OBJECTIVE

The purpose of this study was to exam the oral mucosa and peripheral blood cells of patients with recurrent aph-thous ulceration (RAU) for the presence of the following human herpesviruses: herpes simplex viruses 1 and 2, varicella zoster virus, Epstein-Barr virus, cytomegalovirus, human herpesvirus-6, and human herpesvirus-7.

STUDY DESIGN

Fifty-eight subjects with RAU and 10 control subjects were recruited at an academic referral center and enrolled in this prospective, nonrandomized, case-controlled study. Each of the subjects with RAU was seen during an acute episode, and swab specimens from lesional (RAU-acute/lesion) and clinically normal (RAU-acute/normal) oral mucosa were obtained. Each of 2 subjects with RAU was evaluated during more than one acute episode. Three subjects with RAU were seen between active episodes, and swab specimens were taken from clinically normal (RAU-convalescent) oral mucosa. Swab specimens from clinically normal (control/normal) oral mucosa were obtained from the control subjects. Peripheral blood specimens were obtained from subjects with RAU and control subjects at the time the swab specimens were performed. Through use of polymerase chain reaction, all swab and peripheral blood specimens were examined for the presence of human herpesvirus DNA. Statistical significance was determined by means of chi(2) analysis.

RESULTS

Herpes simplex virus and human herpesvirus-6 were found in a higher percentage of mucosal specimens from the control subjects (herpes simplex virus, 4/10; human herpesvirus-6, 5/9) than from the subjects with RAU (RAU-acute/lesion: 3/45 herpes simplex virus, 13/53 human herpesvirus-6; RAU-acute/normal: 7/48 herpes simplex virus, 9/53 human herpesvirus-6). No difference was demonstrated between RAU-acute/lesion, RAU-acute/normal, and RAU-convalescent mucosal specimens for any of the human herpesviruses. Different human herpesviruses were identified from individual subjects with RAU during subsequent episodes of disease. Epstein-Barr virus (6/35), human herpesvirus-6 (3/40), and human herpesvirus-7 (7/43) were detected in the peripheral blood mononuclear cells during acute RAU but not in RAU-convalescent or control peripheral blood mononuclear cells.

CONCLUSIONS

The detection of human herpesvirus DNA from the oral mucosa and peripheral blood mononuclear cells of patients with RAU appears to represent normal viral shedding rather than a direct causal mechanism in this disorder.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal disorders. Nevertheless, while the clinical characteristics of RAS are well-defined, the precise etiology and pathogenesis of RAS remain unclear. The present article provides a detailed review of the current knowledge of the etiology, pathogenesis, and management of RAS.

Immunopathogenesis of oral lichen planus and recurrent aphthous stomatitis

Oral mucosal bullous/desquamative/ulcerative diseases involve immunopathological mechanisms that account for loss of adhesion between contiguous keratinocytes or to structures within the basal lamina. Some are antibody mediated, in which specific adhesion molecules of the desmosome, hemidesmosome, and basement membrane become antigenic targets. Oral lichen planus and recurrent apthous ulcers, although manifesting disparate clinical appearances and natural history, share immunopathological features that involve T cell-mediated immunity. Although the antigens, haptens, or autoantigens are not usually apparent, current research poses the hypothesis that both of these common oral mucosal diseases are a delayed-type hypersensitivity or cell-mediated response to an antigenic stimulus residing within the epithelium. This article reviews the research evidence for this hypothesis.

Recurrent aphthous stomatitis: clinical characteristics and associated systemic disorders

Recurrent aphthous stomatitis (RAS), commonly known as canker sores, has been reported as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. One of its variants is the most painful condition of the oral mucosa. Recurrent aphthous stomatitis has been the subject of active investigation along multiple lines of research, including epidemiology, immunology, clinical correlations, and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MiAU, MjAU, HU) and severity (simple versus complex). The natural history of individual lesions of RAS is important, because it is the bench mark against which treatment benefits are measured. The lesions of RAS are not caused by a single factor but occur in an environment that is permissive for development of lesions. These factors include trauma, smoking, stress, hormonal state, family history, food hypersensitivity and infectious or immunologic factors. The clinician should consider these elements of a multifactorial process leading to the development of lesions of RAS. To properly diagnose and treat a patient with lesions of RAS, the clinician must identify or exclude associated systemic disorders or "correctable causes." Behçet's disease and complex aphthosis variants, such as ulcus vulvae acutum, mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome, fever, aphthosis, pharyngitis, and adenitis (FAPA) syndrome, and cyclic neutropenia, should be considered. The aphthous-like oral ulcerations of patients with human immunodeficiency virus (HIV) disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause," which, with appropriate treatment, can result in a remission or substantial lessening of disease activity.

Search for human herpesvirus 6, human cytomegalovirus and varicella zoster virus DNA in recurrent aphthous stomatitis tissue

In the present study, the involvement of human herpesvirus 6 (HHV-6), human cytomegalovirus (HCMV) and varicella zoster virus (VZV) in the aetiology of recurrent aphthous stomatitis (RAS) was investigated using the polymerase chain reaction (PCR). Biopsies from 21 RAS patients were analysed, and 20 oral lichen planus (OLP) and 13 normal biopsies were tested as controls. HHV-6-DNA was detected in six of the RAS samples whereas VZV-DNA and HCMV-DNA were not detected in any RAS samples. In the OLP samples, four biopsies were positive for HHV-6-DNA and two were positive for HCMV-DNA. One sample from this group was positive for both HHV-6-DNA and HCMV-DNA. VZV-DNA was not found in any RAS or OLP biopsies. No viral DNA was present in any normal control biopsies. These results do not support an aetiological role for HCMV and VZV in RAS, although the possible involvement of HHV-6 cannot be excluded.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease in North America. In some instances, RAS represents the central feature of the multisystem disease complex Behcet's syndrome. This article reviews the clinical features, contributing etiologic factors, and etiopathogenesis of RAS and Behcet's syndrome and describes therapeutic considerations and strategies essential to management of patients suffering from recurrent mouth ulcers.

Recurrent aphthous stomatitis. An update

Recurrent aphthous ulceration or recurrent aphthous stomatitis is the most common oral mucosal disease known to human beings. Despite much clinical and research attention, the causes remain poorly understood, the ulcers are not preventable, and treatment is symptomatic. The most common presentation is minor recurrent aphthous stomatitis: recurrent, round, clearly defined, small, painful ulcers that heal in 10 to 14 days without scarring. Major recurrent aphthous stomatitis lesions are larger (greater than 5 mm), can last for 6 weeks or longer, and frequently scar. The third variety of recurrent aphthous stomatitis is herpetiform ulcers, which present as multiple small clusters of pinpoint lesions that can coalesce to form large irregular ulcers and last 7 to 10 days. Diagnosis of all varieties is usually made after clinical examination. Many local and systemic factors have been associated with these conditions, and there is evidence that there may be a genetic and immunopathogenic basis for recurrent aphthous ulceration. Management of this condition depends on the clinical presentation and symptoms and includes analgesic, antimicrobial, and immunomodulatory drugs. As dental clinicians and researchers become better trained in oral medicine and stomatology, it is anticipated that the pathophysiology, prevention, and treatment of recurrent aphthous ulceration will improve in the future.

Decreased levels of salivary prostaglandin E2 and epidermal growth factor in recurrent aphthous stomatitis

Prostaglandin E2 and epidermal growth factor are two important cytoprotective compounds in saliva. This study investigated their salivary levels in controls and individuals with minor recurrent aphthous stomatitis. The development of recurrent aphthous stomatitis was divided into three stages: (1) early active stage (mucosal redness); (2) active stage (mucosal ulceration); (3) convalescent stage. Unstimulated mixed saliva was collected from each volunteer. Salivary prostaglandin E2 and epidermal growth factor concentrations were determined by radioimmunoassay. Their levels (mean +/- SEM) were significantly lower during the active stage of ulceration as compared to the control: (a) for prostaglandin E2, 200 +/- 55 versus 73 +/- 11 pg/mg salivary protein (p < 0.01), 447 +/- 123 versus 112 +/- 19 pg/ml saliva (p < 0.01), 215 +/- 30 versus 63 +/- 12 pg/min salivary flow (p < 0.01), control (n = 12) versus active stage (n = 15); (b) for epidermal growth factor, 1.09 +/- 0.17 versus 0.67 +/- 0.17 ng/mg salivary protein (p < 0.05); 2.51 +/- 0.53 versus 0.84 +/- 0.19 pg/ml saliva (p < 0.05), 1.24 +/- 0.26 versus 0.41 +/- 0.09 pg/min salivary flow (p < 0.05), control (n = 12) versus active stage (n = 12). Salivary prostaglandin E2 and epidermal growth factor showed stage-dependent alterations during the development of the stomatitis. The prostaglandin E2 concentration decreased significantly during the active stage of ulceration, and then increased significantly during the convalescent stage. However, the recovery of salivary epidermal growth factor after the ulceration was slower than that of the prostaglandin E2. It is suggested that the diminution of prostaglandin E2 and epidermal growth factor in the saliva may be associated with the ulcer development.

Immunopathology of oral mucosal ulcerative, desquamative, and bullous diseases. Selective review of the literature

Cell/cell and cell/matrix adhesion proteins are responsible for maintaining the integrity of the mucosal lining of the oral cavity. Disease processes that destroy keratinocytes or adversely affect their adhesion to one another or to the subjacent basement membrane will result in erosions, ulcerations, and desquamations. Immunologic processes that have a deleterious effect on the integrity of the epithelial/basement membrane/submucosa complex are reviewed, and current research findings with respect to pathogenesis are discussed. In particular, T-cell-mediated hypersensitivity is involved in recurrent aphthous stomatitis and lichen planus; humoral-mediated immunity to cadherin intercellular adhesion molecules is important in the process of acantholysis in pemphigus vulgaris, and genetic defects and antibody-mediated processes give rise to junctional separation in epidermolysis bullosa and mucous membrane pemphigoid, respectively. An immune complex mechanism appears to underlie the pathogenesis of erythema multiforme.

A clinical trial of Azelastine in recurrent aphthous ulceration, with an analysis of its actions on leukocytes

Azelastine (azelastine hydrochloride) was orally administered to 43 patients with recurrent aphthous ulcers (RAU), and its clinical effects and in vitro influence on leukocytes were examined. During at least 6 months after drug treatment, no oral ulcers occurred in 7 patients, and an improvement of the oral condition was exhibited in all except 4 of the remaining patients. The frequency of occurrence of RAU was significantly reduced, from 1.7 +/- 0.9 to 0.9 +/- 0.5 times/month, and ulcer duration and oral irritation were also significantly reduced from 12.5 +/- 2.5 and 7.5 +/- 2.4 days to 9.8 +/- 2.6 and 5.3 +/- 2.4 days, respectively. Neutrophils from patients treated with Azelastine generated a suppressed volume of superoxide (O2-). Suppression of O2- generation and chemiluminescence by in vitro Azelastine was also confirmed to occur in a dose-dependent manner. Furthermore, the production of TNF-alpha and GM-CSF in lymphocytes was suppressed in the presence of Azelastine, and the drug protected sheep red blood cells and epithelial tumor cell lines against hydrogen peroxide impairment and hypotonic shock. These clinical and experimental results lead to the conclusion that improvement of RAU by Azelastine depends on the protection of cell membranes and the suppression of leukocyte-function, including reactive oxygen generation.

Major aphthous ulcers in patients with HIV disease

Major aphthous ulcers are associated with a high degree of morbidity in patients infected with human immunodeficiency virus. A large representative cohort infected with human immunodeficiency virus was examined to evaluate the prevalence of major aphthous ulcers, demographic data of patients with major aphthous ulcers, and the usage of major aphthous ulcers as a marker for immune deterioration. The effects of tobacco smoking and the use of specific antibiotics, trimethoprim/sulfamethoxazole or dapsone, on the development of major aphthous ulcers was also investigated. In a population of 767 persons infected with human immunodeficiency virus, major aphthous ulcers were found at a prevalence rate of 3.1% (24 patients). This type of lesion did not show any predilection for human immunodeficiency virus transmission category, ethnic group, or gender. Persons who received trimethoprim/sulfamethoxazole or dapsone or had a history of tobacco smoking showed a decreased prevalence of major aphthous ulcers. All patients (100%) with major aphthous ulcers had CD4+ cell counts below 100 cells/mm3, but only 50% had a previous acquired immunodeficiency syndrome defining illness. Major aphthous ulcers in persons infected with human immunodeficiency virus are suggestive of severe immune suppression and may serve as a marker for human immunodeficiency virus disease progression.

A study of macrophages, macrophage-related cells, and endothelial adhesion molecules in recurrent aphthous ulcers in HIV-positive patients

The purpose of this immunohistochemical study was to investigate the presence and distribution of macrophages (CD11c+ and CD68+) and macrophage-related dendritic cells (factor XIIIa+ and CD36+) in early and late aphthous ulcers associated with HIV infection. To substantiate a mechanism by which these cells may move from the vascular compartment to tissue spaces, we also investigated expression of ELAM (endothelial leukocyte adhesion molecule), ICAM-1 (intercellular adhesion molecule), and CD18 (leukocyte function antigen). Numerous CD11c+ and CD68+ macrophages were seen in early lesions, though larger numbers of CD68+ cells were present in older lesions. No significant increases in factor XIIIa+ dendrocytes were seen in either early or late lesions, though dendrocytes appeared enlarged. CD36+ cells and CD18+ leukocytes were more numerous in early than in late aphthous ulcers. ELAM and ICAM expression was most intense on endothelial cells in early aphthous ulcers, with staining intensity fading toward the lesion periphery. Control specimens showed weaker ELAM and ICAM staining than did the ulcer specimens. Keratinocytes did not express ICAM. By virtue of their numbers, macrophages and macrophage subtypes appear to have a significant role in both the early and late stages of this disease. Although factor XIIIa-expressing dendrocytes may not have been more numerous in the ulcers, they appeared to be "activated" because of their prominence in the lesions and their occasional co-expression of CD68 antigen (KP1+). They may have a minor role in antigen processing, phagocytosis, and fibroplasia. ELAM and ICAM expression by endothelial cells provides a mechanism by which macrophages and other leukocytes can be recruited to the site of the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Varicella-zoster virus DNA in recurrent aphthous ulcers

The present study was undertaken to examine for varicella-zoster virus (VZV) constituents in recurrent aphthous ulcers (RAU). Smears and biopsies of ulcers 0-3 days old were obtained from 20 otherwise healthy minor/major RAU patients and from two patients with Behçet's syndrome. VZV could not be cultivated from any of the biopsies, all smears were negative for VZV antigen, and in situ hybridization on the five samples tested was negative for VZV nucleic acid. DNA extracted from biopsies, however, yielded positive polymerase chain reaction (PCR) products in all cases with one primer set of the protein kinase 66 (PK66). Ten control biopsies from non-RAU subjects yielded no PCR products apart from the sample from AP, who obtained the biopsies, and from HOM, who performed the PCR, suggesting that the DNA had been passed on from the patients. Other parts of the PK66 gene and of thymidine kinase 36 yielded no products. Although the consistent presence of VZV DNA in RAU might suggest a pathogenetic implication, the potential presence and possible pathogenetic importance of other herpesviruses cannot be excluded.