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Liu SY, Chen H, Zhou F, Zheng JP, Zhang JT. Development of an innovative eugenol and borax-based orodispersible film for enhanced treatment of mouth ulcers. Eur J Pharm Biopharm 2024; 200:114337. [PMID: 38789062 DOI: 10.1016/j.ejpb.2024.114337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
Orodispersible films (ODFs) have emerged as an advanced and patient-friendly delivery system due to ease of administration, improved patient compliance, quick release and taste-masking of active pharmaceutical ingredients. This research reports the preparation of the ODF containing eugenol and borax (EB-ODF) by a solvent casting technique for treating mouth ulcers. The EB-ODF consisted of vinyl pyrrolidone/vinyl acetate copolymer (Kollidon® VA64, VA64) and hydroxypropyl methylcellulose (HPMC-K250) as the film formers where eugenol and borax were loaded. The thickness of the EB-ODF obtained was 0.119 ± 0.001 mm and the tensile strength was 13.1 ± 1.1 N/mm2 (p > 0.05). The prepared films disintegrated in the oral cavity within 30 s and over 90% of the eugenol was released from the film in the first 5 min. Furthermore, the combined application of eugenol and borax, loaded in EB-ODF, displayed notable synergetic antibacterial property against both gram-negative and gram-positive bacteria. In an in-vivo study on a rat model with chemical burn-induced oral ulcers, the EB-ODF treatment group had a 100% reduction in ulcer area (p > 0.05) after 10 days of treatment and demonstrated a 38.7% higher reduction in oral ulcer area compared to the Dingpeng Cream treatment group (p < 0.0001). The EB-ODF treatment group showed minimal oral irritation, scoring only 1 point and a 65% preference in the taste tests (p < 0.0001). In summary, EB-ODF had successfully overcome the poor palatability of commercially available formulation and provided notable potential for further ulcer treatment product development.
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Affiliation(s)
- Shu-Yin Liu
- Cixi Biomedical Research Institute, Wenzhou Medical University, Cixi 315302, PR China; Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Ningbo Cixi Institute of Biomedical Engineering, Cixi 315300, PR China
| | - Hui Chen
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Ningbo Cixi Institute of Biomedical Engineering, Cixi 315300, PR China
| | - Feng Zhou
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Ningbo Cixi Institute of Biomedical Engineering, Cixi 315300, PR China
| | - Jian-Ping Zheng
- Cixi Biomedical Research Institute, Wenzhou Medical University, Cixi 315302, PR China; Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Ningbo Cixi Institute of Biomedical Engineering, Cixi 315300, PR China.
| | - Jian-Tao Zhang
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, PR China; Ningbo Cixi Institute of Biomedical Engineering, Cixi 315300, PR China.
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Luo D, Yan L, Wang Z, Ji X, Pei N, Jia J, Luo Y, Ouyang H, Yang S, Feng Y. Pulchinenoside B4 ameliorates oral ulcers in rats by modulating gut microbiota and metabolites. Appl Microbiol Biotechnol 2024; 108:292. [PMID: 38592514 PMCID: PMC11003895 DOI: 10.1007/s00253-024-13099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024]
Abstract
Pulchinenoside B4, a natural saponin monomer from the Pulsatilla plant, plays an important role as an immunomodulator in the treatment of acute inflammation. Oral ulcer (OU) is a common ulcerative injury disease that occurs in the oral mucosa, including mucosal ulceration and abnormalities of lips and tongue. A close correlation exists between gut microbiota and circulating metabolites in patients with OU. However, the correlation between gut microbiota and serum metabolomics is not clear. Therefore, this study aimed to explore the changes in gut microbiota and metabolites in OU. The 16S ribosomal RNA (16S rRNA) gene sequencing was used to detect the changes in the composition of gut microbiota in OU rat model. Moreover, the endogenous small metabolites were explored by collecting the non-targeted serum metabolomics data. A total of 34 OU-related biomarkers were identified, mainly related to fatty acid metabolism and inflammatory pathways. The administration of B4 effectively reduced the occurrence of OU and restored the levels of multiple endogenous biomarkers and key gut microbial species to the normal level. This study demonstrated that the gut microbiota and metabolites were altered in the OU rat model, which were significantly restored to the normal level by B4, thereby showing good application prospects in the treatment of OU. KEY POINTS: • The first investigating the correlation between OU and gut microbiota. • A close correlation between metabolites and gut microbiota in OU disease was successfully identified. • Pulchinenoside B4 ameliorates oral ulcers in rats by modulating gut microbiota and metabolites.
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Affiliation(s)
- Dewei Luo
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China
| | - Li Yan
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China
| | - Zhujun Wang
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China
| | - Xiaofan Ji
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China
| | - Na Pei
- Xinyu University, No. 2666 Yangguang Road, Xinyu, 338004, People's Republic of China
| | - Jing Jia
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China
| | - Yingying Luo
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China.
| | - Hui Ouyang
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China.
- Research Center of Natural Resources of Chinese Medicinal Materials and Ethnic Medicine, Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 338004, People's Republic of China.
| | - Shilin Yang
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China
| | - Yulin Feng
- Jiangxi University of Traditional Chinese Medicine, No. 818 Yunwan Road, Nanchang, 330002, People's Republic of China.
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, No. 56 Yangming Road, Nanchang, 330006, People's Republic of China.
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Su K, Li J, Wu X, Deng D, Gu H, Sun Y, Wang X, Huang W, Wang Y, Shang X, Xue C, Liang L, Li X, Li D, Ang S, Zhang K, Wu P, Wu K. One-Step Synthesis of Hydrogel Adhesive with Acid-Responsive Tannin Release for Diabetic Oral Mucosa Defects Healing. Adv Healthc Mater 2024; 13:e2303252. [PMID: 38245866 DOI: 10.1002/adhm.202303252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/12/2024] [Indexed: 01/22/2024]
Abstract
The complex preparation, weak wet tissue adhesion, and limited biological activity of traditional oral wound dressings usually impede their efficient treatment and healing for diabetic oral mucosal defects. To overcome these problems, a novel hydrogel adhesive (named CFT hydrogel) is rapidly constructed using a one-step method based on dual-dynamic covalent cross-linking. Compared with the commercial oral patches, the CFT hydrogel shows superior in vivo (rat tongue) wet tissue adhesion performance. Additionally, the CFT hydrogel exhibits unique acid-responsive properties, thereby facilitating the release of bioactive molecule tannic acid in the acidic diabetic wound microenvironment. And a series of in vitro experiments substantiate the favorable biocompatibility and bioactivity properties (including antibacterial, antioxidative, anti-inflammatory, and angiogenetic effects) exhibited by CFT hydrogel. Moreover, in vivo experiments conducted on a diabetic rat model with oral mucosal defects demonstrate that the CFT hydrogel exhibits significant efficacy in protecting against mucosal wounds, alleviating inflammatory reactions, thereby facilitating the wound-healing process. Taken together, this study provides a promising and comprehensive therapeutic option with great potential for the clinical management of oral mucosa defects in diabetic patients.
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Affiliation(s)
- Kaize Su
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Jinxuan Li
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Xiaoxian Wu
- Instrumental Analysis and Research Center, South China Agricultural University, Guangzhou, 510642, China
| | - Duanyu Deng
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Han Gu
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Ying Sun
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Xu Wang
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Wenhuan Huang
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Yan Wang
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Xiangcun Shang
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Cuiyu Xue
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Lihua Liang
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Xiaofang Li
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Dongli Li
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Song Ang
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Kun Zhang
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Panpan Wu
- School of Pharmacy and Food Engineering, Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, P. R. China
- International Healthcare Innovation Institute (Jiangmen), Jiangmen, 529040, P. R. China
| | - Keke Wu
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, 511495, P. R. China
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Alsahaf S, Alkurdi KA, Challacombe SJ, Tappuni AR. Topical betamethasone and systemic colchicine for treatment of recurrent aphthous stomatitis: a randomised clinical trial. BMC Oral Health 2023; 23:709. [PMID: 37789351 PMCID: PMC10548625 DOI: 10.1186/s12903-023-03335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Recurrent Aphthous Stomatitis (RAS) is painful oral ulceration frequently treated with topical steroids. There is limited published evidence for the efficacy of any treatment for RAS and there remains a need for longitudinal randomised clinical trials to evaluate and compare the effectiveness of different therapies in the management of RAS. The aim of the current project was to assess the efficacy of betamethasone mouthwash and colchicine tablets, individually and combined, for the treatment of RAS, and to establish the optimum treatment period necessary for a significant reduction in the disease severity. METHODOLOGY A randomised, prospective, parallel-group clinical trial was conducted over one year, to compare the efficacy of three therapies in RAS. One hundred and six patients were randomized into three groups; 35 received betamethasone mouthwash, 35 had colchicine tablets and 36 received both therapies. The response was evaluated quantitatively every 3 months for 1 year, using the Ulcer Severity Score (USS). RESULTS For all three treatment regimes, the mean USS decreased by about 30% in the first 3 months (p < 0.001). Further improvement was noted for up to 9 months. At the end of the study, the mean USS had improved by 50% from 34.9 ± 7.2 before treatment to 17.5 ± 8.9 after treatment (p < 0.001). Of included participants, 86% showed significant clinical improvement by the end of the study. There were no significant differences in outcomes between the three regimes (p < 0.05). CONCLUSIONS This clinical trial has provided evidence for the efficacy of betamethasone mouthwash and for colchicine tablets in the treatment of RAS and has shown that at least six months of treatment may be required for optimum effect. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN3267716. Date of clinical trial registration: 15/04/2018.
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Affiliation(s)
- Surab Alsahaf
- Oral Medicine, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, and Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Khlood A Alkurdi
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Office 7, Floor 4, London, E1 2AD, UK
| | - Stephen J Challacombe
- Oral Medicine, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, and Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Anwar R Tappuni
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Office 7, Floor 4, London, E1 2AD, UK.
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Conejero Del Mazo R, García Forcén L, Navarro Aguilar ME. [Recurrent aphthous stomatitis]. Med Clin (Barc) 2023; 161:251-259. [PMID: 37357066 DOI: 10.1016/j.medcli.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
Recurrent aphthous stomatitis (RAS) is the most common clinical disease of the oral mucosa. Its prevalence in the general population varies between 5 and 25%, with its peak appearance in the second decade of life. So far, the etiopathogenesis is not clear. In genetically predisposed patients, the effect of certain triggering factors would initiate the proinflammatory cytokine cascade directed against certain regions of the oral mucosa. Ulcers are round or oval with well-defined erythematous margins and a shallow ulcerated center covered with a gray or yellowish fibrinous pseudomembrane. The ulcers may reappear at intervals of a few days and months. Given the appearance of periodic thrush in the oral mucosa, the first thing to do is to make a correct differential diagnosis, rule out associated systemic diseases and assess treatable causes before reaching the diagnosis of RAS. At present, there is no curative treatment.
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Affiliation(s)
| | - Laura García Forcén
- Centro de Salud Ejea de los Caballeros, Ejea de los Caballeros, Zaragoza, España
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Huber SM, Navarini A, Brandt O, Müller S. Colchicine - Renaissance of an "ancient" drug. J Dtsch Dermatol Ges 2023; 21:239-243. [PMID: 36892188 DOI: 10.1111/ddg.14961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 03/10/2023]
Abstract
Colchicine, which was already used by the ancient Egyptians, has recently experienced a renaissance in various medical disciplines, including dermatology. However, due to the potentially significant side effects of systemic use, many clinicians are cautious in their use of colchicine. This review provides a practical overview of the data on the established and emerging use of systemic and topical colchicine in dermatologic diseases.
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Affiliation(s)
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Oliver Brandt
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Simon Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Huber SM, Navarini A, Brandt O, Müller S. Colchicin - Renaissance eines "uralten" Arzneimittels. J Dtsch Dermatol Ges 2023; 21:239-244. [PMID: 36929556 DOI: 10.1111/ddg.14961_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/31/2022] [Indexed: 03/18/2023]
Affiliation(s)
| | | | - Oliver Brandt
- Dermatologische Klinik, Universitätsspital Basel, Basel, Schweiz
| | - Simon Müller
- Dermatologische Klinik, Universitätsspital Basel, Basel, Schweiz
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Wang Z, Zu X, Xiong S, Mao R, Qiu Y, Chen B, Zeng Z, Chen M, He Y. The Role of Colchicine in Different Clinical Phenotypes of Behcet Disease. Clin Ther 2023; 45:162-176. [PMID: 36732153 DOI: 10.1016/j.clinthera.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Behcet disease (BD) is a multisystemic disorder characterized by variable clinical manifestations that affect nearly all systems and organs. Colchicine, an alkaloid plant extract, is considered as the first-line therapy for gout, pericarditis, and familial Mediterranean fever. However, the role of colchicine in the treatment of different clinical phenotypes of BD has not been clearly described. This narrative review summarizes the clinical use of colchicine in BD. METHODS All relevant literature from 1980 to March 2021 was searched in PubMed, MEDLINE, and Cochrane Library. The Medical Subject Heading terms and related words that were searched are as follows: Behcet's disease, Behcet's syndrome, BD, colchicine, management, treatment, and therapy. FINDINGS BD is an autoimmune systemic vasculitis with various clinical phenotypes, with involvement of skin mucosa, joints, eyes, and gastrointestinal, vascular, and neurologic systems. Colchicine has been used for centuries, acts by binding to tubulin to prevent the mitotic process, and has anti-inflammatory, antitumor, and antifibrotic properties. Colchicine has been reported to be an effective option for the treatment of skin, mucosal, and joint involvement in patients with certain BD clinical phenotypes. IMPLICATIONS Colchicine reduces the severity of certain clinical phenotypes and may improve the overall disease activity index in patients with BD. More randomized clinical trials are needed to confirm the value of colchicine in the treatment of BD, and further elucidation of the mechanisms is also needed, which may reveal new application of colchicine that has been used for centuries.
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Affiliation(s)
- Zeyuan Wang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoman Zu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shanshan Xiong
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baili Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zeng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Giani T, Luppino AF, Ferrara G. Treatment Options in Pediatric Behçet's Disease. Paediatr Drugs 2023; 25:165-191. [PMID: 36626047 PMCID: PMC9838500 DOI: 10.1007/s40272-022-00548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 01/11/2023]
Abstract
Behçet's disease is a rare and poorly understood vasculitis affecting blood vessels of all types and sizes. Uveitis and oral and genital ulcers represent the typical clinical triad. Populations along the ancient trading route connecting the Mediterranean basin with the Middle and Far East are most affected. Up to a quarter of the cases has a pediatric onset, typically around puberty. The aim of the treatment is early intervention to control inflammation, with symptom relief and prevention of relapses, damage, and complications. The heterogeneous clinical presentation often requires a multidisciplinary and tailored approach. Ocular, neurological, gastrointestinal, and vascular involvement is associated with a worse prognosis and needs more aggressive treatments. In young patients with expected prolonged disease, treatment should also focus on preventive measures and lifestyle advice. In recent years, the pharmacological armamentarium has grown progressively, although only a limited number of drugs are currently authorized for pediatric use. Most evidence for these drugs still derives from adult studies and experience; these are prescribed as off-label medications and are only available as adult formulations. Corticosteroids frequently represent the mainstay for the management of the initial acute phases, but their potential serious adverse effects limit their use to short periods. Different conventional disease-modifying anti-rheumatic drugs have long been used. Many other biologic drugs targeting different cytokines such as interleukin-1, interleukin-6, and interleukin-17 and treatments with small molecules including the phosphodiesterase 4 and Janus kinase inhibitors are emerging as novel promising therapeutic agents. In recent years, a growing interest has developed around anti-tumor necrosis factor agents that have often proven to be effective in severe cases, especially in those with a gastrointestinal and ocular involvement.
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Effects of Four Types of Watermelon Frost Combination Medications for the Treatment of Oral Ulcers: A Network Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2712403. [PMID: 35313513 PMCID: PMC8934226 DOI: 10.1155/2022/2712403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/27/2022]
Abstract
Objective. The aim of this study is to identify the effectiveness of the four different watermelon frost combination medications in the treatment of oral ulcers through network meta-analysis and rank them based on their performances. Methods. Five randomized controlled studies of four distinct types of a combination medication for the treatment of oral ulcers were observed in numerous databases, and a network meta-analysis was conducted to evaluate the odds ratio (OR) and sequence of the diverse treatments using Stata software (version 13.0). The underlined studies were categorized into two groups: the control group (watermelon frost alone) and the observation group (one of four watermelon frost combinations). Results. The study comprised of 598 cases and the findings indicated that the pooled OR and 95% CI of oral ulcers that improved relative to watermelon frost alone were 3.26 (1.28 to 8.30) for watermelon frost and Kangfuxin fluid, 8.74 (2.94 to 26.02) for watermelon frost and erythromycin, 6.53 (1.81 to 23.50) for watermelon frost and metronidazole, and 2.62 (0.63 to 10.95) for watermelon frost and cydiodine buccal tablets. The study showed the significant efficacy of watermelon frost combination medications. In terms of clinical efficacy, the combination of watermelon frost and erythromycin was the most promising concomitant medication. It had an 86.3 surface under cumulative ranking (SUCRA). Conclusion. All the studied watermelon frost combinations were effective against oral ulcers validating the use of watermelon frost for oral ulcers. The combination of watermelon frost and erythromycin is the most promising candidate among the four combinations for the treatment of oral ulcers.
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Gyldenløve M, Meteran H, Zachariae C, Egeberg A. Rapid improvement of idiopathic aphthous ulcers with oral roflumilast therapy. Br J Dermatol 2022; 187:258-259. [PMID: 35106757 DOI: 10.1111/bjd.21044] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Mette Gyldenløve
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 15, DK-2900, Hellerup, Denmark
| | - Howraman Meteran
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 15, DK-2900 Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 15, DK-2900, Hellerup, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 15, DK-2900, Hellerup, Denmark.,Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nielsine Nielsens Vej 9, DK-2400, Copenhagen, Denmark
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Halboub E, Al-Maweri SA, Parveen S, Al-Wesabi M, Al-Sharani HM, Al-Sharani A, Al-Kamel A, Albashari A, Shamala A. Zinc supplementation for prevention and management of recurrent aphthous stomatitis: a systematic review. J Trace Elem Med Biol 2021; 68:126811. [PMID: 34146924 DOI: 10.1016/j.jtemb.2021.126811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/26/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is a very common oral ulcerative disease with no definitive cure. Growing evidence suggests a significant association between zinc deficiency and RAS. OBJECTIVES To assess the efficacy of systemic zinc supplementations in the prevention and management of RAS. METHODS Five databases were searched for all English and Chinese studies published up to November 2020. All clinical trials that assessed the efficacy of zinc supplementations in the management and/or prevention of RAS were included. RESULTS Seven clinical trials comprising 482 RAS patients (250 in zinc group) fulfilled the inclusion criteria. The follow-up period ranged from three months to one year. Five studies showed significantly better efficacy of zinc in reducing the recurrence rates of RAS, whereas two studies did not report any significant differences compared to the controls. Four studies reported on signs/symptoms of RAS, three of which showed superior outcomes in favour of zinc, while one study reported comparable results. CONCLUSION Zinc supplementation seems to be efficacious in the management and prevention of RAS. However, further clinical trials with standardized methodologies and adequate follow-up periods are required to confirm the efficacy of zinc supplementations.
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Affiliation(s)
- Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia; Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Yemen.
| | - Sadeq A Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, Vision Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia; Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Yemen.
| | - Sameena Parveen
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia.
| | - Mohammed Al-Wesabi
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen.
| | - Hesham Mohammed Al-Sharani
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Yemen; Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin, China.
| | - Amani Al-Sharani
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen.
| | - Ahlam Al-Kamel
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen.
| | | | - Anas Shamala
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen.
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Abstract
Behcet's syndrome (BS) is a chronic systemic inflammatory vasculitis with a wide range of clinical manifestations including recurrent oral and genital ulcers; cutaneous lesions; and ophthalmic, neurologic, and gastrointestinal involvement. BS has a global distribution but is particularly prevalent in so-called Silk Road populations. Disease onset is usually around the third or fourth decade of life, and the sex ratio is roughly 1:1. Both environmental and genetic factors contribute to the etiology of BS, although the detailed mechanisms remain unclear. At present, there is no laboratory examination with diagnostic value for BS; therefore, a diagnosis is made based on clinical manifestations. The International Study Group diagnostic criteria published in 1990 is the most widely used and recognized, but in order to improve sensitivity, the International Criteria for Behcet's Disease is developed in 2014. Evaluating disease activity in BS is an important basis for treatment selection and monitoring, the simplified Behcet's Disease Current Activity Form (2006 version) is a well-established scoring method. Given that multiple organs are affected in BS, it must be differentiated from other diseases with similar manifestations or that may be induced by drug treatment. The goal of BS treatment is to eradicate triggers and/or aggravating factors, alleviate and control clinical symptoms, prevent and treat any damage to organs, slow disease progression, and improve the patient's quality of life. The clinical management of BS depends on the affected organs and disease severity. In this review, we summarize the current state of knowledge of BS pathogenesis and therapeutic options.
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Affiliation(s)
- Jingjing Chen
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing, 210042, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing, 210042, China.
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Hirahara L, Kirino Y, Soejima Y, Takeno M, Takase-Minegishi K, Yoshimi R, Takeuchi M, Mizuki N, Nakajima H. Efficacy and safety of apremilast for 3 months in Behçet’s disease: A prospective observational study. Mod Rheumatol 2020; 31:856-861. [DOI: 10.1080/14397595.2020.1830504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Lisa Hirahara
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mitsuhiro Takeno
- Nippon Medical School Musashi Kosugi Hospital, Department of Allergy and Rheumatology, Kawasaki, Japan
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Al-Maweri SA, Alaizari N, Alharbi AA, Alotaibi SA, AlQuhal A, Almutairi BF, Alhuthaly S, Almutairi AM. Efficacy of curcumin for recurrent aphthous stomatitis: a systematic review. J DERMATOL TREAT 2020; 33:1225-1230. [PMID: 32893718 DOI: 10.1080/09546634.2020.1819529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is the most common ulcerative lesion of the oral mucosa. The management of RAS is quite challenging with no definitive cure. OBJECTIVE The present systematic review aimed to summarize the available evidence regarding the efficacy of curcumin in the management of RAS. METHODS PubMed, Scopus and Web of Science databases were searched in June 2020 for all relevant studies. Clinical trials that assessed the efficacy of curcumin for the management of RAS were included. The primary outcomes were pain and/or clinical improvement. RESULTS Eight studies involving 439 subjects were included. The efficacy of curcumin was compared with 1% triamcinolone in four studies, glycerin vehicle in one study, placebo in one study, and honey in one study. Overall, the included studies reported a good efficacy of curcumin in reducing pain and ulcers size in patients with RAS. Four studies found curcumin as effective as triamcinolone in relieving signs and symptoms of RAS. Three studies reported superior results with curcumin as compared with control groups. CONCLUSION The limited available evidence suggests that curcumin have potential benefits in alleviating pain and accelerating healing in patients with RAS. Further well-designed clinical trials with standardized curcumin formulations are highly recommended.
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Affiliation(s)
- Sadeq Ali Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, AlFarabi Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia.,Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | - Nader Alaizari
- Department of Oral Medicine and Diagnostic Sciences, AlFarabi Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia
| | | | | | - Alanoud AlQuhal
- AlFarabi Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia
| | | | - Shatha Alhuthaly
- AlFarabi Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia
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