DOCSLIB.ORG

Treatment of Severe, Recalcitrant, Major Aphthous Stomatitis with Adalimumab

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment of Severe, Recalcitrant, Major Aphthous Stomatitis with Adalimumab CONTINUING MEDICAL EDUCATION Treatment of Severe, Recalcitrant, Major Aphthous Stomatitis With Adalimumab Justin Vujevich, MD; Matthew Zirwas, MD GOAL To understand recurrent aphthous stomatitis (RAS) to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Describe the 3 types of RAS lesions. 2. Discuss the pathogenesis of RAS. 3. Explain the treatment options for RAS. CME Test on page 104. This article has been peer reviewed and is accredited by the ACCME to provide continuing approved by Michael Fisher, MD, Professor of medical education for physicians. Medicine, Albert Einstein College of Medicine. Albert Einstein College of Medicine designates Review date: July 2005. this educational activity for a maximum of 1 This activity has been planned and implemented category 1 credit toward the AMA Physician’s in accordance with the Essential Areas and Policies Recognition Award. Each physician should of the Accreditation Council for Continuing Medical claim only that credit that he/she actually spent Education through the joint sponsorship of Albert in the activity. Einstein College of Medicine and Quadrant This activity has been planned and produced in HealthCom, Inc. Albert Einstein College of Medicine accordance with ACCME Essentials. Dr. Vujevich reports no conflict of interest. Dr. Zirwas is a consultant for and has received an unrestricted educational grant from Amgen. The authors discuss off-label use of adalimumab, etanercept, pentoxifylline, and thalidomide. Dr. Fisher reports no conflict of interest. We describe an 18-year-old man with a 7-year ecurrent aphthous stomatitis (RAS) is a history of severe major aphthous stomatitis common disease of the oral mucosa, affecting refractory to multiple standard therapies who R approximately 1 in 5 individuals during their responded completely to therapy with adali- lifetime.1 Clinically, these lesions manifest as painful mumab, a fully humanized monoclonal antibody erythematous erosions or ulcerations typically on against tumor necrosis factor ␣ (TNF-␣). nonkeratinized mucosa. Cutis. 2005;76:129-132. RAS lesions are classified into 3 groups, based on size. Minor recurrent aphthous ulcers, the most common variety, are painful ulcers less than 1.0 cm Accepted for publication April 18, 2005. in diameter that occur on nonkeratinized mucosa. Dr. Vujevich is a dermatology resident, and Dr. Zirwas is Assistant The second class, major recurrent aphthous ulcers, Professor of Dermatology, both in the Department of Dermatology, are similar in clinical appearance but are larger University of Pittsburgh Physicians, Pennsylvania. Ͼ Reprints: Matthew Zirwas, MD, Falk Medical Bldg, 3601 Fifth Ave, ( 1.0 cm), more painful, longer lasting, and heal 5th Floor, Pittsburgh, PA 15213 (e-mail: [email protected]). with scarring. The third group is herpetiform RAS. VOLUME 76, AUGUST 2005 129 Major Aphthous Stomatitis With Adalimumab These painful ulcers frequently cluster on the lower ocular symptoms, genital ulcerations, or risk lip, heal without scarring, occur more often in factors for human immunodeficiency virus. No women, and have a later onset of presentation. amalgam or acrylic material was present in the The etiology of RAS is poorly understood and mouth. Results of a physical examination revealed appears to be multifactorial. Predisposing factors such ulcers 1- to 2-cm in diameter with fibrinous bases as heredity,2 trauma,3 emotional stress,4 reactivation and erythematous borders involving the buccal of latent virus,5 hypersensitivity to certain foods,6 and and labial mucosa (Figure, A), tongue, soft palate, immunoglobulin A (IgA) deficiency7 may contribute and retropharynx. to the pathogenesis of individual cases. Results of an oral biopsy demonstrated a RAS is typically an isolated finding but may mucosal ulceration with nonspecific inflamma- occur as one manifestation of a systemic disease. tion. Test results measuring complete blood count; Associated diseases include Behçet syndrome; serum vitamins B1, B2, B6, and B12; serum folate Reiter syndrome; vitamin deficiency; inflammatory and iron levels; and serum antinuclear antibodies bowel disease; mouth and genital ulcers with were within reference range. The diagnostic eval- inflamed cartilage (MAGIC) syndrome; periodic uation also included a normal colonoscopy and fever, aphthous stomatitis, pharyngitis, and adeni- esophagogastroduodenoscopy, with normal ran- tis (PFAPA) syndrome; Sweet syndrome; and cyclic dom mucosal biopsy results and a normal fundu- neutropenia.8 Although the immunopathogenesis scopic evaluation. of RAS is unknown, most evidence suggests RAS is The patient’s previous therapies included high- a T-cell–mediated disorder resulting in the secre- potency topical steroids, topical tacrolimus oint- tion of cytokines that have a cytotoxic effect on ment, chlorhexidine rinses, topical tetracycline, oral mucosa cells. topical lidocaine, oral colchicine (0.6 mg twice There appears to be an abnormality of cytokine daily), oral dapsone (125 mg/d), oral azathioprine expression in patients with RAS, with tumor (250 mg/d), oral sulfasalazine, and oral prednisone necrosis factor ␣ (TNF-␣) being one of the overex- ranging in doses of 10 to 60 mg. Only oral pred- pressed cytokines. Borra et al9 utilized complemen- nisone had been effective, and the dose required to tary DNA microarray analysis to demonstrate a ameliorate symptoms sufficiently to allow ade- helper T cell subtype 1–predominant immune quate oral intake and speech had averaged 40 mg/d response profile in aphthous ulcer specimens com- over the previous 3 years, with no periods off pared with control oral mucosa. Buno et al10 exam- prednisone during that time. Despite this dose of ined the pattern of cytokine messenger RNA prednisone, an unintentional weight loss of 40 lb expression in lesional and normal mucosa from occurred secondary to decreased oral intake. patients with RAS, and reported higher levels of Based on the in vitro data showing up-regulation the messenger RNAs of the helper T cell subtype 1 of TNF-␣ in RAS and a prior case report describing proinflammatory cytokines interleukin 2, inter- use of etanercept for RAS,13 we decided to undertake feron ␥, and TNF-␣ in lesional biopsy specimens of a therapeutic trial of adalimumab, a monoclonal, patients with RAS compared with mucosa from fully human anti–TNF-␣ antibody, at a dosage of healthy controls. Natah et al11 reported that TNF-␣– 40 mg injected subcutaneously every other week. containing cells were more numerous in RAS oral Two weeks after the first subcutaneous injec- specimens compared with control oral mucosa. tion, our patient showed a 90% clinical improve- Finally, Taylor et al12 demonstrated enhanced ment of ulcerations (Figure, B). Over the next release of TNF-␣ by peripheral blood monocytes in several weeks, all remaining ulcerations had com- patients with RAS. pletely healed. After 4 months, our patient had no recurrence of ulcerations, and his therapy with Case Report oral prednisone was discontinued for the first time An 18-year-old man was referred to our clinic with in 3 years. Our plan is to continue biweekly injec- a 7-year history of severe oral ulcerations. The tions for a 6-month period, and if there is no lesions were extremely painful, were present on an recurrence of ulceration during this time, the essentially continuous basis, and healed with scar- interval between subcutaneous injections will be ring. The ulcerations interfered with eating, drink- lengthened until the minimum required frequency ing, and speaking. No relationship to trauma or of injections is achieved. food intake was noted. The results of a review of symptoms were other- Comment wise negative. Specifically, the patient had no Adalimumab is a recombinant, fully humanized gastrointestinal tract symptoms, fevers or chills, IgG1 monoclonal antibody that binds specifically 130 CUTIS® Major Aphthous Stomatitis With Adalimumab to TNF-␣, preventing the cytokine from binding to arthritis in adults who have had an inadequate its p55 and p75 receptors and therefore neutraliz- response to disease-modifying antirheumatic drugs. ing the activity of the cytokine.14 It is approved by The recommended dosage in these patients is the US Food and Drug Administration for use in 40 mg injected subcutaneously every other week. the treatment of moderate to severe rheumatoid Anti–TNF-␣ therapies have shown success in the treatment of RAS. Pentoxifylline has been shown to reduce the number of recurrent aphthous ulcers in an open clinical trial.15 Thalidomide has been reported to achieve up to a 50% remission in patients with recurrent aphthous ulcers in one crossover study versus placebo.16 Recent reports have shown successful treat- ment of RAS with TNF-␣ monoclonal antibody blocking agents. Robinson and Guitart13 reported a 50-year-old woman with partial improvement in chronic RAS after biweekly subcutaneous injec- tions of etanercept, a dimeric fusion protein com- bining the extracellular portion of the human TNF receptor (p75) linked to the Fc portion of IgG. Kaufman et al17 reported dramatic improve- ment of RAS in patients with Crohn disease using a single 5 mg/kg intravenous infusion of inflix- imab, a chimeric TNF-␣ monoclonal IgG1 anti- body composed of the mouse TNF-␣ receptor linked to the Fc portion of IgG. To our knowledge, this is the first report demon- A strating effectiveness of adalimumab for the treat- ment of RAS. There are
Load more

Recommended publications
  • The Use of Biologic Agents in the Treatment of Oral Lesions Due to Pemphigus and Behçet's Disease: a Systematic Review
    Davis GE, Sarandev G, Vaughan AT, Al-Eryani K, Enciso R. The Use of Biologic Agents in the Treatment of Oral Lesions due to Pemphigus and Behçet’s Disease: A Systematic Review. J Anesthesiol & Pain Therapy. 2020;1(1):14-23 Systematic Review Open Access The Use of Biologic Agents in the Treatment of Oral Lesions due to Pemphigus and Behçet’s Disease: A Systematic Review Gerald E. Davis II1,2, George Sarandev1, Alexander T. Vaughan1, Kamal Al-Eryani3, Reyes Enciso4* 1Advanced graduate, Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA 2Assistant Dean of Academic Affairs, Assistant Professor, Restorative Dentistry, Meharry Medical College, School of Dentistry, Nashville, Tennessee, USA 3Assistant Professor of Clinical Dentistry, Division of Periodontology, Dental Hygiene & Diagnostic Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA 4Associate Professor (Instructional), Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA Article Info Abstract Article Notes Background: Current treatments for pemphigus and Behçet’s disease, such Received: : March 11, 2019 as corticosteroids, have long-term serious adverse effects. Accepted: : April 29, 2020 Objective: The objective of this systematic review was to evaluate the *Correspondence: efficacy of biologic agents (biopharmaceuticals manufactured via a biological *Dr. Reyes Enciso, Associate Professor (Instructional), Division source) on the treatment of intraoral lesions associated with pemphigus and of Dental Public Health and Pediatric Dentistry, Herman Ostrow Behçet’s disease compared to glucocorticoids or placebo. School of Dentistry of USC, Los Angeles, California, USA; Email: [email protected].
    [Show full text]
  • Rebamipide to Manage Stomatopyrosis in Oral Submucous Fibrosis 1Joanna Baptist, 2Shrijana Shakya, 3Ravikiran Ongole
    JCDP Rebamipide to Manage Stomatopyrosis10.5005/jp-journals-10024-1972 in Oral Submucous Fibrosis ORIGINAL RESEARCH Rebamipide to Manage Stomatopyrosis in Oral Submucous Fibrosis 1Joanna Baptist, 2Shrijana Shakya, 3Ravikiran Ongole ABSTRACT Source of support: Nil Introduction: Oral submucous fibrosis (OSF) causes progres- Conflict of interest: None sive debilitating symptoms, such as oral burning sensation (sto- matopyrosis) and limited mouth opening. The standard of care INTRODUCTION (SOC) protocol includes habit cessation, intralesional steroid and hyaluronidase injections, and mouth opening exercises. The Oral submucous fibrosis (OSF) is commonly seen in objective of the study was to evaluate efficacy of rebamipide the Indian subcontinent affecting individuals of all age in alleviating burning sensation of the oral mucosa in OSF in groups. It is a potentially malignant disorder caused comparison with SOC intralesional steroid injections. almost exclusively by the use of smokeless form of Materials and methods: Twenty OSF patients were divided into tobacco products. The malignant transformation rates two groups [rebamipide (100 mg TID for 21 days) and betametha- vary from 3 to 19%.1,2 sone (4 mg/mL biweekly for 4 weeks)] of 10 each by random Oral submucous fibrosis causes progressive debilitat- sampling. Burning sensation was assessed every week for 1 month. Burning sensation scores were analyzed using repeated ing symptoms affecting the oral cavity, such as burning measures analysis of variance (ANOVA) and paired t-test. sensation, loss of cheek elasticity, restricted tongue move- Results: Change in burning sensation score was significant ments, and limited mouth opening. Oral submucous (p < 0.05) in the first four visits. However, score between the fibrosis is an irreversible condition and the management 4th and 5th visit was not statistically significant (p > 0.05).
    [Show full text]
  • 2017 Oregon Dental Conference® Course Handout
    2017 Oregon Dental Conference® Course Handout Nasser Said-Al-Naief, DDS, MS Course 8125: “The Mouth as The Body’s Mirror: Oral, Maxillofacial, and Head and Neck Manifestations of Systemic Disease” Thursday, April 6 2 pm - 3:30 pm 2/28/2017 The Mouth as The Body’s Mirror Oral Maxillofacial and Head and Neck Manifestation of Ulcerative Conditions of Allergic & Immunological Systemic Disease the Oro-Maxillofacial Diseases Region Nasser Said-Al-Naief, DDS, MS Professor & Chair, Oral Pathology and Radiology Director, OMFP Laboratory Oral manifestations of Office 503-494-8904// Direct: 503-494-0041 systemic diseases Oral Manifestations of Fax: 503-494-8905 Dermatological Diseases Cell: 1-205-215-5699 Common Oral [email protected] Conditions [email protected] OHSU School of Dentistry OHSU School of Medicine 2730 SW Moody Ave, CLSB 5N008 Portland, Oregon 97201 Recurrent aphthous stomatitis (RAS) Recurrent aphthous stomatitis (RAS) • Aphthous" comes from the Greek word "aphtha”- • Recurrence of one or more painful oral ulcers, in periods of days months. = ulcer • Usually begins in childhood or adolescence, • The most common oral mucosal disease in North • May decrease in frequency and severity by age America. (30+). • Affect 5% to 66% of the North American • Ulcers are confined to the lining (non-keratinized) population. mucosa: • * 60% of those affected are members of the • Buccal/labial mucosa, lateral/ventral tongue/floor of professional class. the mouth, soft palate/oropharyngeal mucosa • Etiopathogenesis: 1 2/28/2017 Etiology of RAU Recurrent Aphthous Stomatitis (RAS): Types: Minor; small size, shallow, regular, preceeded by prodrome, heal in 7-10 days Bacteria ( S.
    [Show full text]
  • Oral Manifestations of Systemic Disease Their Clinical Practice
    ARTICLE Oral manifestations of systemic disease ©corbac40/iStock/Getty Plus Images S. R. Porter,1 V. Mercadente2 and S. Fedele3 provide a succinct review of oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease. While the majority of disorders of the mouth are centred upon the focus of therapy; and/or 3) the dominant cause of a lessening of the direct action of plaque, the oral tissues can be subject to change affected person’s quality of life. The oral features that an oral healthcare or damage as a consequence of disease that predominantly affects provider may witness will often be dependent upon the nature of other body systems. Such oral manifestations of systemic disease their clinical practice. For example, specialists of paediatric dentistry can be highly variable in both frequency and presentation. As and orthodontics are likely to encounter the oral features of patients lifespan increases and medical care becomes ever more complex with congenital disease while those specialties allied to disease of and effective it is likely that the numbers of individuals with adulthood may see manifestations of infectious, immunologically- oral manifestations of systemic disease will continue to rise. mediated or malignant disease. The present article aims to provide This article provides a succinct review of oral manifestations a succinct review of the oral manifestations of systemic disease of of systemic disease. It focuses upon oral mucosal and salivary patients likely to attend oral medicine services. The review will focus gland disorders that may arise as a consequence of systemic upon disorders affecting the oral mucosa and salivary glands – as disease.
    [Show full text]
  • PRACTICAL CLINICAL COURSES V3969 Common Frustrating Oral
    PRACTICAL CLINICAL COURSES A Service of the Gordon J. Christensen Career Development Program V3969 Common Frustrating Oral Diseases – Diagnosis & Treatment John A. Svirsky, DDS, MEd Gordon J. Christensen, DDS, MSD, PhD Materials Included C.E. Instruction Sheet Products List Clinician Responsible Goals & Objectives Overview References AGD Post-Test Non-SLS Toothpastes Therapy – Treatments 1 Gordon J. Christensen PRACTICAL CLINICAL COURSES PROCEDURE FOR RECEIVING ACADEMY OF GENERAL DENTISTRY AND STATE CREDIT FOR DVDS 1. Complete the enclosed Post-Test.* For each CE Video Purchased, one test is included. If additional tests are needed, the following fees will apply: $25 per test for 1 additional dentist; $10 per test for each auxiliary (dental assistants, hygienists, lab technicians - no limit on auxiliary tests). Fees can be paid either by check or credit card when tests are submitted to Practical Clinical Courses. 2. Complete the demographic information located at the end of the test. Type of Credit: a. If the applicant selects “State,” PCC will send a certificate of verification to the applicant. The applicant must then submit this certificate to his/her state board to obtain credit. b. If the applicant selects “AGD,” PCC will submit credit information to the Academy of General Dentistry and confirmation to the applicant that it has been submitted. (The applicant may check their AGD transcript for verification – please allow 30 days.) c. If the applicant selects “Both,” PCC will complete a. & b. above. 3. Return the Post-Test portion via mail, fax, or email. Our contact information is as follows: Practical Clinical Courses 3707 N Canyon Road Suite 3D Provo, UT 84604 Fax: (801) 226-8637 [email protected] 4.
    [Show full text]
  • Distribution of Oral Ulceration Cases in Oral Medicine Integrated Installation of Universitas Padjadjaran Dental Hospital
    Padjadjaran Journal of Dentistry. 2020;32(3):237-242. Distribution of oral ulceration cases in Oral Medicine Integrated Installation of Universitas Padjadjaran Dental Hospital Dewi Zakiawati1*, Nanan Nur'aeny1, Riani Setiadhi1 1*Department of Oral Medicine, Faculty of Dentistry Universitas Padjadjaran, Indonesia ABSTRACT Introduction: Oral ulceration defines as discontinuity of the oral mucosa caused by the damage of both epithelium and lamina propria. Among other types of lesions, ulceration is the most commonly found lesion in the oral mucosa, especially in the outpatient unit. Oral Medicine Integrated Installation (OMII) Department in Universitas Padjadjaran Dental Hospital serves as the centre of oral health and education services, particularly in handling outpatient oral medicine cases. This research was the first study done in the Department which aimed to observe the distribution of oral ulceration in OMII Department university Dental Hospital. The data is essential in studying the epidemiology of the diseases. Methods: The research was a descriptive study using the patient’s medical data between 2010 and 2012. The data were recorded with Microsoft® Excel, then analysed and presented in the table and diagram using GraphPad Prism® Results: During the study, the distribution of oral ulceration cases found in OMII Department was 664 which comprises of traumatic ulcers, recurrent aphthous stomatitis, angular cheilitis, herpes simplex, herpes labialis, and herpes zoster. Additionally, more than 50% of the total case was recurrent aphthous stomatitis, with a precise number of 364. Conclusion: It can be concluded that the OMII Department in university Dental Hospital had been managing various oral ulceration cases, with the most abundant cases being recurrent aphthous stomatitis.
    [Show full text]
  • Clinical Significance of Dental Anatomy, Histology, Physiology, and Occlusion
    1 Clinical Significance of Dental Anatomy, Histology, Physiology, and Occlusion LEE W. BOUSHELL, JOHN R. STURDEVANT thorough understanding of the histology, physiology, and Incisors are essential for proper esthetics of the smile, facial soft occlusal interactions of the dentition and supporting tissues tissue contours (e.g., lip support), and speech (phonetics). is essential for the restorative dentist. Knowledge of the structuresA of teeth (enamel, dentin, cementum, and pulp) and Canines their relationships to each other and to the supporting structures Canines possess the longest roots of all teeth and are located at is necessary, especially when treating dental caries. The protective the corners of the dental arches. They function in the seizing, function of the tooth form is revealed by its impact on masticatory piercing, tearing, and cutting of food. From a proximal view, the muscle activity, the supporting tissues (osseous and mucosal), and crown also has a triangular shape, with a thick incisal ridge. The the pulp. Proper tooth form contributes to healthy supporting anatomic form of the crown and the length of the root make tissues. The contour and contact relationships of teeth with adjacent canine teeth strong, stable abutments for fixed or removable and opposing teeth are major determinants of muscle function in prostheses. Canines not only serve as important guides in occlusion, mastication, esthetics, speech, and protection. The relationships because of their anchorage and position in the dental arches, but of form to function are especially noteworthy when considering also play a crucial role (along with the incisors) in the esthetics of the shape of the dental arch, proximal contacts, occlusal contacts, the smile and lip support.
    [Show full text]
  • Clinical PRACTICE Blistering Mucocutaneous Diseases of the Oral Mucosa — a Review: Part 2
    Clinical PRACTICE Blistering Mucocutaneous Diseases of the Oral Mucosa — A Review: Part 2. Pemphigus Vulgaris Contact Author Mark R. Darling, MSc (Dent), MSc (Med), MChD (Oral Path); Dr.Darling Tom Daley, DDS, MSc, FRCD(C) Email: mark.darling@schulich. uwo.ca ABSTRACT Oral mucous membranes may be affected by a variety of blistering mucocutaneous diseases. In this paper, we review the clinical manifestations, typical microscopic and immunofluorescence features, pathogenesis, biological behaviour and treatment of pemphigus vulgaris. Although pemphigus vulgaris is not a common disease of the oral cavity, its potential to cause severe or life-threatening disease is such that the general dentist must have an understanding of its pathophysiology, clinical presentation and management. © J Can Dent Assoc 2006; 72(1):63–6 MeSH Key Words: mouth diseases; pemphigus/drug therapy; pemphigus/etiology This article has been peer reviewed. he most common blistering conditions captopril, phenacetin, furosemide, penicillin, of the oral and perioral soft tissues were tiopronin and sulfones such as dapsone. Oral Tbriefly reviewed in part 1 of this paper lesions are commonly seen with pemphigus (viral infections, immunopathogenic mucocu- vulgaris and paraneoplastic pemphigus.6 taneous blistering diseases, erythema multi- forme and other contact or systemic allergic Normal Desmosomes reactions).1–4 This paper (part 2) focuses on Adjacent epithelial cells share a number of the second most common chronic immuno- connections including tight junctions, gap pathogenic disease to cause chronic oral junctions and desmosomes. Desmosomes are blistering: pemphigus vulgaris. specialized structures that can be thought of as spot welds between cells. The intermediate Pemphigus keratin filaments of each cell are linked to focal Pemphigus is a group of diseases associated plaque-like electron dense thickenings on the with intraepithelial blistering.5 Pemphigus inside of the cell membrane containing pro- vulgaris (variant: pemphigus vegetans) and teins called plakoglobins and desmoplakins.
    [Show full text]
  • Oral Manifestations of Pemphigus Vulgaris
    Journal of Clinical & Experimental Dermatology Research - Open Access Research Article OPEN ACCESS Freely available online doi:10.4172/2155-9554.1000112 Oral Manifestations of Pemphigus Vulgaris: Clinical Presentation, Differential Diagnosis and Management Antonio Bascones-Martinez1*, Marta Munoz-Corcuera2, Cristina Bascones-Ilundain1 and German Esparza-Gómez1 1DDS, PhD, Medicine and Bucofacial Surgery Department, Dental School, Complutense University of Madrid, Spain 2DDS, PhD Student, Medicine and Bucofacial Surgery Department, Dental School, Complutense University of Madrid, Spain Abstract Pemphigus vulgaris is a chronic autoimmune mucocutaneous disease characterized by the formation of intraepithelial blisters. It results from an autoimmune process in which antibodies are produced against desmoglein 1 and desmoglein 3, normal components of the cell membrane of keratinocytes. The first manifestations of pemphigus vulgaris appear in the oral mucosa in the majority of patients, followed at a later date by cutaneous lesions. The diagnosis is based on clinical findings and laboratory analyses, and it is usually treated by the combined administration of corticosteroids and immunosuppressants. Detection of the oral lesions can result in an earlier diagnosis. We review the oral manifestations of pemphigus vulgaris as well as the differential diagnosis, treatment, and prognosis of oral lesions in this uncommon disease. Keywords: Pemphigus; Oral mucosa; Autoimmune bullous disease and have a molecular weight of 130 and 160 KDa, respectively [1,7,9,13]. The binding of antibodies to desmoglein at mucosal or Introduction cutaneous level gives rise to the loss of cell adhesion, with separation of epithelial layers (acantholysis) and the consequent appearance of Pemphigus vulgaris (PV) is the most frequently observed blisters on skin or mucosae [1,3].
    [Show full text]
  • AN OVERVIEW of VESICOBULLOUS CONDITIONS AFFECTING the ORAL MUCOSA EMMA HAYES, STEPHEN J CHALLACOMBE Prim Dent J
    AN OVERVIEW OF VESICOBULLOUS CONDITIONS AFFECTING THE ORAL MUCOSA EMMA HAYES, STEPHEN J CHALLACOMBE Prim Dent J. 2016; 5(1):46-50 in the palate, buccal mucosa and labial ABSTRACT mucosa there is an underlying submucosa. The epithelium is formed of several layers, Vesicobullous diseases are characterised by the presence of vesicles or bullae at the deepest being the layer of progenitor varying locations in the mucosa. The most common occurring in the oral cavity cells forming the stratum germinativum, are mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Both adjacent to the lamina propria. are autoimmune diseases with a peak age onset of over 60 years and females Keratinocytes increase in size and flatten are more commonly affected than men. This paper reviews the structure of the as they move through the stratum spinosum oral mucosa, with specific reference to the basement membrane zone, as well and stratum granulosum to the stratum as bullous conditions affecting the mucosa, including PV and pemphigoid, their corneum (in keratinized mucosa) where the aetiology, clinical presentation, and management. desmosomes, which hold the cells together, weaken – therefore allowing normal Learning outcomes desquamation. • Understand the common presentation of vesicobullous diseases. • Appreciate the role of investigations in diagnosis and its interpretation. In addition to desmosomes, epithelial • Appreciate the roles of both primary and secondary care in patient management. cell-cell contact occurs via occludens (tight junctions), and nexus junctions (gap junctions), with each having a complex structure. Desmosomes are small adhesion Introduction proteins (0.2µm) 1 which guarantee the Vesicobullous diseases are characterised by integrity of the epidermis by linking the the presence of vesicles or bullae at varying intermediate filaments within cells to the locations in the mucosa.
    [Show full text]
  • Pathogenic Viruses Commonly Present in the Oral Cavity and Relevant Antiviral Compounds Derived from Natural Products
    medicines Review Pathogenic Viruses Commonly Present in the Oral Cavity and Relevant Antiviral Compounds Derived from Natural Products Daisuke Asai and Hideki Nakashima * Department of Microbiology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan * Correspondence: [email protected]; Tel.: +81-44-977-8111 Received: 24 October 2018; Accepted: 7 November 2018; Published: 12 November 2018 Abstract: Many viruses, such as human herpesviruses, may be present in the human oral cavity, but most are usually asymptomatic. However, if individuals become immunocompromised by age, illness, or as a side effect of therapy, these dormant viruses can be activated and produce a variety of pathological changes in the oral mucosa. Unfortunately, available treatments for viral infectious diseases are limited, because (1) there are diseases for which no treatment is available; (2) drug-resistant strains of virus may appear; (3) incomplete eradication of virus may lead to recurrence. Rational design strategies are widely used to optimize the potency and selectivity of drug candidates, but discovery of leads for new antiviral agents, especially leads with novel structures, still relies mostly on large-scale screening programs, and many hits are found among natural products, such as extracts of marine sponges, sea algae, plants, and arthropods. Here, we review representative viruses found in the human oral cavity and their effects, together with relevant antiviral compounds derived from natural products. We also highlight some recent emerging pharmaceutical technologies with potential to deliver antivirals more effectively for disease prevention and therapy. Keywords: anti-human immunodeficiency virus (HIV); antiviral; natural product; human virus 1. Introduction The human oral cavity is home to a rich microbial flora, including bacteria, fungi, and viruses.
    [Show full text]
  • Comparative Evaluation of the Efficacy of Systemic Levamisole And
    Journal of Advanced Clinical & Research Insights (2019), 6, 33–38 ORIGINAL ARTICLE Comparative evaluation of the efficacy of systemic levamisole and antioxidant in the management of oral submucous fibrosis – A randomized control trial Anuja Anil Shinge1, Preeti Kanchan-Talreja1, Deepa Das1, Amita Navalkar1, Prakash S. Talreja2, Ashutosh Kakade3 1Department of Oral Medicine and Radiology, Y.M.T. Dental College and Hospital, Navi Mumbai, Maharashtra, India, 2Department of Periodontics, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India, 3Department of Pharmacology, M.G.M Medical College and Hospital, Navi Mumbai, Maharashtra, India Keywords: Abstract Cap. Antoxid, tab. levamisole, oral submucous Background: Oral submucous fibrosis (OSF) is a chronic, disabling disease involving fibrosis the entire oral mucosa, mainly reported in Indian population. A number of treatment Correspondence: modalities have been tried, but none of these have been completely therapeutic. Dr. Anuja Anil Shinge, Department of Levamisole, an immunomodulator, has been reported to be beneficial in oral mucosal Oral Medicine and Radiology, Y.M.T. lesions, but there are hardly any studies reported in literature for OSF patients, and Dental College and Hospital, Dr. G. D. Pol hence, the study was taken up. Foundations, Kharghar, Institutional Area, Aim: This study aims to compare the efficacy of levamisole with antioxidant for the Navi Mumbai - 410210. assessment of burning sensation and mouth opening in OSF patients. E-mail: [email protected] Materials and Methods: A total of 60 patients clinically diagnosed of OSF were selected for the study. We assessed patients for burning sensation and mouth opening. Patients Received: 02 February 2019; were divided into four groups according to staging of OSF (More et al., classification), Accepted: 11 March 2019 then randomly subdivided into three groups to dispense medicines.
    [Show full text]