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Monaghan L, Dugdale C. An unusual case of erythema multiforme presenting to an orthodontic department: A case report. J Orthod 2024; 51:60-62. [PMID: 37113104 DOI: 10.1177/14653125231172212] [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] [Indexed: 04/29/2023]
Abstract
A 16-year-old female patient presented to the orthodontic department with a 2-week history of painful oral lesions that were affecting her ability to eat. Clinical examination revealed widespread oral ulceration, crusted bleeding from the lips with evidence of a herpes simplex infection in the region of the right buccal commissure. A diagnosis of oral erythema multiforme (EM) was made after a detailed clinical history and examination by the oral and maxillofacial team. Supportive care was provided alongside management with topical corticosteroids. Within 6 weeks of initial presentation, complete resolution of the lesions had occurred and the patient was able to resume active orthodontic treatment.
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Affiliation(s)
- Liam Monaghan
- University Dental Hospital Manchester, Manchester, UK
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2
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Jeyanthikumari T, Thayumanavan B, Mohideen K, Vinayakam S, Ghosh S, Dhungel S. Oral Manifestation of Viral-Induced Erythema Multiforme Major: A Rare Presentation. Indian J Otolaryngol Head Neck Surg 2024; 76:1164-1167. [PMID: 38440462 PMCID: PMC10908995 DOI: 10.1007/s12070-023-04195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 03/06/2024] Open
Abstract
Erythema multiforme is an acute inflammatory mucocutaneous disease manifested as macules, vesicles, bullae, erosion, and papular lesions. In the present case, a 55-year-old female patient reported painful growth in the oral cavity and difficulty in mastication. The patient gave a history of prodromal symptoms before the onset of lesions On intra-oral examination, elevated plaque-like lesions were present bilaterally on lateral borders of the tongue and buccal mucosa near the retromolar region. Extraoral examination revealed concentric erythematous target (or) bull's eye lesions in palms, forearm, and foot. Based on history, clinical examination, and laboratory investigations, recurrent herpes-associated erythema multiforme was diagnosed. We report a rare clinical presentation of recurrent herpes-associated erythema multiforme manifesting as an extensive plaque-like lesion intra-orally.
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Affiliation(s)
- T Jeyanthikumari
- Government Dental College and Hospital, Chennai, Tamil Nadu India
| | | | - Khadijah Mohideen
- Department of Oral Pathology and Microbiology, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, India
| | - S Vinayakam
- Tamilnadu Government Dental College, Chennai, India
| | - Snehashish Ghosh
- Department of Oral Pathology, College of Medical Sciences, Bharatpur, Nepal
| | - Safal Dhungel
- Department of Oral and Maxillofacial Surgery, College of Medical Sciences, Bharatpur, Nepal
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3
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Martins F, Pallos D, Candeia J, Zerbinati R, Braz-Silva PH, Campos L. Noninvasive Techniques for Management of Erythema Multiforme. Case Rep Dent 2023; 2023:9938939. [PMID: 38149304 PMCID: PMC10751166 DOI: 10.1155/2023/9938939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
An 18-year-old man was referred for a diagnosis of extensive oral lesions. During the interview, he reported a medical history of ganglionic tuberculosis, type 2 herpes infection, and significant weight loss due to dysphagia. Intraoral exam revealed multiple painful and ulcerated lesions covered by pseudomembrane. Lesions were observed on the labial and buccal mucosa, tongue, and soft palate. The laboratory findings included serum positivity for the Epstein-Barr virus, and salivary tests showed positive values for herpes simplex virus (HSV-2) and human herpesvirus (HHV-7). The diagnostic hypothesis was based on clinical findings and viral infection detected in the saliva, which triggered an immunological disorder, that is, erythema multiforme (EM). The treatment consisted of antimicrobial photodynamic therapy (aPDT), with substantial improvement in pain and healing as seen in the following twenty-four hours. Complete resolution of the lesions was achieved five days after the first session. Once the diagnosis of virus-induced EM was confirmed, noninvasive techniques (e.g., salivary tests and aPDT) were very successful and can be indicated for managing these lesions.
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Affiliation(s)
- Fabiana Martins
- Postgraduate Program in Dentistry, School of Dentistry, University of Santo Amaro, Rua Prof. Enéas de Siqueira Neto, 340-Jardim das Imbuias, São Paulo, SP 04829-300, Brazil
- Department of Stomatology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, São Paulo, SP 05508-000, Brazil
| | - Debora Pallos
- Postgraduate Program in Dentistry, School of Dentistry, University of Santo Amaro, Rua Prof. Enéas de Siqueira Neto, 340-Jardim das Imbuias, São Paulo, SP 04829-300, Brazil
| | - Jodkandlys Candeia
- Postgraduate Program in Dentistry, School of Dentistry, University of Santo Amaro, Rua Prof. Enéas de Siqueira Neto, 340-Jardim das Imbuias, São Paulo, SP 04829-300, Brazil
| | - Rodrigo Zerbinati
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, Rua Prof. Enéas Carvalho de Aguiar, 470-Cerqueira Cesar, São Paulo, SP 05403-000, Brazil
| | - Paulo Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, São Paulo, SP 05508-000, Brazil
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, Rua Prof. Enéas Carvalho de Aguiar, 470-Cerqueira Cesar, São Paulo, SP 05403-000, Brazil
| | - Luana Campos
- Postgraduate Program in Dentistry, School of Dentistry, University of Santo Amaro, Rua Prof. Enéas de Siqueira Neto, 340-Jardim das Imbuias, São Paulo, SP 04829-300, Brazil
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4
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Subahi G, Waheeb S, Binmadi N, Almazrooa S, Akeel S, Öhman J, Dafar A. Erythema multiforme-like lip presentation in pemphigus vulgaris patients: a multicenter case series. BMC Oral Health 2023; 23:952. [PMID: 38041037 PMCID: PMC10693153 DOI: 10.1186/s12903-023-03665-w] [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: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Abstract
Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous blistering disease. Autoantibodies are directed against desmogleins, leading to the formation of intraepithelial bullae. PV, as with other autoimmune mucocutaneous disorders of the oral cavity, presents diagnostic and therapeutic challenges. Approximately 50-70% of cases present first with oral lesions. The lesions commonly start as vesicles or bullae that rapidly rupture, leading to erosions and ulcerations. The palatal, gingival, buccal, and labial mucosa are the most commonly affected sites. Oral PV can mimic several other diseases that cause mucosal erosions and/or ulcerations, including erythema multiforme (EM). EM is an acute, immune-mediated, self-limited hypersensitivity condition primarily associated with herpes simplex infection. Oral lesions can be variable, but a very characteristic presentation with labial hemorrhagic erosions, ulcerations and crusting is commonly seen. In this case series, we present six cases of PV: one male patient and five female patients whose ages ranged from 34 to 65 years old. All patients presented with hemorrhage and crusting of the lips in addition to multiple intraoral erosions and ulcerations. Three patients presented with oral and skin lesions. All patients underwent biopsies, and a diagnosis of PV was confirmed. All patients were treated with steroids (topical and systemic) and variable steroid-sparing agents. This case series emphasizes that oral PV may be misdiagnosed as EM in a subgroup of patients who present with persistent lip hemorrhage and crusting. Therefore, a comprehensive history, clinical examination and incisional biopsies should be considered in such patients.
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Affiliation(s)
- Ghidaa Subahi
- Oral Medicine and Pathology Saudi Board Program, Jeddah, Saudi Arabia
| | | | - Nada Binmadi
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Soulafa Almazrooa
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Akeel
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jenny Öhman
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amal Dafar
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Oral and Maxillofacial Surgery, King Fahad General Hospital, Jeddah, Saudi Arabia.
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Patil S, Khan SS, Hosmani J, Khan ZA, Muruganandhan J, Mushtaq S, Yadalam PK, Bhandi S, Awan KH. Identification of oral immune disorders- A review and a diagnostic algorithm. Dis Mon 2023; 69:101350. [PMID: 35337656 DOI: 10.1016/j.disamonth.2022.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Immunological disorders are observed in various clinical presentations in the oral cavity. The pathophysiology of these disorders include but are not limited to primary oral auto-immune disease, systemic disease with oral findings, malignancies, hypersensitivity reactions, drug-induced, and infection-related. Many of these disorders have overlapping oral features, making it difficult for the clinician to diagnose and treat the disorder. There is a need to provide a simple and practical decision-making algorithm to the clinicians and provide them guidance on laboratory investigations. The present review provides a diagnostic algorithm that might minimize outpatient process delays and lead to early management. This is crucial in many cases where oral findings may be the first sign of the disorder, and early treatment can preclude dissemination and complications of the disorder.
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Affiliation(s)
- Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia; Department of Maxillofacial Surgery & Diagnostic Sciences, Division. of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Samar Saeed Khan
- Department of Maxillofacial Surgery & Diagnostic Sciences, Division. of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Jagadish Hosmani
- Oral Pathology Division, Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Zafar Ali Khan
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Jayanandan Muruganandhan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India
| | - Shazia Mushtaq
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia
| | - Pradeep Kumar Yadalam
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600 077, India
| | - Shilpa Bhandi
- Department of Restorative Dental Science, Division of Operative Dentistry, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Kamran Habib Awan
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States.
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Messina F, Piaserico S. The dark side of the moon: the immune-mediated adverse events of IL-17A/IL-17R inhibition. J DERMATOL TREAT 2022; 33:2443-2454. [PMID: 35393910 DOI: 10.1080/09546634.2022.2062281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As aberrant IL-17 signaling plays a critical role in the pathogenesis of psoriasis, biologic agents targeting this pathway have become an important weapon against this disease. Some biologic agents such as IL-17 inhibitors (secukinumab and ixekizumab) and the IL-17 receptor (IL17R) inhibitor (brodalumab) are relatively safe, tolerable and efficacious drugs. Nevertheless, side effects of IL-17 pathway inhibition occur. This review focuses on the dermatological manifestations linked to these treatments. Paradoxical psoriasis and atopic-like eczema may be the most common cutaneous adverse events, while manifestations such as neutrophilic dermatoses, hypersensitivity reactions, lichenoid eruptions, vasculitides, bullous diseases, lupus-like reactions, pigmentation disorders, adnexal diseases and granulomatous dermatoses have been described less frequently.
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Affiliation(s)
- Francesco Messina
- Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy
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7
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Oral Lesions in Children and Adolescents. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Maden CL, Ah-Kye L, Alfallouji Y, Kulakov E, Ellery P, Papamichael E. Erythema multiforme major with ocular involvement following COVID-19 infection. Oxf Med Case Reports 2021; 2021:omab120. [PMID: 34987850 PMCID: PMC8713588 DOI: 10.1093/omcr/omab120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 01/21/2023] Open
Abstract
We report a case of membranous conjunctivitis and erythema multiforme major (EMM) after a coronavirus disease 2019 (COVID-19) diagnosis. A previously well 18-year-old man presented with increasingly erythematous eyes and oral and genital ulceration 2 weeks after confirmation of COVID-19 infection. Clinical examination showed sloughy membranous conjunctivitis with normal visual acuity. He was reviewed by dermatology and diagnosed with EMM secondary to severe acute respiratory syndrome coronavirus 2 infection. The symptoms resolved with oral and topical steroids, lubricants and chloramphenicol eye drops. Erythema multiforme has been reported in association with COVID-19, although the major form is rare. Ophthalmologists should consider current or previous COVID-19 infection in patients presenting with conjunctivitis or pseudomembrane formation. Prompt initiation of steroids aids resolution.
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Affiliation(s)
- Carla L Maden
- FY2, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Ah-Kye
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Yasmin Alfallouji
- Dermatology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elizabeth Kulakov
- Dermatology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter Ellery
- Histopathology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Esther Papamichael
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
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Dalipi ZS, Dragidella F, Dragidella DK. Oral Manifestations of Exudative Erythema Multiforme in a Patient with COVID-19. Case Rep Dent 2021; 2021:1148945. [PMID: 34476106 PMCID: PMC8408009 DOI: 10.1155/2021/1148945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a viral infection with multiorgan manifestations that may affect the oral mucosa. The full range of oral manifestations of COVID-19 are unknown, and there are limited reports describing the features of oral manifestations of COVID-19, including taste loss, oral lesions, and xerostomia. The aim of this study is to report a case of oral erythema multiforme (EM) manifesting as oral, lip, and skin lesions in a COVID-19 patient. The presence of oral lesions in the late stage of COVID-19 could be related to weak patient immunity or related therapies.
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Affiliation(s)
- Zana Sllamniku Dalipi
- Department of Periodontology and Oral Medicine, University Dentistry Clinical Center of Kosovo, Medical Faculty, University of Prishtina, Street Lagjja e Spitalit p.n., 10000 Prishtina, Kosovo
| | - Fatmir Dragidella
- Department of Periodontology and Oral Medicine, University Dentistry Clinical Center of Kosovo, Medical Faculty, University of Prishtina, Street Lagjja e Spitalit p.n., 10000 Prishtina, Kosovo
| | - Donika Kastrati Dragidella
- Department of Periodontology and Oral Medicine, University Dentistry Clinical Center of Kosovo, Medical Faculty, University of Prishtina, Street Lagjja e Spitalit p.n., 10000 Prishtina, Kosovo
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10
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Petti S, Lodi G. The controversial natural history of oral herpes simplex virus type 1 infection. Oral Dis 2019; 25:1850-1865. [PMID: 31733122 DOI: 10.1111/odi.13234] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/10/2019] [Indexed: 02/06/2023]
Abstract
The natural history of oral herpes simplex virus type 1 (HSV-1) infection in the immunocompetent host is complex and rich in controversial phenomena, namely the role of unapparent transmission in primary infection acquisition, the high frequency of asymptomatic primary and recurrent infections, the lack of immunogenicity of HSV-1 internalized in the soma (cell body) of the sensory neurons of the trigeminal ganglion, the lytic activity of HSV-1 in the soma of neurons that is inhibited in the sensory neurons of the trigeminal ganglion and often uncontrolled in the other neurons, the role of keratin in promoting the development of recurrence episodes in immunocompetent hosts, the virus-host Nash equilibrium, the paradoxical HSV-1-seronegative individuals who shed HSV-1 through saliva, the limited efficacy of anti-HSV vaccines, and why the oral route of infection is the least likely to produce severe complications. The natural history of oral HSV-1 infection is also a history of symbiosis between humans and virus that may switch from mutualism to parasitism and vice versa. This balance is typical of microorganisms that are highly coevolved with humans, and its knowledge is essential to oral healthcare providers to perform adequate diagnosis and provide proper individual-based HSV-1 infection therapy.
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Affiliation(s)
- Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Giovanni Lodi
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
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11
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Abstract
Mucocutaneous diseases affecting the oral cavity are predominantly immune mediated or inflammatory. Three of the most common and clinically significant conditions are reviewed in this article: lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Because oral manifestations may be the first or only manifestation of mucocutaneous diseases, oral health professionals play a critical role in the early diagnosis and multidisciplinary management of these conditions.
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12
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Minhas S, Sajjad A, Kashif M, Taj F, Waddani HA, Khurshid Z. Oral Ulcers Presentation in Systemic Diseases: An Update. Open Access Maced J Med Sci 2019; 7:3341-3347. [PMID: 31949540 PMCID: PMC6953949 DOI: 10.3889/oamjms.2019.689] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diagnosis of oral ulceration is always challenging and has been the source of difficulty because of the remarkable overlap in their clinical presentations. AIM The objective of this review article is to provide updated knowledge and systemic approach regarding oral ulcers diagnosis depending upon clinical picture while excluding the other causative causes. METHODS For this, specialised databases and search engines involving Science Direct, Medline Plus, Scopus, PubMed and authentic textbooks were used to search topics related to the keywords such as oral ulcer, oral infections, vesiculobullous lesion, traumatic ulcer, systematic disease and stomatitis. Associated articles published from 1995 to 2019 in both dental and medical journals including the case reports, case series, original articles and reviews were considered. RESULTS The compilation of the significant data reveals that ulcers can be classified according to (i) duration of onset, (ii) number of ulcers and (iii) etiological factors. Causation of oral ulcers varies from slight trauma to underlying systemic diseases and malignancies. CONCLUSION Oral manifestations must be acknowledged for precise diagnosis and appropriate treatment.
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Affiliation(s)
- Sadia Minhas
- Department of Oral Pathology, Akhtar Saeed Dental College, Lahore, Pakistan
| | - Aneequa Sajjad
- Department of Oral Pathology, Akhtar Saeed Dental College, Lahore, Pakistan
| | - Muhammad Kashif
- Department of Oral Pathology, Bakhtawar Amin Medical & Dental College, Multan, Pakistan
| | - Farooq Taj
- Department of Prosthetic, Khyber Medical University Institute of Dental Sciences, Kohat, Pakistan
| | - Hamed Al Waddani
- Department of Medicine and Surgery, College of Dentistry, King Faisal University, Hofuf, Al-Ahsa Governorate, Saudi Arabia
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Hofuf, Al-Ahsa Governorate, Saudi Arabia
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da Costa Vieira V, Almeida Sarmento V, Leite Ribeiro PM, Martins Netto E, Brites C, Lins-Kusterer L. Unusual oral findings of the toxic epidermal necrolysis in an HIV-infected patient: a case report. Braz J Infect Dis 2019; 23:363-367. [PMID: 31562853 PMCID: PMC9428039 DOI: 10.1016/j.bjid.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/22/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022] Open
Abstract
Erythema multiforme (EM), Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN) have been reported as possible adverse effects of some classes of first-line antiretroviral drugs (ART) for HIV treatment. Herein we report an unusual presentation of TEN lesions associated with ART in an HIV-infected patient. The patient presented disseminated cutaneous eruption and oral lesions from the lips to the oropharynx region, causing odynophagia and dysphagia. In the tongue, circular, atypical erythematous lesions appeared, increasing in diameter over seven days and coalescing since then to complete remission. TEN treatment included efavirenz interruption, use of methylprednisolone, prophylactic antibiotic, and daily laser therapy with low-intensity red light. The circular oral lesions have not been described yet. Reporting our findings and clinical management may help diagnosing other similar cases and guide the clinical conduct. Analgesia and acceleration of oral ulcer repair with red laser therapy are recommended.
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Affiliation(s)
- Vinicius da Costa Vieira
- Complexo Hospitalar Universitário Professor Edgard Santos, Serviço de Estomatologia, Salvador, BA, Brazil.
| | | | | | - Eduardo Martins Netto
- Complexo Hospitalar Universitário Professor Edgard Santos, Laboratório de Investigação de Doenças Infecciosas, Salvador, BA, Brazil.
| | - Carlos Brites
- Complexo Hospitalar Universitário Professor Edgard Santos, Laboratório de Investigação de Doenças Infecciosas, Salvador, BA, Brazil.
| | - Liliane Lins-Kusterer
- Complexo Hospitalar Universitário Professor Edgard Santos, Laboratório de Investigação de Doenças Infecciosas, Salvador, BA, Brazil.
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14
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Affiliation(s)
- Samantha Shwe
- Department of Dermatology, University of California, Irvine, California
| | - Christina N Kraus
- Department of Dermatology, University of California, Irvine, California
| | - Kenneth G Linden
- Department of Dermatology, University of California, Irvine, California
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine, California
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15
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Adverse Immunologically Mediated Oral Mucosal Reactions to Systemic Medication: Lichenoid Tissue Reaction/Interface Dermatitis-Stomatitis, Autoimmune Vesiculobullous Disease, and IgE-Dependent and Immune Complex Reactions. J Immunol Res 2018; 2018:7645465. [PMID: 29984259 PMCID: PMC6015680 DOI: 10.1155/2018/7645465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
Drug-induced hypersensitivity immune reactions are exaggerated immunoinflammatory responses to allergenic components of the medications that occur in genetically susceptible subjects. The type of hypersensitivity immune response generated, whether antibody mediated or T cell mediated, or an immune complex reaction is determined by multiple factors, including the molecular characteristics of the allergen, the route of administration of the medication, the manner of presentation of the allergen by antigen-presenting cells to naïve T cells, the repertoire of the T cell receptors, and the cytokine profile within the microenvironment. This review deals with the clinical and histopathological aspects of adverse immunologically mediated oral mucosal reactions to systemic medication. We elaborate on diseases showing features of lichenoid tissue reaction/interface dermatitis-stomatitis, autoimmune vesiculobullous oral lesions, and immunoglobulin E- (IgE-) and immune complex-mediated oral reactions to drugs.
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16
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Porter SR, Mercadante V, Fedele S. Oral manifestations of systemic disease. Br Dent J 2018; 223:683-691. [PMID: 29123296 DOI: 10.1038/sj.bdj.2017.884] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 12/17/2022]
Abstract
While the majority of disorders of the mouth are centred upon the direct action of plaque, the oral tissues can be subject to change or damage as a consequence of disease that predominantly affects other body systems. Such oral manifestations of systemic disease can be highly variable in both frequency and presentation. As lifespan increases and medical care becomes ever more complex and effective it is likely that the numbers of individuals with oral manifestations of systemic disease will continue to rise. The present article provides a succinct review of oral manifestations of systemic disease. In view of this article being part of a wider BDJ themed issue on the subject of oral medicine, this review focuses upon oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease.
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Affiliation(s)
- S R Porter
- UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD
| | - V Mercadante
- UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD
| | - S Fedele
- UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD.,UCL NIHR Biomedical Research Centre
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Abstract
Inflammatory dermatoses encompass a variety of histologic patterns that affect different portions of the skin. In spongiotic, psoriasiform, lichenoid, pityriasiform, and blistering disorders, there are predominately epidermal and junctional activities with variable superficial dermal inflammation. Hypersensitivity reactions can show either epidermal or mostly dermal changes depending on whether the exposure of the exogenous allergen occurs through an external or internal route, respectively. Exceptions include erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis, where the etiology is often due to infection or ingested medications, but the histologic features are almost exclusively confined to the epidermis and dermoepidermal junction. Autoimmune disorders are unique in that lesions typically incorporate a mixture of epidermal and dermal inflammatory patterns with periadnexal inflammation, while the vast majority of vasculitis/vasculopathy and alopecia have changes limited to only the vessels and hair follicles, respectively. It is critical to recognize that a relatively limited number of histologic patterns are seen in a large array of clinical entities. Therefore, clinicopathologic correlation and careful examination of histologic details are of the utmost importance when evaluating skin biopsies for inflammatory disorders.
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Affiliation(s)
- Andy C Hsi
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Ilana S Rosman
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.,2 Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
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de Arruda JA, Silva P, Amaral MB, Cotta F, Avendanho R, Mesquita R. Erythema multiforme induced by alendronate sodium in a geriatric patient: A case report and review of the literature. J Clin Exp Dent 2017; 9:e929-e933. [PMID: 28828163 PMCID: PMC5549594 DOI: 10.4317/jced.53653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/27/2017] [Indexed: 12/04/2022] Open
Abstract
Erythema multiforme is an uncommon acute inflammatory disorder caused by exposure to microbes or drugs. Erythema multiforme minor typically affects only one mucosa and can be associated with symmetrical target skin lesions on the extremities. The disease usually occurs in patients in their 3rd and 4th decade of life, but can also affect children and adolescents. Alendronate sodium has been approved for the prevention and treatment of osteoporosis in postmenopausal women, but is associated with adverse events. This study reports and discusses a case of erythema multiforme minor. In addition, a literature search of articles published in PubMed-Medline was performed. The case was a 96-year-old woman who had taken alendronate. Intraoral clinical examination demonstrated hypersalivation and macrocheilia of the lower lip, associated with an ill-defined ulcer with erythematous borders measuring 20 mm in greatest diameter and covered with serofibrinous exudates. The aging of the population in developed and developing countries has increased the use of alendronate sodium to prevent osteoporosis and clinicians should be aware of possible oral adverse events associated with this drug.
Key words:Adverse events, erythema multiforme, therapeutics, diagnosis, alendronate.
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Affiliation(s)
- José-Alcides de Arruda
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Universidade de Pernambuco, Camaragibe, Brazil
| | - Pedro Silva
- Department of Stomatologic Sciences, School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Márcio-Bruno Amaral
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda Cotta
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renata Avendanho
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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19
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AAOM Clinical Practice Statement Subject: Medication-induced Oral Reactions. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:369-370. [PMID: 28743665 DOI: 10.1016/j.oooo.2017.05.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
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20
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Gossart R, Malthiery E, Aguilar F, Torres JH, Fauroux MA. Fuchs Syndrome: Medical Treatment of 1 Case and Literature Review. Case Rep Dermatol 2017; 9:114-120. [PMID: 28559809 PMCID: PMC5437436 DOI: 10.1159/000468978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 11/22/2022] Open
Abstract
Fuchs syndrome is a particular type of erythema multiforme major; the lesions are only found on the mucosae and specifically affect oral, ocular, and genital mucosae. The cause is not always immediately apparent, which is why this pathology requires a rigorous, detailed clinical examination to eliminate a differential diagnosis. The severity of the symptoms, particularly of oral and ocular symptoms, requires immediate treatment. The treatment of this pathology requires a multiple-drug regime. Through a clinical case study, the objective of this work is to help guide practitioners when diagnosing and treating this pathology as no current consensus exists on these 2 subjects. The authors present the case of a 29-year-old patient who was suffering from a recurring outbreak of Fuchs syndrome, suspected of having been triggered by Mycoplasma pneumoniae. After completing the treatment program based on colchicine and prednisolone, the patient was relieved from pain and has not suffered from any further periodic eruptions of erythema multiforme.
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Affiliation(s)
- Rémy Gossart
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Eve Malthiery
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Fanny Aguilar
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Jacques-Henri Torres
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Alix Fauroux
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
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21
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Thongprasom K. Treatment of a Pregnant Patient with Herpes Associated Erythema Multiforme (HAEM): A case report. Acta Stomatol Croat 2016; 50:265-268. [PMID: 27847401 DOI: 10.15644/asc50/3/10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Erythema Multiforme, (EM) is an uncommon, acute inflammatory disease of the skin and mucous membranes characterized by ulcerations caused by hypersensitivity to drugs, microbial agents or other allergens. An EM outbreak can result in more severe forms of EM involving the skin, and there are several types of EM manifestations. A hemorrhagic crust on the lip is a pathognomonic sign of this disease. Target lesions may or may not be present in EM cases. When target lesions are not present on the skin, it is very difficult to make a differential diagnosis of EM. Herpes associated erythema multiforme (HAEM) is an uncommon lesion caused by herpes simplex virus infection. A case of severe painful lesions in a 28-year-old pregnant patient with HAEM is presented here. HAEM is rarely found in pregnant women, and its clinical findings, diagnosis and treatment have not previously been reported.
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Affiliation(s)
- Kobkan Thongprasom
- Oral Medicine Department, Faculty of Dentistry Chulalongkorn University, Bangkok, Thailand
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22
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Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree. Int J Dent 2016; 2016:7278925. [PMID: 27781066 PMCID: PMC5066016 DOI: 10.1155/2016/7278925] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022] Open
Abstract
Diagnosis of oral ulcerative lesions might be quite challenging. This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. Various general search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “oral ulcer,” “stomatitis,” and “mouth diseases.” Thereafter, English-language articles published since 1983 to 2015 in both medical and dental journals including reviews, meta-analyses, original papers, and case reports were appraised. Upon compilation of the relevant data, oral ulcerative lesions were categorized into three major groups: acute, chronic, and recurrent ulcers and into five subgroups: solitary acute, multiple acute, solitary chronic, multiple chronic, and solitary/multiple recurrent, based on the number and duration of lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by stepwise progression.
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23
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Erythema multiforme major secondary to a cosmetic facial cream: first case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e10-5. [DOI: 10.1016/j.oooo.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 12/13/2022]
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24
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Celentano A, Tovaru S, Yap T, Adamo D, Aria M, Mignogna MD. Oral erythema multiforme: trends and clinical findings of a large retrospective European case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:707-16. [DOI: 10.1016/j.oooo.2015.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/08/2015] [Accepted: 08/13/2015] [Indexed: 12/24/2022]
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25
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Papatsiros VG, Athanasiou LV, Psalla D, Petridou E, Maragkakis GG, Papatsas I, Arsenakis I, Maes D. Erythema Multiforme Associated with Respiratory Disease in a Commercial Breeding Pig Herd. Viral Immunol 2015; 28:464-71. [PMID: 26266696 DOI: 10.1089/vim.2015.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study describes an erythema multiforme (EM) in breeding sows, after their mixing in the group housing system. Sows at 30-35 days of gestation showed red and raised skin areas, depression, anorexia, fever, respiratory problems, and increased return to estrus. Blood and nasal samples from diseased sows were examined by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay for respiratory pathogens. Hematological and biochemical analyses were performed on the blood samples. From diseased sows, vaginal swabs for microbiological examinations and samples at slaughterhouse for gross and microscopic examinations were collected. Samples from the complete gestation and lactation feed were examined for mycotoxins. All sampled sows were seropositive for Actinobacillus pleuropneumoniae (App) and porcine reproductive and respiratory syndrome virus (PRRSV). No viremia for PRRSV and porcine circovirus type 2 were detected. All nasal samples were positive for Streptococcus suis, one for Swine Influenza Virus and one for App, Hemophilus parasuis, and S. suis. In all vaginal swabs, Escherichia coli and Streptococcus spp. were detected. Diseased sows had moderate leukocytosis, mild anemia, and thrombocytopenia. No mycotoxins were detected in feed. Histopathological examination revealed increased vascularization of the superficial and middle dermis. EM was likely due to illness caused by viral and bacterial infections. This study suggests that stress caused by the sows' mixing might have triggered the problem.
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Affiliation(s)
- Vasileios G Papatsiros
- 1 Clinic of Medicine, Faculty of Veterinary Medicine, University of Thessaly , Karditsa, Greece
| | - Labrini V Athanasiou
- 1 Clinic of Medicine, Faculty of Veterinary Medicine, University of Thessaly , Karditsa, Greece
| | - Dimitra Psalla
- 2 Laboratory of Pathology, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Evanthia Petridou
- 3 Laboratory of Microbiology and Infectious Diseases, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Giorgos G Maragkakis
- 1 Clinic of Medicine, Faculty of Veterinary Medicine, University of Thessaly , Karditsa, Greece
| | | | - Ioannis Arsenakis
- 5 Department of Reproduction, Obstetrics, and Herd Health Unit Porcine Health Management, Faculty of Veterinary Medicine, Ghent University , Ghent, Belgium
| | - Dominiek Maes
- 5 Department of Reproduction, Obstetrics, and Herd Health Unit Porcine Health Management, Faculty of Veterinary Medicine, Ghent University , Ghent, Belgium
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26
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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27
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BaniHani A, Nazzal H, Webb L, Toumba KJ, Fabbroni G. An unusual presentation of erythema multiforme in a paediatric patient. Eur Arch Paediatr Dent 2015; 16:297-302. [DOI: 10.1007/s40368-015-0181-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/05/2015] [Indexed: 11/29/2022]
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28
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Shah SN, Chauhan GR, Manjunatha BS, Dagrus K. Drug induced erythema multiforme: two case series with review of literature. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2014. [PMID: 25386550 DOI: 10.7860/jcdr/2014/10173.4761.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Erythema Multiforme, (EM) an uncommon, acute inflammatory reactive mucocutaneous disorder and primary allergies confined to the oral mucosa. However the subsequent attacks can produce more severe forms of EM involving the skin. Manifestations of EM are varied and present a diagnostic dilemma because infections (particularly herpes simplex and mycoplasma pneumoniae) and drugs seem to predispose towards development of EM. We report two cases of EM in which drugs (Dioclofenac sodium & Amoxycilline) seems to be precipitating factor. In addition, the article reviews various aspects of EM as relevant to dental practice and highlight the associated potential etiologic agents, pathogenic mechanisms and therapies.
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Affiliation(s)
- Shreyas N Shah
- Senior Lecturer, Department of Oral and Maxillofacial Pathology, KM Shah Dental Collage & Hospital , SumandeepVidyapeeth, Vadodara, Gujarat, India
| | - Girish R Chauhan
- Reader, Department of Oral Pathology, Government Dental Collage & Hospital , Jamnagar, Gujarat, India
| | - B S Manjunatha
- Professor, Department of Oral and Maxillofacial Pathology, KM Shah Dental Collage & Hospital , SumandeepVidyapeeth, Vadodara, Gujarat, India
| | - Kapil Dagrus
- Senior Lecturer, Department of Oral and Maxillofacial Pathology, KM Shah Dental Collage & Hospital , SumandeepVidyapeeth, Vadodara, Gujarat, India
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29
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Shah SN, Chauhan GR, Manjunatha BS, Dagrus K. Drug induced erythema multiforme: two case series with review of literature. J Clin Diagn Res 2014; 8:ZH01-4. [PMID: 25386550 DOI: 10.7860/jcdr/2014/10173.4761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/14/2014] [Indexed: 12/27/2022]
Abstract
Erythema Multiforme, (EM) an uncommon, acute inflammatory reactive mucocutaneous disorder and primary allergies confined to the oral mucosa. However the subsequent attacks can produce more severe forms of EM involving the skin. Manifestations of EM are varied and present a diagnostic dilemma because infections (particularly herpes simplex and mycoplasma pneumoniae) and drugs seem to predispose towards development of EM. We report two cases of EM in which drugs (Dioclofenac sodium & Amoxycilline) seems to be precipitating factor. In addition, the article reviews various aspects of EM as relevant to dental practice and highlight the associated potential etiologic agents, pathogenic mechanisms and therapies.
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Affiliation(s)
- Shreyas N Shah
- Senior Lecturer, Department of Oral and Maxillofacial Pathology, KM Shah Dental Collage & Hospital , SumandeepVidyapeeth, Vadodara, Gujarat, India
| | - Girish R Chauhan
- Reader, Department of Oral Pathology, Government Dental Collage & Hospital , Jamnagar, Gujarat, India
| | - B S Manjunatha
- Professor, Department of Oral and Maxillofacial Pathology, KM Shah Dental Collage & Hospital , SumandeepVidyapeeth, Vadodara, Gujarat, India
| | - Kapil Dagrus
- Senior Lecturer, Department of Oral and Maxillofacial Pathology, KM Shah Dental Collage & Hospital , SumandeepVidyapeeth, Vadodara, Gujarat, India
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30
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Shephard M, Hodgson T, Hegarty AM. Vesiculobullous disorders affecting the oral cavity. Br J Hosp Med (Lond) 2014; 75:502-8. [PMID: 25216166 DOI: 10.12968/hmed.2014.75.9.502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Martina Shephard
- Specialist Registrar in Oral Medicine, Eastman Dental Hospital, UCLH Foundation NHS Trust London, London
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31
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Satpute P, Yadav L, Ahmed R, Kashid A, Peter K. Herbal toothpowder induced erythema multiforme. J Clin Diagn Res 2014; 8:275-6. [PMID: 24783158 DOI: 10.7860/jcdr/2014/7694.4185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
Abstract
Herbal toothpowders are available in market in a wide varieties, which consist of various ingredients. In rural areas of the developing countries, they are still used for cleansing teeth. Erythema multiforme (EM) is an acute mucocutaneous disorder that is believed to be a sequel of a cytotoxic immunologic attack on keratinocytes which express non-self-antigens. A 31-year-old male who used herbal toothpowder for oral-hygiene maintenance presented with ulcers in mouth, encrustation on lips and target lesions on both hands, suggesting Erythema multiforme. An oral biopsy confirmed the diagnosis. To the best of our knowledge, there is no report of an association of herbal extracts and EM in the English literature. With this report, we present a rare new triggering factor of Erythema mutiforme, thus adding it to the endless list of aetiologies.
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Affiliation(s)
- Pranali Satpute
- Assistant Professor, Department of Dentistry, Government, Dental College and Hospital , Nagpur, India
| | - Lalita Yadav
- Assistant Professor, Department of Oral Pathology and Microbiology, Dental College and Hospital , Meerut (U.P), India
| | - Riyaz Ahmed
- Assistant Professor, Department of Dentistry, Dental College and Hospital , Akola, India
| | - Avinash Kashid
- Assistant Professor, Department of Dentistry, S.R.T.R.Government Medical college and Hospital , Ambajogai, India
| | - Kalpak Peter
- Assistant Professor, Department of Periodontology, Dental College and Hospital , Nagpur, India
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32
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Patil B, Hegde S, Naik S, Sharma R. Oral blistering - report of two cases of erythema multiforme & literature review. J Clin Diagn Res 2013; 7:2080-3. [PMID: 24179950 DOI: 10.7860/jcdr/2013/5171.3412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 08/13/2013] [Indexed: 11/24/2022]
Abstract
Erythema multiforme and related disorders comprise a group of mucocutaneous disorders that often compromise the quality of life. The clinical classification of these disorders is variable, thus making definitive diagnosis difficult. Early recognition and prompt management will benefit the patients. This article highlights two such cases of erythema multiforme with detailed literature review on etiopathogenesis, clinical features, and treatment.
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Affiliation(s)
- Bharati Patil
- Reader, Department of Oral Medicine and Radiology, The Oxford Dental College and Hospital Bangalore, Karnataka, India
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33
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Vierucci F, Tuoni C, Moscuzza F, Saggese G, Consolini R. Erythema multiforme as first sign of incomplete Kawasaki disease. Ital J Pediatr 2013; 39:11. [PMID: 23406772 PMCID: PMC3632492 DOI: 10.1186/1824-7288-39-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/09/2013] [Indexed: 12/18/2022] Open
Abstract
Incomplete Kawasaki disease represents a diagnostic challenge for pediatricians. In the absence of classical presentation, the laboratoristic evaluation of systemic inflammation can help in placing the correct diagnosis to promptly start adequate therapy. Erythema multiforme is an acute, self-limiting condition considered to be a hypersensitivity reaction commonly associated with various infections or medications. This aspecific skin condition has been rarely described as a sign of Kawasaki disease. We report on the case of a 4 years old boy presenting high-grade fever associated with erythema multiforme and evidence of systemic inflammation who showed a good response to prompt treatment with intravenous immunoglobulins.
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Affiliation(s)
- Francesco Vierucci
- Pediatric Unit, Maternal & Infant Department, S. Chiara University-Hospital, Via Roma 67, Pisa 56126, Italy.
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34
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Affiliation(s)
- Nisha C Desai
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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35
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Sargenti Neto S, de Paulo LFB, Rosa RR, Durighetto AF. Stevens-Johnson syndrome: an oral viewpoint. Int J Pediatr Otorhinolaryngol 2013; 77:284-6. [PMID: 23149180 DOI: 10.1016/j.ijporl.2012.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 10/22/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
The Stevens-Johnson syndrome (SJS) is a severe variant of erythema multiforme (EM) that occasionally can rise to systemic upset and possibly compromise life. In this report, we described important oral and dermatologic aspects of a case of SJS triggered by Mycoplasma pneumoniae infection.
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Affiliation(s)
- Sergio Sargenti Neto
- Program of Specific Care of Oral Diseases, Stomatology Diagnosis Unit, Faculty of Dentistry, Federal University of Uberlândia, MG, Brazil
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36
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Abstract
Ciprofloxacin is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with ciprofloxacin are rare with an incidence of 0.6%. One of the side effects of ciprofloxacin is erythema multiforme (EM). EM is an acute, self -limiting mucocutaneous hypersensitivity syndrome. It exhibits a diverse etiology, often recurs, has unusual clinical features and is of uncertain etiopathogenesis. It usually exhibits a distinctive skin or mucosal lesions that are characterized by combination of bullae, papules, macules or ulcers. It is most probably an immunologically mediated process. With the use of ciprofloxacin becoming more and more widespread, fatal complications of ciprofloxacin should be borne in mind. In this article we present a case of ciprofloxacin induced erythema multiforme in 40 year old woman.
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Affiliation(s)
- H S Shilpashree
- Department of Oral Medicine and Radiology, RKDF Dental College and Research Center, Bhopal, Madhya Pradesh, India
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37
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Abstract
Erythema multiforme is an acute and a self-limiting mucocutaneous hypersensitivity reaction triggered by certain infections and medications. One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus. Herpes associated erythema multiforme (HAEM) is an acute exudative dermatic and mucosal disease caused by the infecting herpes simplex virus. It has recurrence and idiorestriction, characterized by increasing of CD4+T leukomonocyte. This article reports a case of HAEM in a 9-year-old girl, with a review of relevant literature, and discusses the pathophysiology and treatment of erythema multiforme triggered by herpes simplex virus
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Affiliation(s)
- K A Kamala
- Department of Oral Medicine and Radiology, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Science and Research Center, Belgaum, India
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38
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Beckwith H. Erythema multiforme: a simple rash or sinister sign? BMJ Case Rep 2012; 2012:bcr.11.2011.5072. [PMID: 22665466 DOI: 10.1136/bcr.11.2011.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hannah Beckwith
- Acute Medicine Department, Whipps Cross Hospital, London, UK.
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39
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Kohli PS, Kaur J. Erythema multiforme-oral variant: case report and review of literature. Indian J Otolaryngol Head Neck Surg 2011; 63:9-12. [PMID: 22754823 PMCID: PMC3146678 DOI: 10.1007/s12070-011-0169-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 05/26/2008] [Indexed: 11/28/2022] Open
Abstract
Erythema multiforme (EM) is an interesting dermatologic disease which has oral manifestations. EM is clinically characterized by a "minor" form and a "major" form. It presents a diagnostic dilemma because the oral cavity has the ability to produce varied manifestations. Infections (particularly herpes simplex and mycoplasma pneumonia) and drugs seem to predispose toward the development of EM. The range of possible etiologies for oral disease is immense. Therefore, an otolaryngologist or a dentist while treating such patients should have a differential diagnosis for all oral lesions. We report a case of erythema multiforme in which alcohol (ethanol) seems to be the precipitating factor and have also reviewed the English literature in the present context.
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Affiliation(s)
| | - Jasbir Kaur
- Adesh Hospital and Research Centre, Kotkapura road, Muktsar, 152026 India
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40
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Sankar V, Hearnden V, Hull K, Juras DV, Greenberg MS, Kerr AR, Lockhart PB, Patton LL, Porter S, Thornhill M. Local drug delivery for oral mucosal diseases: challenges and opportunities. Oral Dis 2011; 17 Suppl 1:73-84. [PMID: 21382140 DOI: 10.1111/j.1601-0825.2011.01793.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are few topical formulations used for oral medicine applications most of which have been developed for the management of dermatological conditions. As such, numerous obstacles are faced when utilizing these preparations in the oral cavity, namely enzymatic degradation, taste, limited surface area, poor tissue penetration and accidental swallowing. In this review, we discuss common mucosal diseases such as oral cancer, mucositis, vesiculo-erosive conditions, infections, neuropathic pain and salivary dysfunction, which could benefit from topical delivery systems designed specifically for the oral mucosa, which are capable of sustained release. Each condition requires distinct penetration and drug retention profiles in order to optimize treatment and minimize side effects. Local drug delivery may provide a more targeted and efficient drug-delivery option than systemic delivery for diseases of the oral mucosa. We identify those mucosal diseases currently being treated, the challenges that must be overcome and the potential of novel therapies. Novel biological therapies such as macromolecular biological drugs, peptides and gene therapy may be of value in the treatment of many chronic oral conditions and thus in oral medicine if their delivery can be optimized.
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Affiliation(s)
- V Sankar
- Department of Comprehensive Dentistry, The University of Texas Health Science Center at San Antonio, TX, USA
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41
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Schifter M, Yeoh SC, Coleman H, Georgiou A. Oral mucosal diseases: the inflammatory dermatoses. Aust Dent J 2010; 55 Suppl 1:23-38. [PMID: 20553242 DOI: 10.1111/j.1834-7819.2010.01196.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The oral inflammatory dermatoses is a term used to describe a number of predominantly immune-mediated disorders: lichen planus (LP), erythema multiforme (EM), the vesiculobullous diseases pemphigoid (MMP), pemphigus (PV) and epidermolysis bullosa acquisita (EBA). These conditions are characterized by frequent involvement of the oral mucosa and often associated with extraoral manifestations, particularly of the skin, but can involve the eyes, both the conjunctiva and sclera, the nasal and pharyngeal mucosa, as well as the genitals. Given their frequent, and sometimes initial involvement of the oral mucosa, oral health professionals need to be both familiar with the clinical features and presentations of these conditions, and appreciate their critical role in management. This paper reviews the clinical features and presentation of the oral dermatoses, provides guidance as to the appropriate investigations needed to differentiate and correctly diagnose these conditions, details the aetio-pathology of these diseases and discusses their management.
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Affiliation(s)
- M Schifter
- Oral Medicine/Oral Pathology Unit, Westmead Centre for Oral Health, Westmead Hospital, Sydney.
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42
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Sanchis JM, Bagán JV, Gavaldá C, Murillo J, Diaz JM. Erythema multiforme: diagnosis, clinical manifestations and treatment in a retrospective study of 22 patients. J Oral Pathol Med 2010; 39:747-52. [DOI: 10.1111/j.1600-0714.2010.00912.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Fu Y, Gregory DG, Sippel KC, Bouchard CS, Tseng SC. The Ophthalmologist's Role in the Management of Acute Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Ocul Surf 2010; 8:193-203. [DOI: 10.1016/s1542-0124(12)70234-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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44
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Erythema multiforme caused by Treponema pallidum in a young patient with human immunodeficiency virus infection. J Clin Microbiol 2010; 48:2640-2. [PMID: 20504989 DOI: 10.1128/jcm.00075-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Erythema multiforme (EM) is usually caused by drug reactions or virus infection. We report a case of secondary syphilis presenting as EM in an HIV-infected patient, proved by immunohistochemical staining, which is rare in the literature. It is valuable to determine the etiology of EM to optimize treatment.
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Edwards PC, Hess S, Saini T, Norton N. Twenty-eight-year-old woman with recent onset of painful oral erosions. J Oral Maxillofac Surg 2010; 68:1890-5. [PMID: 20417592 DOI: 10.1016/j.joms.2009.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 06/30/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Paul C Edwards
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA.
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46
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Flynn TR, Hunter GJ, Johnson MM. Case records of the Massachusetts General Hospital. Case 6-2010. A 37-year-old man with a lesion on the tongue. N Engl J Med 2010; 362:740-8. [PMID: 20181976 DOI: 10.1056/nejmcpc0910089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas R Flynn
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, USA
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47
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Ng F, Mammen OK, Wilting I, Sachs GS, Ferrier IN, Cassidy F, Beaulieu S, Yatham LN, Berk M. The International Society for Bipolar Disorders (ISBD) consensus guidelines for the safety monitoring of bipolar disorder treatments. Bipolar Disord 2009; 11:559-95. [PMID: 19689501 DOI: 10.1111/j.1399-5618.2009.00737.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Safety monitoring is an important aspect of bipolar disorder treatment, as mood-stabilising medications have potentially serious side effects, some of which may also aggravate existing medical comorbidities. This paper sets out the International Society for Bipolar Disorders (ISBD) guidelines for the safety monitoring of widely used agents in the treatment of bipolar disorder. These guidelines aim to provide recommendations that take into consideration the balance between safety and cost-effectiveness, to highlight iatrogenic and preventive clinical issues, and to facilitate the broad implementation of therapeutic safety monitoring as a standard component of treatment for bipolar disorder. METHODS These guidelines were developed by an ISBD workgroup, headed by the senior author (MB), through an iterative process of serial consensus-based revisions. After this, feedback from a multidisciplinary group of health professionals on the applicability of these guidelines was sought to develop the final recommendations. RESULTS General safety monitoring recommendations for all bipolar disorder patients receiving treatment and specific monitoring recommendations for individual agents are outlined. CONCLUSIONS These guidelines are derived from evolving and often indirect data, with minimal empirical cost-effectiveness data available to provide guidance. These guidelines will therefore need to be modified to adapt to different clinical settings and health resources. Clinical acumen and vigilance remain critical ingredients for safe treatment practice.
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Affiliation(s)
- Felicity Ng
- Discipline of Psychiatry, School of Medicine, University of Adelaide, SA, Australia
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48
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Recurrent erythema multiforme after alcohol ingestion in a patient receiving ciprofloxacin: a case report. CASES JOURNAL 2009; 2:7787. [PMID: 19830014 PMCID: PMC2740177 DOI: 10.4076/1757-1626-2-7787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 06/18/2009] [Indexed: 11/08/2022]
Abstract
The incidence of cutaneous adverse reactions to quinolones is low; moreover their development in patients with concomitant alcohol consumption is a phenomenon that has been scarcely reported. We present a case of 46-year-old male who developed erythema multiforme after ingestion of alcohol, while being treated with ciprofloxacin. The lesion was self-limiting and abstinence from alcohol permitted the completion of the course of therapy without any other adverse reaction.
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Muñoz-Corcuera M, Esparza-Gómez G, González-Moles MA, Bascones-Martínez A. Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers. Clin Exp Dermatol 2009; 34:289-94. [PMID: 19309371 DOI: 10.1111/j.1365-2230.2009.03220.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. They can be classified as acute or chronic according to their presentation and progression. Acute oral ulcers are be associated with conditions such as trauma, recurrent aphthous stomatitis, Behçet's disease, bacterial and viral infections, allergic reactions or adverse drug reactions. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in the oral cavity. In the first part of this two-part review, acute oral ulcers are reviewed.
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Affiliation(s)
- M Muñoz-Corcuera
- Stomatology Department, Dental School, Complutense University of Madrid, Spain
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50
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Relevance and consequences of erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in gynecology. Arch Gynecol Obstet 2009; 280:851-4. [DOI: 10.1007/s00404-009-1008-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 02/10/2009] [Indexed: 10/21/2022]
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