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Warner AJ, Hathaway-Schrader JD, Lubker R, Davies C, Novince CM. Tetracyclines and bone: Unclear actions with potentially lasting effects. Bone 2022; 159:116377. [PMID: 35248788 PMCID: PMC9035080 DOI: 10.1016/j.bone.2022.116377] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 01/11/2023]
Abstract
Tetracyclines are a broad-spectrum class of antibiotics that have unclear actions with potentially lasting effects on bone metabolism. Initially isolated from Streptomyces, tetracycline proved to be an effective treatment for Gram +/- infections. The emergence of resistant bacterial strains commanded the development of later generation agents, including minocycline, doxycycline, tigecycline, sarecycline, omadacycline, and eravacycline. In 1957, it was realized that tetracyclines act as bone fluorochrome labels due to their high affinity for the bone mineral matrix. Over the course of the next decade, researchers discerned that these compounds are retained in the bone matrix at high levels after the termination of antibiotic therapy. Studies during this period provided evidence that tetracyclines could disrupt prenatal and early postnatal skeletal development. Currently, tetracyclines are most commonly prescribed as a long-term systemic therapy for the treatment of acne in healthy adolescents and young adults. Surprisingly, the impact of tetracyclines on physiologic bone modeling/remodeling is largely unknown. This article provides an overview of the pharmacology of tetracycline drugs, summarizes current knowledge about the impact of these agents on skeletal development and homeostasis, and reviews prior work targeting tetracyclines' effects on bone cell physiology. The need for future research to elucidate unclear effects of tetracyclines on the skeleton is addressed, including drug retention/release mechanisms from the bone matrix, signaling mechanisms at bone cells, the impact of newer third generation tetracycline antibiotics, and the role of the gut-bone axis.
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Affiliation(s)
- Amy J Warner
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Jessica D Hathaway-Schrader
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Rena Lubker
- Medical University of South Carolina Libraries, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Stomatology-Division of Population Oral Health, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Christopher Davies
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Biochemistry & Molecular Biology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Chad M Novince
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Black bone disease of the skull incidentally discovered during endoscopic brow lifting. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Binmadi NO, Bawazir M, Alhindi N, Mawardi H, Mansour G, Alhamed S, Alfarabi S, Akeel S, Almazrooa S. Medication-Induced Oral Hyperpigmentation: A Systematic Review. Patient Prefer Adherence 2020; 14:1961-1968. [PMID: 33116439 PMCID: PMC7573322 DOI: 10.2147/ppa.s275783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Medication-induced oral hyperpigmentation is an oral condition that impacts patients' quality of life and has been linked to many systemic therapeutic agents. The exact pathogenesis of tissue pigmentation varies greatly and is not completely known. This systematic review aimed to present data on the causal association between medications and the development of oral/mucosal pigmentation as an adverse drug reaction. METHODS A systematic review and analysis of literature were conducted using the following databases: PubMed, Science Direct, ProQuest, Web of Science, and Scopus. The systematic review included original articles written in English and published between January 1982 and June 2020. Following the PRISMA statement, eligible articles were systematically reviewed, and data were extracted from eligible studies and analyzed. RESULTS A total of 235 articles were identified, of which 57 met the inclusion criteria and were included in this review. The mean age of included patients was 46.2±16.38 years (range: 10-90 years) with a male to female ratio of 1:1.45. Oral mucosal hyperpigmentation was reported following the use of several classes of medications such as antiviral (eg, zidovudine), antibiotic (eg, minocycline), antimalarial (eg, chloroquine), anti-fungal (eg, ketoconazole), antileprotic (eg, clofazimine), antihypertensive (eg, amlodipine), chemotherapeutic, and antineoplastic drugs. The risk of developing oral pigmentation was significantly higher with antimalarial medications, antibiotics, antineoplastic and chemotherapeutic agents. Medication-induced oral hyperpigmentation was most frequent among women and in the hard palate. CONCLUSION Future research is warranted to better understand the pathogenesis and risk factors for medication-induced oral hyperpigmentation in order to reassure patients during prescription and management.
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Affiliation(s)
- Nada O Binmadi
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maram Bawazir
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nada Alhindi
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani Mawardi
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghada Mansour
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sana Alhamed
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sarah Alfarabi
- 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
| | - Soulafa Almazrooa
- Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Teoh L, Moses G, McCullough MJ. A review and guide to drug‐associated oral adverse effects—Dental, salivary and neurosensory reactions. Part 1. J Oral Pathol Med 2019; 48:626-636. [DOI: 10.1111/jop.12911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Leanne Teoh
- Melbourne Dental School The University of Melbourne Carlton Victoria Australia
| | - Geraldine Moses
- School of Pharmacy University of Queensland Woolloongabba Queensland Australia
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5
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Tosios KI, Kalogirou EM, Sklavounou A. Drug-associated hyperpigmentation of the oral mucosa: report of four cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:e54-e66. [DOI: 10.1016/j.oooo.2017.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/14/2017] [Accepted: 10/23/2017] [Indexed: 12/22/2022]
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6
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Rusty green stained temporal bone associated with exposure to tetracycline: an unusual presentation of black bone disease. The Journal of Laryngology & Otology 2015; 129:276-8. [PMID: 25673477 DOI: 10.1017/s002221511500016x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To review the phenomenon and implications of temporal bone and craniofacial bone staining in the context of prolonged exposure to tetracycline antibiotic. METHODS Case report and literature review. RESULTS A 52-year-old male with a 5-year history of tetracycline use presented to undergo tympanomastoidectomy and was found to have an unusual rusty green pigmentation of the entire aspect of the exposed temporal bone. A literature review revealed more than 20 cases of tetracycline-induced pigmentation of intraoral maxillary and mandibular bone, and 2 prior cases involving the cranial bones. CONCLUSION Tissue and organ pigmentation is an unexpected and unfavourable consequence of the use of tetracyclines, particularly minocycline. Tetracycline is contraindicated in children because of the risk for dysosteogenesis and enamel hypoplasia. In adults, although the unusual staining may present as an unexpected dilemma upon surgical exposure, current research shows no significant clinical consequences for this type of pigmentation.
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Zuckerman MD, Boyle KL, Rosenbaum CD. Minocycline toxicity: case files of the University of Massachusetts medical toxicology fellowship. J Med Toxicol 2012; 8:304-9. [PMID: 22777680 DOI: 10.1007/s13181-012-0247-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Matthew D Zuckerman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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8
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Chan CM, Hicks DG, Giordano BD. Minocycline-Induced Bone Discoloration: A Case Report. JBJS Case Connect 2012; 2:e47. [PMID: 29252545 DOI: 10.2106/jbjs.cc.k.00153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Charles M Chan
- Department of Orthopaedics and Rehabilitation (C.M.C. and B.D.G.), Department of Pathology and Laboratory Medicine (D.G.H.), University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. . .
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Reed DN, Gregg FO, Corpe RS. Minocycline-induced black bone disease encountered during total knee arthroplasty. Orthopedics 2012; 35:e737-9. [PMID: 22588418 DOI: 10.3928/01477447-20120426-30] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Finding discolored bone intraoperatively can be confusing and concerning to orthopedic surgeons. Multiple causes of pigmented bone exist, including ochronosis, metabolic bone diseases, metal deposits, sequestrum, metastatic disease, and minocycline use. Bone quality is an important consideration in intraoperative decision making with respect to components and fixation options in total joint arthroplasty. Abnormal bone encountered in routine arthroplasty can raise concerns over the integrity and healing potential of the bone when the etiology is uncertain.Minocycline is a drug routinely used for the treatment of acne, rosacea, and rheumatoid arthritis. Pigmentation is a commonly recognized adverse reaction associated with most of the drugs in the tetracycline family, affecting the skin, nails, teeth, oral mucosa, bones in the oral cavity, ocular structures, cartilage, thyroid, and other visceral structures.This article describes a case of pigmented bone secondary to minocycline use in a 55-year-old woman undergoing total knee arthroplasty. This entity has rarely been documented in the orthopedic literature; however, orthopedic surgeons should be aware of this side effect secondary to the widespread use of minocycline. Questions concerning the effect of minocycline on bone metabolism and structural integrity have yet to be fully answered, but an understanding and recognition of the entity will help guide surgeons with intraoperative decision making.
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Affiliation(s)
- Dale N Reed
- Department of Orthopaedic Surgery, Georgia Health Sciences University, Augusta, GA 30912, USA.
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Laure B, Petraud A, Sury F, Bayol JC, Marquet-Van Der Mee N, de Pinieux G, Goga D. [Black bone disease of the skull and facial bones]. ACTA ACUST UNITED AC 2009; 110:303-5. [PMID: 19596380 DOI: 10.1016/j.stomax.2009.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 03/17/2009] [Accepted: 03/18/2009] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We report the case of a patient with a craniofacial black bone disease. This was discovered accidentally during a coronal approach. CASE REPORT A 38-year-old patient was referred to our unit for facial palsy having appeared 10 years before. Rehabilitation of the facial palsy was performed with a lengthening temporal myoplasty and lengthening of the upper eyelid elevator. An unusual black color of the skull was observed at incision of the coronal approach. Subperiostal dissection of skull and malars confirmed the presence of a black bone disease. A postoperative history revealed minocycline intake (200mg per day) during 3 years. DISCUSSION This craniofacial black bone disease was caused by minocycline intake. The originality of this case is to see directly the entire craniofacial skeleton black. This abnormal pigmentation may affect various organs or tissues. Bone pigmentation is irreversible unlike that of the mouth mucosa or of the skin. This abnormal pigmentation is usually discovered accidentally.
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Affiliation(s)
- B Laure
- Service de chirurgie maxillofaciale et plastique de la face, CHU Trousseau, route de Loche, 37044 Tours cedex, France.
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Peyriere H, Hillaire-Buys D, Dereure O, Meunier L, Blayac J. Muco-cutaneous pigmentation and photosensitization induced by minocycline hydrochloride. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639909056011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lapid-Gortzak R, Nieuwendaal CP, Slomovic AR, Spanjaard L. Corneal staining after treatment with topical tetracycline. Cornea 2006; 25:969-70. [PMID: 17102677 DOI: 10.1097/01.ico.0000224647.66472.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this paper is to report a case of corneal staining after treatment with topical tetracycline. METHODS A patient with crystalline keratopathy caused by Streptococcus viridans after corneal transplantation was treated topically with tetracycline eye drops, based on results of bacterial sensitivity testing. After 3 weeks of intensive treatment, the donor cornea was stained with a brownish hue, which was ascribed to the tetracycline drops. RESULTS One patient with crystalline keratopathy developed corneal staining after intensive treatment with topical tetracycline eye drops. After a year of follow-up, the staining of the cornea had not changed significantly. CONCLUSION Hourly topical tetracycline eye drops may induce corneal pigmentation. To our knowledge, this is the first published case report of corneal staining caused by tetracycline eye drops.
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Affiliation(s)
- Ruth Lapid-Gortzak
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
OBJECTIVE The goal of this review was to summarize the available literature covering the safety profiles of oral doxycycline and minocycline. METHODS Scientific literature published between 1966 and August 2003 was searched using the MEDLINE, EMBASE, and Biosis databases (search terms: minocycline or doxycycline, each paired with adverse reaction, adverse event, and side effect, and doxycycline or minocycline with the limits English language, human, and clinical trials). Safety information was collected from case reports and clinical trials. Adverse event (AE) rates in the United States were calculated by comparing data from the MedWatch AE reporting program used by the US Food and Drug Administration (FDA) with the number of new prescriptions dispensed for each drug from January 1998 to August 2003. RESULTS Between 1966 and 2003, a total of 130 and 333 AEs were published in case reports of doxycycline and minocycline, respectively. In 24 doxycycline clinical trials (n = 3833) and 11 minocycline trials (n = 788), the ranges in incidence of AEs were 0% to 61% and 11.7% to 83.3%, respectively. Gastrointestinal AEs were most common with doxycycline; central nervous system and gastrointestinal AEs were most common with minocycline. From January 1998 to August 2003, the FDA MedWatch data contained 628 events for doxycycline and 1099 events for minocycline reported in the United States. Approximately 47,630,000 doxycycline and 15,234,000 minocycline new prescriptions were dispensed in the United States during that period, yielding event rates of 13 per million for doxycycline and 72 per million for minocycline, based on FDA data. CONCLUSIONS Between 1998 and 2003, doxycycline was prescribed 3 times as often as minocycline. The incidence of AEs with either drug is very low, but doxycycline had fewer reported AEs. Although more head-to-head clinical trials are needed for a direct comparison of AE frequency, these preliminary data from separate reports suggest the possibility that AEs may be less likely with doxycycline than minocycline.
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Affiliation(s)
- Kelly Smith
- Warner Chilcott Laboratories, Rockaway, NJ 07866, USA.
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Dodiuk-Gad RP, de Morentin HM, Schafer J, Harel A, Neudorfer M, Misonzhnik F, Gitstein G, Rozenman D, Tur E, Brenner S. Minocycline-induced cutaneous hyperpigmentation: confocal laser scanning microscope analysis. J Eur Acad Dermatol Venereol 2006; 20:435-9. [PMID: 16643143 DOI: 10.1111/j.1468-3083.2006.01436.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Minocycline has a characteristic yellow-green fluorescent emission. This fluorescence has been previously demonstrated only in type 1 minocycline-induced skin hyperpigmentation. OBJECTIVE To investigate whether the fluorescence can be detected in other types of minocycline-induced cutaneous hyperpigmentation, and to study the possible mechanisms. METHODS Biopsies of pigmented and nonpigmented skin from 3 patients with different types of skin hyperpigmentation induced by minocycline were analysed by light microscopy and Confocal Laser Scanning Microscope (CLSM). RESULTS A yellow-green fluorescence was observed in the hyperpigmented skin of two patients with type 2, and one patient with type 4 minocycline-induced cutaneous hyperpigmentation. No fluorescence was detected in the non-pigmented skin. CONCLUSION Minocycline can possibly serve as a fluorescent probe in the diagnosis of all types of minocycline-induced cutaneous hyperpigmentation.
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Affiliation(s)
- R P Dodiuk-Gad
- Department of Dermatology, Ha'emek Medical Center, Afula, Israel
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Affiliation(s)
- Matthew J Hepburn
- Department of Medicine, Brooke Army Medical Center, Ft Sam Houston, TX, USA
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Abstract
Minocycline-induced dark pigmentation has been described affecting the oral cavity (teeth, mucosa, alveolar bone), skin, nails, eyes and thyroid. To date, there is no report of other bones being affected. We report a case of black pigmentation of the acromian in a patient who had used minocycline on a long-term basis for acne rosecea. Biopsy of the iliac crest revealed that the pelvis was also affected.
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Affiliation(s)
- S Pandit
- Perth Royal Infirmary, Perth PH1 1NX, UK.
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Treister NS, Magalnick D, Woo SB. Oral mucosal pigmentation secondary to minocycline therapy: report of two cases and a review of the literature. ACTA ACUST UNITED AC 2004; 97:718-25. [PMID: 15184854 DOI: 10.1016/j.tripleo.2003.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Minocycline is a semisynthetic broad-spectrum antimicrobial agent that was first introduced into clinical practice in 1967. The most common use of minocycline is for the long-term treatment of acne vulgaris. A well-recognized side effect of minocycline treatment is pigmentation, which has been reported in multiple tissues and fluids including thyroid, skin, nail beds, sclera, bone, and teeth. While there have been several reports of oral pigmentation following minocycline therapy, these have been, for the most part, pigmentation of the underlying bone with the overlying oral mucosa only appearing pigmented. We report two cases of actual pigmented oral mucosal lesions on the hard palate secondary to minocycline therapy with the accompanying histopathology, followed by a discussion of minocycline-induced oral pigmentation and a differential diagnosis of these lesions.
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Affiliation(s)
- Nathaniel S Treister
- Department of Oral Medicine, Infection, and Immunity, Harvard University School of Dental Medicine, Boston, MA, USA.
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Abstract
OBJECTIVE The aim of this study was to investigate the antibacterial effect of Coptidis Rhizoma (CR), a traditional medicinal plant, on oral bacteria. MATERIALS AND METHODS CR extract was prepared by boiling CR in water for 2 h. Alkaloids contained in CR extract were assayed by high performance liquid chromatography (HPLC). Antibacterial activity of CR extract was estimated from the lowest concentration that did not permit bacterial growth (minimum inhibitory concentration, MIC) and the concentrations that inhibited 50% of bacterial proteolytic activity (IC50). RESULTS CR extract inhibited the growth of Actinomyces naeslundii, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Actinobacillus actinomycetemcomitans at MIC of 0.031-0.25 mg ml(-1), whereas it had less inhibitory effect (MIC: 0.5-2 mg ml(-1)) on the growth of Streptococcus and Lactobacillus. The major active component of CR extract was berberine (Ber), an alkaloid, and its inhibiting specificity to bacterial growth was similar to that of CR extract. CR extract and Ber were bacteriostatic at the MICs against most of the bacteria, and bacteriocidal at the concentrations higher than the MICs. Ber inhibited the activities of collagenase from P. gingivalis and A. actinomycetemcomitans. CONCLUSION CR extract and Ber had an inhibitory effect on periodontopathogenic bacteria. These results suggest the possibility of their clinical application for the treatment of periodontal diseases.
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Affiliation(s)
- J P Hu
- Department of Oral Biochemistry, Tohoku University School of Dentistry, Sendai, Japan
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Abstract
Minocycline is a semisynthetic tetracycline used in the treatment of inflammatory acne because of its broad spectrum of activity, less common development of resistant organisms, and its anti-inflammatory effects. A number of adverse reactions are reported, including skin and oral pigmentation. This paper details the pharmacology of minocycline and describes the pigmentation and likely mechanisms active in both hard and soft tissues. Oral pigmentation usually involves the hard tissues only and presents typically as a discrete band occupying the central zone of the alveolar mucosa and palate. As with other sites, it may persist following withdrawal of the drug. Early recognition by the dental practitioner may allow an alternative form of therapy to be sought, minimizing the likelihood of a long-term aesthetic problem.
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Abstract
Several of the more common oral lesions secondary to medication use have been presented in this article. Although some of these conditions are specific to the oral tissues, some are not. Numerous cutaneous reactions to medications have mucosal counterparts. It is important for the clinician to recognize that many oral lesions are simply a manifestation of a systemic condition and should be managed with that in mind.
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