1
|
Ding X, Xu F, Zhang X. Clinical therapeutic effects of topical agents in adult patients with human immunodeficiency virus-related oral mucosa ulcers: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23626. [PMID: 33578511 PMCID: PMC7886410 DOI: 10.1097/md.0000000000023626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The number of adult patients affected by the human immunodeficiency virus (HIV) still remains high, mainly in the developing countries. However, only a few affected patients fail to experience oral lesions in the course of their experience with the virus. In particular, oral mucosa ulcers detected among HIV patients may be severe, which depictions may inhibit oral functioning and change patients' quality of life. Thus, it can result in considerable morbidity among this group of patients. To this end, the present study aims to examine the topical agent's clinical therapeutic efficacy among adult patients suffering from HIV-related oral mucosa ulcers. METHODS For the investigation, only randomized controlled trials on any topical agent used to treat adult patients with HIV oral mucosa ulcers are to be explored from different databases: PubMed, the Cochrane Library, PsycINFO, EMBASE, SCOPUS, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, VIP, and WanFang databases. All databases will be searched from their inceptions to October 2020. Additionally, 2 independent authors will evaluate the possibly eligible studies to be included in the study. They will also perform data's trial extraction and risk of bias assessment. Accordingly, all data will be analysed by means of the RevMan 5.3 software. RESULTS The present study seeks to evaluate the topical agents' clinical therapeutic efficacy to treat adult patients with HIV-related oral mucosa ulcers. CONCLUSION The study can be applicable in providing evidence of any topical agents for treating adult patients with HIV-related oral mucosa ulcers for clinical practice. PROTOCOL REGISTRATION NUMBER DOI 10.17605/OSF.IO/5CYR2 (https://osf.io/5cyr2/).
Collapse
|
2
|
Akagi T, Mukai T, Fujita S, Yamamoto T, Fukuda M, Morita Y. Severe oral stomatitis due to reactivation of herpes simplex virus type 1 in a methotrexate-treated patient with dermatomyositis. Immunol Med 2020; 44:56-60. [PMID: 32649847 DOI: 10.1080/25785826.2020.1787585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We herein report a case of a 79-year-old Japanese woman who developed severe oral stomatitis during methotrexate (MTX) treatment for dermatomyositis. She had been treated with MTX (12 mg/week) and prednisolone (5 mg/day) for dermatomyositis for 4 years. She developed painful stomatitis, fever, and pancytopenia. Initially, her symptoms were suspected to be caused by mucosal toxicity of MTX. Therefore, the drug was discontinued, and leucovorin was administered. However, oral stomatitis worsened in a few days, resulting in intolerance of oral ingestion due to severe pain. Polymerase chain reaction revealed the presence of herpes simplex virus type 1 (HSV-1) in oral erosive lesions, and blood examination was positive and negative for anti-HSV IgG and anti-HSV IgM, respectively. Therefore, HSV-1 reactivation-induced oral stomatitis was diagnosed, and acyclovir treatment was started, which promptly improved oral stomatitis. HSV-1 reactivation is usually asymptomatic or results in localized vesicular lesions at the mucocutaneous junction of the lips in immunocompetent individuals. Our case illustrates that HSV-1 reactivation induces severe stomatitis in patients treated with low-dose MTX for autoimmune diseases, not just in those with severe immunosuppressive conditions. Of note, HSV-1 reactivation-induced stomatitis is a diagnostic challenge, especially during MTX treatment.
Collapse
Affiliation(s)
- Takahiko Akagi
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Tomoyuki Mukai
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Shunichi Fujita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Takenobu Yamamoto
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Mikiko Fukuda
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshitaka Morita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
3
|
Abstract
Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease affecting the oral mucosa. RAS occurs mostly in healthy individuals and has an atypical clinical presentation in immunocompromised individuals. The etiology of RAS is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS using topical and systemic therapies is based on severity of symptoms and the frequency, size, and number of lesions. The goals of therapy are to decrease pain and ulcer size, promote healing, and decrease the frequency of recurrence.
Collapse
Affiliation(s)
- Sunday O Akintoye
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Martin S Greenberg
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA
| |
Collapse
|
4
|
Leite ACL, Barbosa FF, Cardoso MVDO, Moreira DRM, Coêlho LCD, da Silva EB, Filho GBDO, de Souza VMO, Pereira VRA, de C. Reis L, Ferreira PMP, Pessoa C, Wanderley AG, Mota FVB, da Silva TG. Phthaloyl amino acids as anti-inflammatory and immunomodulatory prototypes. Med Chem Res 2013. [DOI: 10.1007/s00044-013-0730-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
5
|
Honda M. [Current status and overview of HIV/AIDS infection]. ACTA ACUST UNITED AC 2012. [PMID: 23193646 DOI: 10.3950/jibiinkoka.115.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
6
|
Feller L, Khammissa RA, Wood NH, Meyerov R, Pantanowitz L, Lemmer J. Oral ulcers and necrotizing gingivitis in relation to HIV-associated neutropenia: a review and an illustrative case. AIDS Res Hum Retroviruses 2012; 28:346-51. [PMID: 21728927 DOI: 10.1089/aid.2011.0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An unusual case of necrotizing gingivitis and neutropenic oral ulcers in an HIV-seropositive patient is presented. In spite of a very low CD4(+) T cell count and severe neutropenia, the necrotizing gingivitis responded favorably to standard periodontal treatment, and the oral ulcers healed after administration of granulocyte colony-stimulating factor (G-CSF). Nonspecific oral ulcers in HIV-seropositive subjects with neutropenia should be regarded as neutropenic ulcers. The term nonspecific ulcers should be restricted to those ulcers with nonspecific histopathological features in patients without neutropenia or a nutritional deficiency such as iron, folic acid, and vitamin B.
Collapse
Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Razia A.G. Khammissa
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Neil H. Wood
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Robin Meyerov
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Centre, Pittsburgh, Pennsylvania
| | - Johan Lemmer
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| |
Collapse
|
7
|
Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S. Recurrent aphthous stomatitis: a review. J Oral Pathol Med 2012; 41:577-83. [PMID: 22413800 DOI: 10.1111/j.1600-0714.2012.01134.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recurrent aphthous stomatitis (RAS) is a common clinical condition producing painful ulcerations in oral cavity. The diagnosis of RAS is based on well-defined clinical characteristics but the precise etiology and pathogenesis of RAS remain unclear. The present article provides a detailed review of the current concepts and knowledge of the etiology, pathogenesis, and management of RAS.
Collapse
Affiliation(s)
- Mahesh Chavan
- Department of Oral Medicine and Radiology, Dr. D. Y. Patil Dental College, Pune, India.
| | | | | | | | | | | |
Collapse
|
8
|
Abstract
BACKGROUND In HIV-infected adults, oral ulcers occur more frequently, last longer and produce more painful symptoms than in immunocompetent people. Oral aphthous ulcers observed during the course of HIV infection may be severe and can result in significant morbidity in these patients. Such manifestations may interfere with oral functions and alter patients' quality of life. OBJECTIVES To evaluate the efficacy and side effects of topical agents used in the treatment of HIV-related oral aphthous ulcers in adults. SEARCH METHODS The following electronic databases were searched from the year 1980 to May 2011 for randomised controlled trials involving managements of oral ulcers, apthouses in HIV infected adults: EMBASE, PUBMED, the Cochrane Central Register of Controlled Trials (CENTRAL). SELECTION CRITERIA Only randomised controlled trials that evaluated the efficacy of any topical agent in treating HIV oral aphthous ulcerations in HIV positive adults were considered. DATA COLLECTION AND ANALYSIS Two authors independently assessed the potentially eligible studies for inclusion. We did not find any studies that meet our eligibility criteria. Therefore, no analysis was performed. MAIN RESULTS A total of 233 abstracts were retrieved from the databases searched. None of the identified studies met our inclusion criteria. Ten of the studies identified were reports of systemic rather than topical treatment. Therefore, no studies were included in this review. AUTHORS' CONCLUSIONS There is a need for well designed studies to evaluate the efficacy and safety of topical agents for the treatment of HIV related oral aphthous ulcers.
Collapse
Affiliation(s)
- Teslim Kuteyi
- Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos,
| | | |
Collapse
|
9
|
Pilotte AP, Hohos MB, Polson KMO, Huftalen TM, Treister N. Managing stomatitis in patients treated with Mammalian target of rapamycin inhibitors. Clin J Oncol Nurs 2012; 15:E83-9. [PMID: 21951751 DOI: 10.1188/11.cjon.e83-e89] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mammalian target of rapamycin (mTOR) inhibitors are a class of targeted cancer therapeutic agents with clinical benefit for multiple tumor types. Oral ulcerations are a common side effect of mTOR inhibitors; however, the clinical findings resemble aphthous stomatitis rather than the mucositis seen with chemotherapy. Consequently, the appearance of aphthous-like oral ulcerations has been referred to as mTOR inhibitor-associated stomatitis (mIAS). The severity of mIAS can be minimized by following common preventive steps and initiating treatment at the first sign of mouth discomfort, thereby reducing the likelihood of treatment discontinuation. mIAS can be managed through prophylactic measures, such as patient education in oral hygiene and avoidance of triggers. Patients who develop mIAS may be treated topically using rinses or other local therapies, including corticosteroids. In severe cases, dose modifications may be required. Oncology nurses have an important role in the management of patients with cancer and are well positioned to offer strategies for minimizing the occurrence and impact of mIAS.
Collapse
Affiliation(s)
- Amy Potter Pilotte
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | | | | | | | | |
Collapse
|
10
|
Topical use of systemic drugs in dermatology: A comprehensive review. J Am Acad Dermatol 2011; 65:1048.e1-22. [DOI: 10.1016/j.jaad.2010.08.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 07/28/2010] [Accepted: 08/06/2010] [Indexed: 11/24/2022]
|
11
|
O’Neill I. Efficacy of tumour necrosis factor-α antagonists in aphthous ulceration: review of published individual patient data. J Eur Acad Dermatol Venereol 2011; 26:231-5. [DOI: 10.1111/j.1468-3083.2011.04041.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
12
|
Smith JA. HIV and AIDS in the Adolescent and Adult: An Update for the Oral and Maxillofacial Surgeon. Oral Maxillofac Surg Clin North Am 2008; 20:535-65. [DOI: 10.1016/j.coms.2008.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
13
|
Corticoides tópicos en la estomatitis aftosa recurrente. Revisión sistemática. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73314-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
14
|
Hegarty AM, Chaudhry SI, Hodgson TA. Oral healthcare for HIV-infected patients: an international perspective. Expert Opin Pharmacother 2008; 9:387-404. [DOI: 10.1517/14656566.9.3.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
15
|
Quijano D, Rodríguez M. Topical Corticosteroids in Recurrent Aphthous Stomatitis. Systematic Review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
16
|
Baccaglini L, Atkinson JC, Patton LL, Glick M, Ficarra G, Peterson DE. Management of oral lesions in HIV-positive patients. ACTA ACUST UNITED AC 2007; 103 Suppl:S50.e1-23. [PMID: 17379155 DOI: 10.1016/j.tripleo.2006.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 11/01/2006] [Indexed: 11/24/2022]
Abstract
HIV/AIDS is currently the leading cause of death in Africa and the fourth leading cause of death worldwide. This systematic review of the literature was conducted to evaluate the evidence for treatment of the most common oral lesions associated with HIV: oral candidiasis with or without oropharyngeal involvement (OPC), oral hairy leukoplakia (OHL), recurrent aphthous-like ulcerations (RAU), oral Kaposi's sarcoma (OKS), orolabial herpes simplex infection (HSV), oral herpes zoster infection (VZV), intraoral or perioral warts (HPV), and HIV-associated periodontal diseases. Treatment of HIV-associated salivary gland disease is addressed in a different section of this World Workshop. We found the largest body of evidence for treatment of OPC in HIV patients. Future trials will be needed to test drugs currently in development for treatment of Candida strains that are resistant to existing therapies. There were no double blind, placebo-controlled randomized clinical trials (RCT) for topical treatment of OHL, and only one RCT for systemic treatment of the lesion with desciclovir. Systemic thalidomide was the only drug tested in RCT for treatment or prevention of RAU. Only 1 double-blind RCT comparing vinblastine and sodium tetradecyl sulfate was identified for localized treatment of OKS. Three drugs (famciclovir, acyclovir, and valaciclovir) were shown to be effective in randomized, double-blind trials for treatment or suppression of mucocutaneous HSV lesions in HIV patients. In all 3 trials, the effects of these medications on orolabial HSV lesions were not reported separately. There were no double-blind, placebo-controlled RCT testing topical treatments for orolabial HSV lesions in HIV patients. No trials testing treatments of oral VZV were identified. There were no double-blind, placebo-controlled RCT for treatment of HIV-associated intraoral or perioral warts or periodontal diseases. In conclusion, there is a need for well-designed RCTs to assess the safety and efficacy of topical and systemic treatments of most oral mucosal and perioral lesions in HIV patients. There is also a need to develop newer drugs for treatment of resistant fungal and viral microorganisms. Finally, standardized outcome measures should be developed for future clinical trials to allow comparisons of studies using different populations.
Collapse
Affiliation(s)
- Lorena Baccaglini
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32610-3628, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Samet N, Laurent C, Susarla SM, Samet-Rubinsteen N. The effect of bee propolis on recurrent aphthous stomatitis: a pilot study. Clin Oral Investig 2007; 11:143-7. [PMID: 17285269 DOI: 10.1007/s00784-006-0090-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Accepted: 11/02/2006] [Indexed: 10/23/2022]
Abstract
Recurrent aphthous stomatitis (RAS) is a common, painful, and ulcerative disorder of the oral cavity of unknown etiology. No cure exists and medications aim to reduce pain associated with ulcers through topical applications or reduce outbreak frequency with systemic medications, many having serious side effects. The purpose of this pilot study was to evaluate the potential of a product to reduce the number of outbreaks of RAS ulcers. Propolis is a bee product used in some cultures as treatment for mouth ulcers. In this randomized, double-blind, placebo-controlled study, patients were assigned to take 500 mg of propolis or a placebo capsule daily. Subjects reported a baseline ulcer frequency and were contacted biweekly to record recurrences. Data were analyzed to determine if subjects had a decrease of 50% in outbreak frequency. The data indicated a statistically significant reduction of outbreaks in the propolis group (Fisher's exact test, one sided, p = 0.04). Patients in the propolis group also self-reported a significant improvement in their quality of life (p = 0.03). This study has shown propolis to be effective in decreasing the number of recurrences and improve the quality of life in patients who suffer from RAS. Propolis should be evaluated further in a larger sample clinical trial.
Collapse
Affiliation(s)
- Nachum Samet
- Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
18
|
Udovicić B. [Oral manifestation of HIV/AIDS]. VOJNOSANIT PREGL 2006; 63:663-6. [PMID: 16875427 DOI: 10.2298/vsp0607663u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Bozidar Udovicić
- Visa medicinska skola, Cara Dusana 254, 11 000 Beograd, Srbija i Crna Gora
| |
Collapse
|
19
|
Shrivastava R, John GW. Treatment of Aphthous Stomatitis with Topical Alchemilla vulgaris in Glycerine. Clin Drug Investig 2006; 26:567-73. [PMID: 17163290 DOI: 10.2165/00044011-200626100-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Recurrent aphthous ulceration is the most common oral mucosal disease known. It presents as three types: minor (most prevalent), major and herpetiform. However, there are no well established effective and reliable treatments of this condition. Alchemilla vulgaris (Lady's Mantle) has traditionally been used in oral hygiene and was recently shown to accelerate wound healing when used in combination with glycerine. The objective of this study was to determine whether this combination is effective in the treatment of the most prevalent form of aphthous ulcers. METHODS An open-label study was conducted in 48 otherwise healthy male and female patients aged 4-44 years to determine the putative healing properties and tolerability of a standard 3% extract of A. vulgaris in glycerine (Aphtarine) on common minor oral ulcers. Patients with major or herpetiform ulcers were excluded from the study. RESULTS Topical application three times daily of Aphtarine gel to minor mouth ulcers relieved discomfort and produced complete healing in the majority of patients (60.4%) within 2 days and in 75% within 3 days, compared with 10.4% and 33.3%, respectively, without treatment and 15% and 40%, respectively, with commonly available treatments. Most patients appreciated the product's ease of application, taste and texture. Aphtarine was well tolerated locally and most patients rated the product good to excellent overall. CONCLUSION Aphtarine is a safe, well tolerated and highly effective promising new treatment for healing common mouth ulcers.
Collapse
Affiliation(s)
- Ravi Shrivastava
- Naturveda-Vitro-Bio Research Institute, ZAC de Lavaur, Issoire, France
| | | |
Collapse
|
20
|
Abstract
The cause of recurrent aphthous stomatitis (RAS) remains unknown despite considerable research. This article reviews the evidence for current theories regarding this disorder, including possible suspected relationships with microbial and immunologic factors, and presents medical diseases that mimic RAS lesions in certain patients. Topical management of the common form of minor RAS is described along with systemic therapy currently available to patients with severe forms of this disease.
Collapse
Affiliation(s)
- Sunday O Akintoye
- The Robert Schnatter Center, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA
| | | |
Collapse
|