Contact sensitisation in oral lichen planus: An Australian perspective

BACKGROUND

The role of contact sensitisation in the pathogenesis of oral lichen planus (OLP) has not been clearly defined.

OBJECTIVE

We aimed to evaluate relevant contact sensitisers in OLP.

METHODS

A retrospective study was conducted on OLP patients who underwent patch testing from 1 January 2006 to 31 December 2020 at an Australian tertiary dermatology institution, compared to cheilitis patients patch tested over the same time period.

RESULTS

Ninety-six OLP patients and 152 cheilitis patients were patch tested during the 15-year period. Seventy-one (73.9%) OLP patients and 100 (65.8%) cheilitis patients recorded one or more relevant reactions. Forty-three (44.8%), 22 (22.9%), 21 (21.9%) and 17 (17.7%) OLP patients had relevant reactions to mercury-related chemicals, amalgam, spearmint and carvone, respectively, compared to 6 (3.9%), 3 (2.0%), 4 (2.6%) and 0 (0%) cheilitis patients, respectively (p-value <0.001 each). Four (4.2%) OLP patients had relevant positive reactions to sodium metabisulfite, compared to none in the cheilitis group (p-value 0.021).

CONCLUSION

While dental amalgam is used less frequently these days, we report that mercury (found in amalgam) and additionally spearmint and carvone are relevant sensitisers in OLP in Australia. Sodium metabisulfite may also be a relevant sensitiser in OLP, which has not previously been reported.

Prevalence and causative allergens of contact cheilitis in Thailand

BACKGROUND

Cheilitis is an inflammatory condition of the lips. Its causes can be exogenous (irritants, allergens), endogenous (atopic dermatitis, systemic disorders) or unknown.

OBJECTIVES

To determine the prevalence of allergic contact cheilitis (ACC), its risk factors, and common allergens in patients with cheilitis at a Thai university-based tertiary care hospital.

METHODS

A retrospective chart review was conducted on patients with cheilitis referred for patch testing between January 2007 and December 2021.

RESULTS

Among 5366 patients referred for patch testing, 410 (7.6%) had cheilitis. ACC was diagnosed in 32% of the cheilitis patients. Compared to non-ACC cases, the patients with ACC were more likely to be young and female and have a disease duration of <3 months, no underlying disease and a white-collar job (p-value <0.05). The most common contact allergens were patient's products (73.3%), nickel sulfate (29.8%), potassium dichromate (14.5%), castor oil (14.3%) and benzalkonium chloride (13.0%). Lip cosmetics and toothpastes were major ACC sources.

CONCLUSIONS

ACC should be considered in cheilitis patients, especially in patients with specific risk factors. Castor oil is an emerging allergen. Patch testing using commercial allergen series and patients' own products is crucial for identifying causative agents. The development of a specific cheilitis series is warranted.

Effectiveness Of Oral Omega 3 In Reducing Mucocutaneous Side Effects Of Oral Isotretinoin In Patients With Acne Vulgaris

BACKGROUND

Acne vulgaris has been a common clinical condition. Due to. high prevalence and unclear etio-pathogenesis of acne vulgaris, large number of treatment options have been available across the globe. Limited work has been done to explore the options which may manage or prevent these adverse effects and improve the adherence to the prescribed medications. We therefore conducted this trial to look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris.

OBJECTIVE

To look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. It was a randomized control trial conducted at Department of Dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020.

METHODS

A total of 60 patients of acne vulgaris put on oral isotretinoin by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the placebo along with oral isotretinoin while Group B received oral omega 3 in standard dose in addition to oral isotretinoin. Comparison was made in both the groups regarding common mucocutaneous side effects.

RESULTS

Out of 60patients with acne vulgaris and put on isotretinoin included in the study, 26 (43.3%) received placebo in addition to isotretinoin while 34 (56.7%) received omega 3 in addition to isotretinoin. Forty (66.7%) patients were female while 20 (33.3%) were male. Cheilitis 35 (58.3%) was the commonest side effect followed by lip dryness 33 (55%). Application of chi-square test revealed that cheilitis, lip dryness and xerosis were significantly found in more patients who received placebo as compared to those who received omega 3 along with isotretinoin.

CONCLUSION

Mucocutaneous side effects were a very common finding among patients of acne vulgaris managed with isotretinoin. Cheilitis was the most reported mucocutaneous side effects among the target population. This RCT demonstrated that omega 3 was superior to placebo in order to prevent or manage cheilitis, xerosis or dry lips.

Reviewing the use of imiquimod for molluscum contagiosum

We discuss imiquimod associated with non-application site mucosal reactions and two of our own clinical cases. In one of our patients, erosive cheilitis developed in a young boy after using topical imiquimod 5% cream for 5 nights weekly on bilateral cheeks, chin, and near vermillion border for molluscum contagiosum. The case is discussed with concerns for imiquimod use in molluscum contagiosum when used near mucosal surfaces.

P2X3 receptor mediates ectopic mechanical allodynia with inflamed lower lip in mice

Ectopic pain in other orofacial regions develops with local inflammation in separated orofacial structures. However, the basis for the spreading of pain to adjacent orofacial areas after local inflammation is still unknown. In the present study, we determined if the P2X(3) receptor (P2X(3)R) was associated with altered mechanical sensitivity of the whisker pad skin following complete Freund's adjuvant (CFA) injection into the lower lip. Mice with local inflammation induced by CFA injection into the lower lip demonstrated significant mechanical allodynia of whisker pad skin. The mechanical allodynia was reversed by P2X(3)R antagonist, A-317491 administration into whisker pad skin. The number of P2X(3)R and calcitonin gene-related peptide (CGRP) positive trigeminal ganglion (TG) neurons that innervates the whisker pad skin and lower lip was increased after CFA injection into the lower lip. CGRP protein expression in TG ipsilateral to CFA injection was also significantly greater than that of the saline-injected mice. The present findings suggest that induced CGRP by local inflammation in the lower lip increases P2X(3)R in TG neurons, the increased P2X(3)Rs are involved in the sensitization of primary afferent neurons in the whisker pad skin. This P2X(3)R overexpression may underlie ectopic mechanical allodynia in the whisker pad skin after CFA injection into the lower lip.

Oral side effects of isotretinoin chronic intake

Isotretinoin (13-cis-retinoic acid) is a retinoid that has been used for the past 20 years to treat a variety of dermatologic conditions. It is beneficial in many skin conditions, although its side effects and toxicity require careful monitoring by physicians and other health professionals, among them, dentists, who should be prepared to manage an adverse occurrence. In this paper, the oral side effects of isotretinoin are described; and some of them are illustrated.

Treatment of a Patient with Metal Hypersensitivity after Orthognathic Surgery

In this case report, orthodontic materials may have induced metal allergic reactions in the form of lip swelling and redness after orthognathic surgery. Two months after surgery, the patient suffered continuous lip swelling and redness. She visited a dermatological hospital and was diagnosed with herpes. However, since her symptoms did not improve after 1-month of drug therapy, a metal allergy was subsequently suggested. Patch tests conducted in the dental hospital revealed reactions to chromium, which is not used in prosthetic appliances. For confirmation, the metal composition of all prosthetic appliances was examined using a fluorescent x-ray analyzer, but no chromium was detected (copper, gold, palladium, and silver were detected). However, the orthodontic brackets, wires, and bands do contain chromium and, considering that they may have induced the metal allergic reactions, they were replaced with materials made of polymer with no metals. As a result, the lip swelling and redness improved. For retention, the anterior part of the retainer was bonded on the lingual side of the anterior lower and upper jaws. During retention, no further symptoms of hypersensitivity were observed, suggesting that the nonmetal polymer is useful for treatment of metal allergic patients.

Allergic contact cheilitis from a lipstick misdiagnosed as herpes labialis: Subsequent worsening due to Zovirax�contact allergy

A 29-year-old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax cream. Patch tests were positive to Zovirax cream, propylene glycol, the patient's favourite lipstick and propyl gallate. No reaction was seen with Zovirax ophthalmic ointment and Zovirax tablet. The propylene glycol component of the Zovirax cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.

Valproic acid combined with 13-cis retinoic acid and 1,25-dihydroxyvitamin D3 in the treatment of patients with myelodysplastic syndromes

Valproic acid (VPA), an inhibitor of histone deacetylases, inhibits the growth of leukemia cells and induces their differentiation in vitro. In the present study, VPA in combination with two differentiating agents, 13-cis retinoic acid and 1,25-dihydroxyvitamin D3, was given to 19 previously untreated patients with MDS or CMML. Eight patients had to discontinue treatment before week 16 due to toxicity. According to international working group criteria, three patients (16%) responded to treatment. No correlation between VPA serum level, histone acetylation or clinical response was observed.

Allergic contact cheilitis due to geraniol in food

Fragrance materials are present in many foods and are referred to as flavours and spices. However, despite their widespread use, there are few reports of allergic contact dermatitis caused by these additives. Here, we report contact allergy to geraniol in a patient who developed cheilitis on exposure to certain foods.

Severe reaction to 5% imiquimod cream with excellent clinical and cosmetic outcomes

Imiquimod, an immune response modifier approved for the treatment of external genital warts, actinic keratoses, and superficial basal cell carcinoma, can induce a severe local inflammatory response. This phenomenon can accompany inappropriately overzealous, as well as entirely conventional, drug utilization. Despite strikingly brisk reactions, the 9 patients reported herein ultimately experienced excellent cosmetic and clinical outcomes. We report this series to alert clinicians of the good prognosis for a satisfactory outcome even when faced with extreme imiquimod cream-induced inflammation.

Cheilitis caused by contact allergy to anethole in spearmint flavoured toothpaste

A 63-year-old woman presented with a 6-year history of persistent cheilitis. Minimal improvement was achieved with therapeutic measures. Patch testing was positive to anethole, a flavouring used in her toothpaste. Her cheilitis resolved after cessation of the flavoured toothpaste. This case demonstrates the importance of considering contact allergy to toothpaste flavours in patients with cheilitis.

Localized cutaneous polyvinylpyrrolidone storage disease mimicking cheilitis granulomatosa

Polyvinylpyrrolidone (PVP), a polymer of the monomer N-vinylpyrrolidone with various molecular weights, was originally developed as a plasma expander. Currently, it is widely used in hair sprays, skin care products, fruit juices, and as a retarding agent in drugs such as procaine and hormones. PVP polymers with a molecular weight greater than 20,000 cannot be excreted by the kidneys and therefore are phagocytosed and permanently stored in the reticular endothelial system, leading to the so-called PVP storage disease. We report a case of localized cutaneous PVP storage disease presenting with persistent upper lip swelling and mimicking cheilitis granulomatosa, which has never been reported before.

Dermal and mucosal reactions to an antimicrobial irreversible hydrocolloid impression material: A clinical report

As an adjunct to infection control in dental impression procedures, several manufacturers have incorporated disinfectants into irreversible hydrocolloid impression materials. However, these compounds have been shown to be tissue irritants and capable of producing allergic reactions. An anonymous, self-administered questionnaire was distributed to 56 second-year dental students who had used an irreversible hydrocolloid containing a quaternary ammonium compound as an antimicrobial (Jeltrate Plus) to make impressions during a summer preclinical occlusion course. Within the limitations of this report, the incorporation of a quaternary ammonium compound into an irreversible hydrocolloid impression material resulted in a greater incidence of dermal and mucosal irritation.

Serious cutaneous adverse reactions to traditional Chinese medicines

INTRODUCTION

Serious cutaneous adverse reactions to traditional medicines are not well described or reported in the literature, despite growing use of these medicines.

METHODS

This is a case series of four patients who were found to have various serious cutaneous adverse reactions to the traditional Chinese medicines that they had taken.

RESULTS

In this series, there was a patient with toxic epidermal necrolysis from traditional Chinese medicine, another with acute generalised exanthematous pustulosis from piroxicam and salicylate-contaminated traditional Chinese medicine, and two patients with drug hypersensitivity syndrome--one from traditional Chinese medicine and the other from phenylbutazone-adulterated traditional Chinese medicine.

CONCLUSION

The series illustrates that serious cutaneous adverse reactions do occur with traditional medicines and emphasises the importance of being aware of such reactions.

Photoaging and phototoxicity from long-term voriconazole treatment in a 15-year-old girl

Voriconazole is a second-generation triazole that was approved by the Food and Drug Administration in May 2002 for treatment of severe fungal infections. In clinical trials it demonstrated superior efficacy in addition to a survival benefit when compared with the then current treatment standard, amphotericin B, for primary treatment of invasive aspergillosis. Voriconazole is a highly selective inhibitor of fungal cytochrome P450 enzymes. Adverse cutaneous reactions have been reported, namely cheilitis, erythema, discoid lupus erythematosus, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, and photosensitivity reactions. We report a case of photoaging caused by voriconazole therapy. A 15-year-old patient developed cheilitis and erythema over the sun-exposed areas of her body 5 weeks after beginning voriconazole for a severe fungal infection. The lesions showed a mild transient improvement before subsequent photodamage occurred to the back of her forearms, back of her hands, and face. Voriconazole was discontinued once the fungal infection had completely resolved. The patient's blisters, erythema, and cheilitis resolved after discontinuation of voriconazole. However, she was left with solar elastotic changes, multiple lentigines, and ephelides of sun-exposed areas. These cutaneous manifestations may represent a unique adverse event caused by a new second-generation triazole.

Cheilitis caused by contact allergy to cocamidopropyl betaine in '2-in-1 toothpaste and mouthwash'

A 10-year-old girl presented with a 2-year history of severe cheilitis. Despite cessation of any lip-licking behaviour her symptoms continued to worsen, with only minimum relief from therapeutic measures. Patch testing proved strongly positive to cocamidopropyl betaine, which was noted to be present in the patient's '2-in-1 toothpaste and mouthwash'. Her cheilitis settled after avoidance of this product. Cocamidopropyl betaine, a surfactant, is a common allergen in hairdressers; however, this case highlights the importance of excluding a contact allergy to this product in patients with intractable cheilitis.

Safety and side effects of the acne drug, oral isotretinoin

Isotretinoin is a very effective medication for the treatment of severe recalcitrant acne. However, its use is associated with many side effects, some of which can be very serious. The most important issue is its teratogenicity, which has resulted in new pregnancy prevention policies and programmes implemented by the manufacturer. Recently, the association of isotretinoin with depression has been recognised and new guidelines have been adopted for this possible side effect. The most common adverse events, observed during treatment, are mucocutaneous and ophthalmological. In addition, laboratory abnormalities and effects in the nervous, musculoskeletal, gastrointestinal, pulmonary and other systems have been described.

Amiodarone-induced peri-oral photosensitivity

We describe a 70-year-old Caucasian man with recurrent history of blistering of peri-oral skin during summer months. Following the diagnosis of a phototoxic reaction to Amiodarone, this was discontinued and an alternative drug to control his cardiac arrhythmia was prescribed. His peri-oral lesions rapidly resolved, and there has been no further recurrence. A brief review on photosensitivity and the underlying mechanisms are discussed.

Update and future of systemic acne treatment

Systemic treatment is required in patients with moderate-to-severe acne, especially when acne scars start to occur. Antibiotics with anti-inflammatory properties, such as tetracyclines (oxytetracycline, tetracycline chloride, doxycycline, minocycline and limecycline) and macrolide antibiotics (erythromycin and azithromycin) are the agents of choice for papulopustular acne, even though the emerging resistant bacterial strains are minimizing their effect, especially regarding erythromycin. Systemic antibiotics should be administered during a period of 8-12 weeks. In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. Hormonal treatment represents an alternative regimen in female acne, whereas it is mandatory in resistant, severe pubertal or post-adolescent forms of the disease. Compounds with anti-androgenic properties include estrogens combined with progestins, such as ethinyl estradiol with cyproterone acetate, chlormadinone acetate, desogestrel, drospirenone, levonogestrel, norethindrone acetate, norgestimate, and other anti-androgens directly blocking the androgen receptor (flutamide) or inhibiting androgen activity at various levels, corticosteroids, spironolactone, cimetidine, and ketoconazole. After 3 months of treatment control of seborrhea and acne can be obtained. Low-dose corticosteroids (prednisone, prednisolone, or dexamethasone) are indicated in patients with adrenal hyperandrogenism or acne fulminans. New developments and future trends represent low-dose long-term isotretinoin regimens, new isotretinoin formulations (micronized isotretinoin), isotretinoin metabolites, combination treatments to reduce toxicity, insulin-sensitizing agents, 5alpha-reductase type 1 inhibitors, antisense oligonucleotide molecules, and, especially, new anti-inflammatory agents, such as lipoxygenase inhibitors.

Oral retinoid therapy for dermatologic conditions in children and adolescents

The efficacy of systemic retinoid therapy in a number of dermatologic diseases is well established; however, concerns about potential side effects limit their use, especially in children. We review the efficacy and toxicity of oral retinoids in the pediatric population. The acute mucocutaneous toxicities commonly observed are typically well tolerated, readily treatable, and reversible. Systemic toxicities include teratogenicity and effects on the musculoskeletal, neurologic, and gastrointestinal systems. Children, like adults, generally tolerate short-term retinoid therapy without major complications. Concerns regarding serious systemic side effects are greater for those on high doses of oral synthetic retinoids for longer periods of time. Close patient monitoring and patient education can minimize the occurrence of complications. (J Am Acad Dermatol 2003;49:171-82.)Learning objective At the conclusion of this learning activity, participants should be familiar with use of oral retinoids for childhood dermatologic conditions such as psoriasis, acne, and ichthyoses as well as safety and risks associated with oral retinoid use in children and adolescents.

Allergic contact cheilitis in the United Kingdom: a retrospective study

BACKGROUND

To date, only a few cohorts of patients with allergic cheilitis have been described, most of them from Australia and Asia.

OBJECTIVE

To establish the prevalence of cheilitis in a UK specialist contact dermatitis clinic and to identify the most common allergens.

METHOD

We analyzed our patch-test database in a tertiary referral center in the United Kingdom, retrospectively. All patients presenting with cheilitis over a 19-year period (1982 to 2001) were included.

RESULTS

Data were available from a total of 146 patients. A positive allergic patch-test reaction was thought to be relevant in 15% of the patients (n = 22) and to be of possible relevance in 6.8% (n = 10). Of the 22 patients with relevant allergic results, 95% (n = 21) were women. The most common allergens included fragrance mix (mainly cinnamaldehyde, oak moss, and isoeugenol) in 41% of patients, shellac in 18%, colophony in 18%, and Myroxylon pereirae in 14%. For half of the patients, the allergen was believed to stem from lipsticks or lip products. Eighteen percent of patients with allergic cheilitis reacted to only their own products.

CONCLUSIONS

Patients should be tested to extended lipstick/cosmetic vehicle series in addition to standard series. As a significant percentage of patients react to their own products only, a thorough clinical history and testing to patients' own products are important.

A yoga teacher with persistent cheilitis

This is a depiction of an evolving case report right from its presentation to the physician and its documentation and further sharing of it through the net via e-mails and evidence-based-health@jiscmail.ac.uk as well as other colleagues.

A randomized clinical trial of 4-hydroxyphenylretinamide for high-grade squamous intraepithelial lesions of the cervix

PURPOSE

Previous trials of topical trans-retinoic acid treatment of cervical intraepithelial neoplasia (CIN) grades 2 and 3 led to a statistically significant regression of CIN 2, but not CIN 3. We tested N-(4-hydroxyphenyl)retinamide (4-HPR), a promising oral retinoid that has been shown to induce apoptosis through nonretinoic receptor acid-mediated pathways, for its toxicity and efficacy against CIN 2/3.

EXPERIMENTAL DESIGN

In a blinded randomized trial, 4-HPR at 200 mg/day for 6 months (with a 3-day/month drug holiday) was compared with placebo in patients with biopsy-proven CIN-2/3 [high-grade squamous intraepithelial lesions (HGSILs)]. Patients were treated with placebo or 4-HPR for 6 months, biopsied, and then followed for an additional 6 months. At the 12-month end point, they underwent either loop excision if a histological lesion was present or a biopsy from the original area of the lesion if no lesion was present.

RESULTS

An interim analysis of blinded data showed a significantly worse prognosis at 12 months for one group. When the code was broken because of the poorer outcomes, we discovered that the 4-HPR treatment arm was performing more poorly than was the placebo at 6 and 12 months (25 versus 44% response rates at 6 months; 14 versus 50% at 12 months). Toxicity was not significant in either arm.

CONCLUSIONS

4-HPR at 200 mg/day with a 3-day/month drug holiday is not active compared with placebo in the treatment of HGSIL. Because 4-HPR is active in the laboratory, the lack of effect in our trial may indicate that higher doses are needed in patients to achieve comparable results.

Muco-cutaneous retinoid-effects and facial erythema related to the novel triazole antifungal agent voriconazole

Voriconazole is a new azole antifungal drug with activity against a wide range of systemic fungal pathogens, including Aspergillus spp. Five patients with chronic invasive aspergillosis were treated for 12-58 weeks with voriconazole, 200 mg twice daily and developed facial erythema and cheilitis. One who received 58 weeks of therapy also developed discoid lupus erythematosus-like lesions on both sides of her neck. Both erythema and cheilitis resolved after discontinuation of voriconazole. Serum retinoids were elevated in the three patients in whom they were measured. Voriconazole has the potential for retinoid-like side-effects and facial erythema.

Safety issues in isotretinoin therapy

Isotretinoin (Accutane, Roche Laboratories Inc, Nutley, NJ) is an important drug, not only for the treatment of severe acne, but also for other diagnoses and in chemoprevention settings. Because the use of isotretinoin is increasing, it is important for physicians to be aware of the adverse events, toxicities, and management issues related to its use. The most important issue is that of congenital defects, which has resulted in new pregnancy prevention policies and programs implemented by the manufacturer. A relatively new concern is that of depression associated with isotretinoin use, also resulting in new policies placed by the manufacturer and the FDA. The most common adverse effects observed during treatment are mucocutaneous and ocular in nature, but laboratory abnormalities and effects in the nervous, musculoskeletal, gastrointestinal, pulmonary, hematologic, and other systems are also described. Additionally, potential drug interactions, follow-up, and toxicity prevention measures are discussed.

Orofacial effects of antiretroviral therapies

This paper summarises some of the oral adverse effects of antiretroviral agents. Some are related to bone marrow suppression which may also predispose to mouth ulcers. Erythema multiforme and toxic epidermal necrolysis are especially well recognized in HIV disease, particularly as reactions to sulphonamides and to antiretroviral agents. Oral lichenoid reactions have been described in HIV disease often relating to zidovudine use. Didanosine has also produced erythema multiforme and not unusually induces xerostomia, again by an unknown mechanism. Xerostomia may be seen in up to one-third of patients taking didanosine. Taste abnormalities are common with the protease inhibitors and oral and perioral paraesthesia can be a disturbing adverse effect. Ritonavir in particular can give rise to circumoral paraesthesia in over 25% of patients. Indinavir can also produce cheilitis.

Cheilitis caused by contact urticaria to mint flavoured toothpaste

A 26-year-old woman presented with a 12-month history of persistent dermatitis of the lips. She had failed to respond to cosmetic avoidance and therapeutic measures. Patch testing was negative, including her toothpaste and toothpaste flavours. She defied diagnosis until an acute flare followed immediately after dental treatment with a mint flavoured tooth cleaning powder. This led us to prick test her to mint leaves and this was positive. Her cheilitis settled after changing from her mint-flavoured toothpaste. A diagnosis of contact urticaria should be considered in cases of cheilitis of unknown cause.

Eruptive cheilitis: a new adverse effect in reactive HIV-positive patients subjected to high activity antiretroviral therapy (HAART). Presentation of six clinical cases

A variety of exfoliative cheilitis has been observed in reactive HIV-1 patients subjected to high activity antiretroviral therapy (HAART). The lesions exhibit exfoliation, crater formation, fissuring, erosions and/or the formation of papules, vesicles and blisters associated to erythema and edema. The condition is not included in the 1993 EEC Clearinghouse classification (1) of oral lesions associated with HIV infection. In an earlier series of 1899 patients (2), we failed to observe this pathology and have only found one similar case described in the literature to date (3).

OBJECTIVE

We present a series of 6 patients with HIV infection and morpho-histological alterations of the labial semimucosa, subjected to HAART.

MATERIALS AND METHODS

The 6 patients were selected from among 20 HIV-positive individuals treated in our Infectious Diseases Unit with a combination of nucleoside and non-nucleoside reverse transcriptase inhibitors and protease inhibitors requiring stomatological care for painful lesions of the lips and oral cavity. The study was conducted over a 6-month period between May and October 1998. An analysis was made of the case histories, CD4-positive cell counts and viral load. The stomatological explorations were completed with biopsies, hematoxylin-eosin staining and immunohistochemical studies involving AE1 and AE3 monoclonal antibodies, vimentin, protein S-100, carcinoembryonic antigen (CEA), laminin, CD8, HLA-DR, BM-1 and CD31 markers. At the time of detection of the oral lesions, the patients had received different combinations of the following antiretroviral treatments: stavudine (D4T), zalcitabine (DDC), didanosine (DDI), zidovudine (AZT), lamivudine (3TC), nelfinavir (NFV), saquinavir (SQV), ritonavir (RTV), hydroxyurea (HU), indinavir (IDN) and efavirenz (EFV).

RESULTS

There were four males and two females (age range 31-42 years). The CD4-positive and viral load ranges were 70-330 cells/mm3 and 200-500,200 copies, respectively. Stomatologic manifestations: The oral clinical manifestations consisted of desquamation, cracks, fissures, scabs, ulcerations, edema, erythema, multiple punctate xanthomas (1 case), dryness and labial semimucosal thickening. Microscopic study: Microscopically, the lesions consisted of ulcerations with adjacent hyperkeratosis and suprabasal vacuolization accompanied by a dense lymphocyte infiltrate within the chorion. Inmunohistochemistry: The immunohistochemical study in turn revealed surface epithelial alterations with AE1-AE3 monoclonal antibody labeling. Membrane glycoprotein activation (laminin) was detected, along with the presence of cytotoxic lymphocytes (CD8) and activated lymphocytes (BM-1). CD31 labeling in turn indicated endothelial activation.

A randomized trial of 13-Cis retinoic acid in children with advanced neuroblastoma after high-dose therapy

One hundred and seventy-five children with Stage 3 or 4 neuroblastoma who had obtained a good response to conventional therapy were randomly allocated to 13-Cis retinoic acid at a dose of 0.75 mg/kg/day or placebo for up to 4 years. Toxicity was mild but no advantage in event-free survival was shown for the children receiving retinoic acid.

Multicentre study of allergic contact cheilitis from toothpastes

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially-targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop-restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Lip cosmetics

Throughout the centuries, the beauty of lips has been extolled by poets, and painters; and people in many different cultures decorate their lips. Modern cosmetics are designed not only to beautify the lips but also to moisturize and protect them from environmental hazards. Familiarity with the ingredients used in lip cosmetics is essential to recognizing and diagnosing the adverse reactions that are associated with these products.