[The effect of four immunosuppressive drugs on oral manifestations after organ transplantation].

PURPOSE: To assess the prevalence of oral manifestations in a group of allogenic liver, kidney or haematopoietic stem cell transplantation recipients and patients, and analyze the possible oral manifestations associated with the use of 4 immunosuppressive drugs. METHODS: One hundred and eighteen patients submitted to liver, kidney and hematopoietic stem cell transplantation who used tacrolimus， sirolimus，cyclosporine or mycophenolate mofetil were enrolled. Through a questionnaire survey and oral examination, their oral manifestations were recorded, and the possible statistical associations with immunosuppressive drugs were analyzed using SPSS 21.0 software package. RESULTS: The prevalence of oral lichenoid lesions and cheilitis for the group of patients using tacrolimus after transplantation was significantly lower than the group of patients who did not used the agent(P＜0.01). The prevalence of oral lichenoid lesions for the group of patients who used cyclosporine was significantly higher than the group of patients who did not used the drug(P＜0.05), and the prevalence of cheilitis for the group of patients who used cyclosporine was significantly higher than the group of patients who did not used the drug(P＜0.01). The prevalence of oral lichenoid lesions and cheilitis for the group of patients who used tacrolimus was significantly lower than the group of patients who used cyclosporine(P＜0.01). The group of patients who used mycophenolate mofetil after transplantation had a significantly lower prevalence of dry mouth than the group of patients who did not used the drug(P＜0.01). The prevalence of oral manifestations in patients with sirolimus after transplantation was not significantly reduced. CONCLUSIONS: The use of tacrolimus improved the symptoms of oral lichenoid lesions and cheilitis and the effect was better than cyclosporine after transplantation. The use of mycophenolate mofetil improved dry mouth after organ transplantation.

Sun protection as a protective factor for actinic cheilitis: Cross-sectional population-based study.

OBJECTIVE: To determine whether sun protection is associated with lower occurrence of actinic cheilitis in adults living in a city from southern Brazil. MATERIALS AND METHODS: A multi-stage proportional sample of 404 individuals 18 years and older was obtained. Interviews and clinical examinations were conducted in participants' households. Four categories of self-reported use of sun protection were determined. Multivariable Poisson regression was used to assess the associations. RESULTS: Prevalence of actinic cheilitis was 47.1%. In the first main-effects multivariable model, AC was significantly associated with sex, age, skin colour and duration of sun exposure, but not with sun protection. However, the association between sun protection and actinic cheilitis was modified by the time of sun exposure. Among those exposed ≥4 hr/day to sun, individuals using physical protection or physical + chemical protection were 33% (prevalence ratio = 0.67, 95% confidence interval [CI] 0.47-0.94, p = .02) and 36% (PR = 0.64, 95% CI 0.47-0.94, p = .02), respectively, less likely to have actinic cheilitis than those who did not use any sun protection, adjusting for sex, age and skin colour. CONCLUSIONS: Physical and chemical sun protection were associated with lower occurrence of actinic cheilitis in individuals with greater exposure to sun.

Development and evaluation of the efficiency of ointment for cheilitis treatment in patients with dental and jaw anomalies

Cheilitis is a group of chronic diseases of the vermilion border that are diverse in etiology, pathogenesis and clinical picture. The development of various forms of cheilitis is facilitated by defects of the architectonics of the lips, unhealthy lifestyle, anatomical features of the lip structure, adverse meteorological effects, decrease in specific and non-specific factors for protecting the oral cavity, the patient's psycho-emotional state, immuno-allergic factors and accompanying general somatic and dental pathologies. The issues of prevention and comprehensive treatment of lip diseases are especially relevant in dental practice. The article presents data on the prevalence of cheilitis and dentoalveolar anomalies and the need for their treatment in young people. Furthermore, the authors provide a composition justification and develop an ointment for the treatment of cheilitis in this category of patients.

Use of lip photoprotection in patients suffering from actinic cheilitis.

BACKGROUND: Actinic cheilitis (AC) is a chronic condition that affects mainly the lower lip. OBJECTIVES: To investigate the use of lip photoprotection in patients with AC. MATERIALS AND METHODS: A cross-sectional multicentre study of patients, ≥45 years of age, was performed in eight dermatology departments in the Galicia region over a period of one year. From 1,239 patients included in the study, 410 were diagnosed with AC and complete data were available for 408. An analysis of lip photoprotection habits and possible associations in patients with AC is reported. RESULTS: Mean age of patients with AC was 71.9 years and 53.8% were women. More than 90% of AC patients (370/408) had never used lip photoprotection. In the group of patients who used it, 62.16% of them had only used a single stick within the previous year. The only variable significantly associated with the use of lip sun protection was low Fitzpatrick's skin types I and II (p=0.039). Study limitations include the inclusion of patients 45 years or older and the use of a semiquantitative scale for measuring the frequency of application of lip photoprotection. CONCLUSION: To our knowledge, this is the first European study focused on lip photoprotection in patients suffering from AC. Only a minority of AC patients protect their lips from UV radiation. Specific lip sun protection recommendations should be promoted, especially in high-risk populations.

Management of oropharyngeal mycosis in head and neck cancer occurring during (chemo) radiotherapy: an Italian radio-oncologist survey.

AIMS AND BACKGROUND: Oropharyngeal candidiasis is a common disorder in head and neck cancer patients (HNCPs) who underwent (chemo)-radiotherapy. An Italian survey was conducted in order to investigate radiation oncologists' behavior in regard to diagnosis, prevention, and treatment of oral candidiasis. METHODS AND STUDY DESIGN: Between April and May 2013, a national online 18-question survey was sent to major Italian radiotherapy centers. RESULTS: All Italian regions were represented and 86 radiation oncologists were involved. Eighty-three percent of responders estimated that oropharyngeal candidiasis occurred in 30%-40% of their HNCPs. The majority of responders were able to recognize oral mycosis when it occurred in a localized pseudomembranous form and all responders agreed with the fact that oral candidiasis was always associated with mucositis. A prophylactic therapy was prescribed occasionally by 35% and routinely by 20% of responders. Forty percent prescribed an antifungal drug in the case of suspected mycotic infection and 20% waited for symptomatic clinical evidence before prescribing a therapy. In the presence of candidiasis, mainly topical fluconazole (59%) and itraconazole (36%) were prescribed. Concomitant chemo-radiotherapy was first identified as a risk factor for mycosis occurrence and development. Ninety-nine percent of responders believed that oral mycosis was associated with increased toxicity and 44% of them interrupted treatment due to candidiasis. CONCLUSIONS: A variety of approaches to oropharyngeal candidiasis emerges from this survey; further clinical trials are necessary to identify the best approach for oral mycosis prevention and treatment and to establish specific international guidelines for HNCPs.

Efficacy of vitamin E to prevent dermal complications of isotretinoin.

Acne treatment depends on whether patents have a mild, moderate, or severe type of acne. The aim of this study was to compare the using of Isotretinoin (Rokutan) with and without oral vitamin E in treating acne. This study was performed on 60 patients on 0.5 mg/kg/day isotretinoin treatment for 6 months. The first group received 800 IU day(-1) Vit E during treatment and the second group recieved 800 Iu day(-1) cod liver oil capsules. All patients were observed for the complications at 1th, 4th and 6th weeks during treatment. Cheilitis was the most common side effect among these patients (69%). Epistaxis was the second side effect in both groups (22%). Other side effects were xerosis, pruritus, epigastric pain and nail fragility. The frequency and the severity of complications were less common at 4th and 6th weeks of treatment. Isotretinoin is a useful and effective drug in treating severe and treatment-resistance acne lesions.

Photodynamic therapy with 5-aminolevulinic acid in actinic cheilitis: an 18-month clinical and histological follow-up.

BACKGROUND: Actinic cheilitis (AC) may bear the initial and superficial changes of actinically induced squamous cell carcinoma (SCC) and may progress into fully developed SCCs. Early and effective treatment is important. OBJECTIVE: To assess the clinical and histological long-term outcome in AC after two ALA-PDT sessions. METHODS: Patients with histologically proven grade 1 and 2 AC received two ALA-PDT sessions at 2 weeks interval. Subjects with complete clinical response at 3 months were evaluated further clinically and histologically at months 6, 12 and 18. Long-term study outcome was defined as clinical and histological AC recurrence among patients with complete clinical response 3 months after treatment. Cosmetic outcome was assessed by the investigators at the final follow-up visit at 18 months. RESULTS: Of the 40 patients enrolled, 38 completed the study. Complete clinical response at 3 months was achieved in 26 patients. At 6 months, clinical and histological recurrence occurred in three patients and at 12 months, one more patient showed clinical and histological recurrence. At 18 months, overall clinical recurrence rate was 15.38% (4/26), while overall histological recurrence rate was 34.61% (9/26). Cosmetic outcome was rated as excellent in more than 80% of evaluated cases. CONCLUSION: PDT represents a moderately effective treatment modality in AC. Optimization of treatment procedure and protocols is still needed for higher response rates to be achieved. Moreover, the high treatment cost should be given consideration. Further long-term follow-up studies are needed for assessment of clinical and histological very late recurrences that could be expected after PDT.

[Stomatitis, cheilitis and conjunctivitis after a common cold]. / Stomatitis, Cheilitis und Konjunktivitis nach grippalem Infekt.

A 24-year-old female patient complained of odynophagy, rhinitis, general apathy and fever (38.5 degrees C) which had persisted for 5 days. Treatment had initially been a combination of paracetamol, ibuprofen and acetylsalicylic acid and when no improvement occurred amoxicillin was prescribed. Nutrition and fluid intake was not possible due to excessive odynophagy. In addition to leukocytosis and increased C-reactive protein, there were pronounced erosive, reddened edematous and fibrin-covered alterations of the whole oral, pharyngeal and laryngeal mucous membranes as well as conjunctivitis. The lips were red with hemorrhagic scabs. The diagnosis was Fuchs' syndrome which is a severe medication-induced skin reaction. Abstinence from the agent (medication) responsible and early cortisone therapy are decisive.

Patterns of cosmetic contact allergy.

Certain patterns of dermatitis, such as those affecting the face, eyelids, lips, and neck, should raise the suspicion of a cosmetic-related contact allergy. Patch testing with a broad screening series, supplemented by a patient's own personal care products, should be considered when evaluating patients with suspected cosmetic dermatitis. Once the offending allergen is identified, an avoidance regimen should be established to avoid further exposure.

Lesões da mucosa oral em pacientes idosos: um problema pouco enfatizado por médicos e pesqisadores / Oral mucosa lesions in elderlly inpatients: a problem little emphasized by doctors and researchers

Objetivos: Estimar a freqüência de lesões da mucosa oral em idosos internados nas várias especialidades de hospital geral, em Belo Horizonte, Minas Gerais; determinar com qual freqüência as lesões detectadas pelos pesquisadores haviam sido identificadas também pelos médicos responsáveis pelos pacientes estudados e veridicar a possível associação dessas lesões com sexo, tabagismo, etilismo, edentulismo e uso de próteses dentárias. Pacientes e métodos: Os pacientes foram selecionados de acordo com a idade (60 anos e mais), a partir do prontuário médico, de onde também se extraíram informações sobre o sexo, realização do exame da cavidade oral pelo médico assistente e sobre a detecção de lesões da mucosa oral pelo mesmo. O diagnóstico das lesões baseou-se nas suas características clínicas. Resultados: Foram avaliados 198 pacientes, com idade média de 75 anos, sendo 116 do sexo feminino e 82 masculino. Foram detectadas lesões nas cavidades orais de 69 pacientes (34,8 por cento). Em apenas 13 pacientes (6,6 por cento) as lesões haviam sido detectadas também pelo médico assistente. As lesões mais freqüentemente encontradas foram candidíase (23 por cento), epulis fissuratum (11 por cento), hiperplasia inflamatória (11 por cento), afta recorrente (10 por cento), papiloma (10 por cento), queilite angular (7 por cento) e leucoplasia (3 por cento). Em relação à associação das lesões com sexo, tabagismo, etilismo, edentulismo e uso de prótese, encontrou-se que o uso de prótese esteve associado com maior número de lesões, especificamente, com hiperplasia inflamatória. Conclusões: Os dados ora apresentados são comparáveis aos observados em outros estudos, mas, diferentemente daqueles, demonstram o pequeno interesse dos médicos pelo exame da cavidade oral dos seus pacientes. Ressaltamos, portanto, a importância deste trabalho, cujos resultados alertam para a necessidade da realização do exame da cavidade oral por todos os profissionais que cuidam de pacientes idosos.

Aims: To estimate the prevalence of oral mucosa lesions in elderly inpatients admitted to different specialities of a general hospital, its possible association with gender, smoking habit, alcohol use, edentulis and dental prosthesis anda how often these lesions go unrecognizes. Patients and methods: The case notes of all patients 60 years of age and older of both sexes were analyzes in order to identify whether the oral cavity was examined by the responsible doctor and what kind of oral mucosa lesions were detected. Results: A total of 198 patients (median age: 75 years) (116 females; 82 males) were evaluated. Oral cavity lesions were detected in 69 patients (34,8 percent). In only 13 patients (6,6 percent) lesions were recognized by the responsible doctor. The most frequently found lesions were: candidiasis (23 percent), epulis fissuratum (11 percent), inflammatory hyperplasia (11 percent), recurrente aphthous ulcer (10 percent), papilloma (10 percent), angular chelilitis (7 percent) and leucoplakia (3 percent). The use of dental prosthesis was associated with a greater number of lesions specifically inflammatory hyperplasia. Conclusions: The prevalence and type of oral mucosa lesions found in our study is similar to other studies. Nevertheless, is was clear that routine examination of the oral cavity was not performed regularly. It's highlighted the importance of routine examination of elderly oral cavity.

Estudo da prevalência de alterações labiais em pescadores da ilha de Santa Catarina / Prevalence of lips pathologies in fishermen of Santa Catarina Island

São várias as alterações provocadas pela exposição labial continuada e desprotegidas à radiação ultravioleta, com destaque para a Queilite Actínica e o Carcinoma Epidermóide. O objetivo desta pesquisa foi levantar a prevalência de alterações labiais relacionadas à exposição crônica ao sol e estudar a sua relação com outros possíveis fatores etiológicos numa população de pescadores de Florianópolis/SC bem como os dispositivos e métodos de prevenção regularmente utilizados. De uma população de aproximadamente 4000 pescadores filiados a Federação de Pescadores do Estado de Santa Catarina, foram examinados 111 pescadores de 08 comunidades pesqueiras de Florianópolis, no período compreendido entre agosto de 2002 e março de 2003. Todos os participantes voluntßrios da amostra foram entrevistados e examinados em sedes ou associações das colônias de pescadores incluídas na amostra. As alterações labiais diagnosticadas no exame clínico foram registradas em ficha clínica própria. Dentre as patologias labiais diagnosticadas, destacaram-se 48 casos de queilite actínica, 2 casos de queilite actínica aguda, 3 de leucoplasia, 4 de hiperceratose e 4 suspeitas de Carcinoma Epidermóide. Foram realizadas 22 palestras educativas e distribuídos mais de 350 folhetos com orientações bßsicas sobre prevenção do câncer de boca; 16 pacientes foram encaminhados para o atendimento especializado no Ambulatório de Estomatologia do Hospital Universitßrio. O diagnóstico precoce de alterações labiais em pescadores, bem como a conscientização destes sobre os prejuízos da radiação ultra-violeta são fundamentais pelo fato dos mesmos pertencerem a uma população de risco ao desenvolvimento de lesões cancerizáveis e câncer de lábio.

Effectiveness of health care worker training on the oral health of elderly residents of nursing homes.

OBJECTIVES: The aim of this study was to evaluate the effect of a staff training programme on mouth care on the oral health of elderly residents of long-term care institutions. METHODS: Seventy-eight residents of five long-stay institutions were enrolled and underwent a baseline oral health assessment. Staff caring for residents in three of the sites received intensive training in mouth care. This comprised lecture and video material complemented by clinical demonstrations. The oral health of residents at all five sites was reassessed at periods of 3 and 9 months. Staff caring for residents in the remaining two institutions were then provided with mouth care training and all patients were reassessed at 18 months. Statistical analyses were undertaken to examine for significant changes in selected oral health parameters after training, within each group. RESULTS: Oral mucosal disease and oral dryness were common at baseline. The staff training was well received. Following staff training, there was a significant reduction in the number of residents left to undertake their own oral care. There were significant improvements in denture hygiene and a reduction in the number of residents wearing dentures overnight. The prevalence of oral mucosal disease dropped, with significant reductions in angular cheilitis and denture stomatitis. CONCLUSION: This education programme was effective in changing oral health care procedures within long-stay institutions for the elderly, with measurable improvements in oral health of the residents.

Effectiveness of small-volume, intralesional, delayed-release triamcinolone injections in orofacial granulomatosis: a pilot study.

BACKGROUND: Orofacial granulomatosis (OFG) is an idiopathic disorder characterized by chronic orofacial swellings causing significant cosmetic and functional problems. Treatment with high-volume triamcinolone injections has been shown to be effective but requires nerve block anesthesia and causes a dramatic temporary increase of lip swelling. OBJECTIVE: We have performed a noncomparative open-label pilot study in 7 patients with OFG in order to evaluate the effectiveness of small volumes of extended-release high-concentrate triamcinolone injections in reducing lip swelling and preventing recurrences. METHODS: Seven patients with OFG were studied. Small-volume, intralesional, high-concentrate, extended-release triamcinolone was injected on the basis of a weekly schedule. A standard cycle consisted of 2 or 3 injection sessions over 14 or 21 days, depending on the clinical response. RESULTS: After cycle completion, all patients remained without recurrences or with cosmetically acceptable slight lip enlargement for a mean time of 19 months (range, 8-30 months). No side effects were observed, except in one patient with hypopigmentation of the skin of the upper lip. CONCLUSIONS: Slow-volume, intralesional, high-concentrate, extended-release triamcinolone injections appear to be effective in reducing lip enlargement in patients with OFG and do not require nerve block anesthesia or cause a temporary troublesome increase of swelling. A long disease-free period is generally obtained.

Queilite actínica: aspectos clínicos e preventivos / Actinic cheilitis: clinical and preventive aspects

A queilite actínica é uma alteraçäo dos lábios causada pela exposiçäo crônica aos raios solares ultravioleta. É comum em indivíduos idosos de pele clara e que mantêm hábitos ocupacionais ou de lazer ao ar livre, expondo-se à radiaçäo actínica. Este trabalho comenta as características clínicas e a relaçäo com os achados microscópicos, assim como o diagnóstico e as formas de tratamento da queilite actínica. É ressaltada importância de sua detecçäo precoce, da instituiçäo de medidas preventivas e do controle clínico dos pacientes, visando evitar o desenvolvimento de câncer de lábio

Phase I trial of alpha-tocopherol effects on 13-cis-retinoic acid toxicity.

BACKGROUND: Retinoids are under intensive study for the treatment and prevention of cancer. Substantial dose-related toxicities of retinoids are a major obstacle to this work. In a recent retrospective analysis of combined 13-cis-retinoic acid (13cRA) and alpha-tocopherol (AT) in myelodysplasia, 13cRA toxicity was reduced significantly and 13cRA activity was enhanced. These results suggested the need for prospective testing of this new combination. This trial tested the hypotheses that At can reduce toxicity of high-dose 13cRA and does not interfere with 13cRA absorption/activity as reflected by reduced 13cRA serum levels. PATIENTS AND METHODS: This was a phase I trial design in which patients received fixed-dose 13cRA (100 mg/m2/d) plus escalating-dose AT (beginning at 800 IU/d, increased 400 IU/d each month until 2000 IU/d). We collected toxicity data every four weeks from self-report forms, clinical examinations and laboratory studies. AT effects on 13cRA toxicity were determined by comparing maximum toxicity at lowest AT dose with that at highest AT dose. We also measured serum levels of both agents every four weeks. RESULTS: Of the 45 patients registered, 36 had cancer (active or prior history), 9 had premalignant lesions. Thirty-nine patients could be evaluated for initial-course toxicity; 31 for final course toxicity. Median time on treatment (all patients) was four months (range, 1-9 months); a total of 223 month-long courses of treatment were given. Eighteen percent of patients (7/39) developed grade 3 or 4 toxicity in the initial course. The rates of increase and decrease in 13cRA toxicity associated with increasing AT doses were similar: 36% decreased (11/31), 32% increased (10/31) (P = 0.84). At did not reduce 13cRA serum levels. After initial increases of mean AT plasma levels (17.9 micrograms/ ml at baseline to 45.4 micrograms/ml after first four-week course), subsequent AT plasma increases (< 2-fold) did not keep pace with increased AT doses (2-3-fold). No major activity occurred in the 21 patients with active refractory cancer. The complete response rate in patients with premalignant head-and-neck or lung lesions was 77.8% (7/9), which included two patients previously refractory to 13cRA alone. CONCLUSION: Although escalating doses of AT did not reduce 13cRA toxicity, the rate of initial-course (including 800 IU/d of AT) high-grade toxicity was substantially lower than that typical of high-dose 13cRA-alone and similar to that typical of low-dose 13cRA-alone. Indeed, a trial of 13cRA-alone followed by 13cRA plus AT may have detected a significant toxicity difference. We did not design such a trial out of ethical concern for known side effects of high-dose 13cRA. The increase in AT serum levels was not proportional with increasing doses of AT, which may explain the lack of a dose-response effect of AT on 13cRA toxicity. Previous trials have established that 13cRA has an approximate 10% complete response rate in oral premalignancy. Our small trial's 77.8% complete response rate in premalignant lesions suggests that AT may enhance 13cRA clinical activity. Future trials of 13cRA plus AT are needed to define this combinations toxicity profile, clinical activity and pharmacokinetics.

Actinic damage and skin cancer in albinos in northern Tanzania: findings in 164 patients enrolled in an outreach skin care program.

Persons with albinism are particularly vulnerable to the deleterious effects of UV light on their skin. We obtained histories and performed skin examinations on 164 albino patients living in equatorial Africa to determine their sun exposure, sun protection, and sun damage. Many patients did not wear hats and most wore short-sleeved shirts. Except for four infants, all patients had sunburned skin. Actinic cheilitis, actinic keratoses, and skin cancers were detected in many patients. Sun protection methods will be important for prevention of skin damage in albino patients.

Actinic cheilitis and carcinoma of the lip.

During dental examinations, the lips are readily overlooked. Dentists should routinely examine the lips visually and by palpation. Actinic cheilitis is a common condition caused by damage to the lips through exposure to sunlight, and is readily diagnosed clinically. Its progress can be minimized by the use of an appropriate sun screen when outdoors. Actinic cheilitis can undergo malignant transformation into squamous cell carcinoma. The clinical features and management of these conditions are described.

Actinic cheilitis.

Ultraviolet (UV) radiation of the vermilion border of the lips can precipitate recurrent herpetic infections, varying degrees of dysplasia, and squamous cell carcinoma. UV light also can aggravate certain systemic conditions, such as lupus erythematosus, and produce solar urticaria, porphyrias, and drug photosensitivity reactions.