A case of guttate psoriasis after primary herpetic gingivostomatitis.

Herpetic gingivostomatitis and anogenital herpes are widely known manifestations of sexually transmitted herpesvirus infections. What is less recognized is the potential causative role of such infections in triggering immune-mediated skin disorders such as guttate psoriasis. We describe the case of a 23-year-old man with an acute episode of guttate psoriasis related to primary herpetic gingivostomatitis. The diagnosis of guttate psoriasis was pathologically confirmed and the condition fully regressed after proper antiviral therapy. This case adds herpes simplex virus to the growing list of pathogens capable of acting as triggers for guttate psoriasis and highlights the need for better insight of the relationship between psoriasis and viral infections.

Supportive care and antiviral treatments in primary herpetic gingivostomatitis: a systematic review.

OBJECTIVES: Herpes simplex virus 1 (HSV-1) is the main pathogen responsible for herpes infections. In 13-30% of the cases, primary HSV-1 leads to the primary herpetic gingivostomatitis (PHGS), often a self-limiting infection; however, it can limit the ability to drink/eat with, sometimes, the need for hospitalization. Multiple therapeutic methods have been proposed. This systematic review aims to collect and critically appraise the available evidence about the clinical management of PHGS. MATERIALS AND METHODS: Literature search including three databases (PubMed, Scopus, Embase), study design, and data analysis were performed following PRISMA guidelines, according to the PICO tool (PROSPERO n° CRD42023391386). Risk of bias was assessed with RoB 2 and ROBINS-I. RESULTS: Five studies on a total of 364 patients (average age: 7.6 years) were identified. The treatment regimens were summarized in acyclovir; acyclovir + honey; fluids and analgesic; maalox + diphenhydramine; lidocaine; chlorhexidine (CHX); CHX + ialuronic acid; CHX + Mucosyte®; antimicrobial photodynamic therapy (aPDT); topical antiviral; topical antiviral + aPDT; and others. CONCLUSIONS: Although PHGS is a disease with a high worldwide prevalence, the lack of consensus about therapeutic management indicates gaps in existing evidence. Most of the proposed treatment consists in symptomatic drugs with empiric regimens which are ineffective for the viral replication. The main limit to realize randomized clinical trial is due to the rapid onset and remission of the disease. In fact, the diagnostic delay, estimated in 72 h, decreases the effectiveness of any antiviral drugs. CLINICAL RELEVANCE: Out of the five studies included in this systematic review, only one was able to provide some weak evidence that ACV is an effective treatment, improving healing of oral lesions and reducing duration of symptoms.

Atypical herpetic ulcerations in COVID-19 positive patients: A report of three cases.

Since the global COVID-19 pandemic, numerous reports have been made regarding oral lesions seen in COVID-19 patients. It remains unclear whether or not these are true manifestations of COVID-19. Here we present 3 patients who were hospitalized for COVID-19 and who developed atypical herpetic ulcerations during their treatment with remdesivir (Veklury) and steroids. In healthy patients, recurrent infection by herpes simplex virus (HSV) presents as lesions only on the lips and the attached oral mucosa. Atypical herpetic ulcerations are seen in immunocompromised patients. They present as large, stellate shaped ulcerations with raised borders and may involve movable mucosa. The 3 cases presented in this report resembled the atypical herpetic ulcerations typically seen in patients with immunosuppression. Through our report, we aimed to introduce the possibility of atypical herpetic ulcers in patients being treated for COVID-19, to allow for their timely diagnosis and to raise awareness of the underlying immunocompromised state.

Severe pediatric oral mucositis.

We initially suspected primary herpetic gingivostomatitis. But the patient's lab work, persistent fever, and cough led us in a different direction.

Efficacy of antimicrobial photodynamic therapy versus antiviral therapy in the treatment of herpetic gingivostomatitis among children: Aa randomized controlled clinical trial.

AIM: The aim of the present study was to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to topical antiviral therapy for the treatment of children having herpetic gingivostomatitis. MATERIALS AND METHODS: 45 individuals (age group 12-18 years) with herpetic gingivostomatitis (HG) were divided into three groups on the basis of provision of treatment. (a) Group A: topical anti-viral therapy (TAT) (n = 14, mean age = 17.0 years) (b) Group B: antimicrobial photodynamic therapy (aPDT) (n = 15, mean age =17.7 years) and (c) Group C: topical anti-viral therapy + adjunctive aPDT (n = 16, mean age = 18.0 years) respectively. Pain scores [visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ)] were assessed and HSV-1 was quantified. ENZYME LINKED IMMUNOSORBENT ASSAY (ELISA) was used to compute the pro-inflammatory cytokine including interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α). The analysis of the mean values and inter group comparisons were evaluated with the Mann-Whitney test. The Friedman test was used to establish the comparison of the changes observed in HSV quantification, pain scores, and pro-inflammatory cytokines. ANOVA tests were employed for the quantification of differences observed at follow-ups. The assessments for the clinical trial were done at baseline, immediate after post-op, two, and four weeks, and three and six months respectively. RESULTS: According to the analysis of the data obtained after the clinical assessment, the three groups reported a decrease in the pain scores, HSV-1 quantification and levels of the pro-inflammatory cytokines. However, Group C (TAT + aPDT) reported improvement in the observed parameters which was statistically significant in comparison to Group A (TAT) and Group B (aPDT) respectively. CONCLUSION: Antimicrobial photodynamic therapy (aPDT) in conjunction with topical antiviral therapy (TAT) helped in reducing the pain scores and pro-inflammatory cytokine levels in herpetic gingivostomatitis among children.

ACUTE HERPETIC STOMATITIS: CLINICAL MANIFESTATIONS, DIAGNOSTICS AND TREATMENT STRATEGIES.

OBJECTIVE: The aim: To evaluate the recent scientific articles concerning peculiarities of this oral pathology. The goal is to carry out a literature review by evaluating all signs and clinical symptoms related to this disease, so as to provide the clinician with a useful tool for an early diagnosis and treatment of the disease. PATIENTS AND METHODS: Materials and methods: The collection of relevant data were done using the scientific databases Pubmed, Google Scholar. A manual search on Dentistry and Pharmacological sources was also conducted for relevant studies published. The selected key words: ("Herpes virus" OR "HSV") AND ("oral" OR "oral lesions") were used for collecting the data. CONCLUSION: Conclusions: The article presents clinical peculiarities of herpetic stomatitis depending on disease severity and course. Primary herpetic stomatitis appears as spherical clustered vesicles on the gingival and adjacent mucosa. Soon after eruption of elements of lesion they rupture forming painful halo like aphtae / ulcers. Typical symptoms are: pain from ruptured vesicles, lymphadenitis, fever etc. Early diagnosis of disease is important and treatment with antiviral medicaments can modify the course of the disease by reducing symptoms and potentially reducing recurrences. Management of acute herpetic stomatitis include antiviral medicaments intake, maintenance of fluids and electrolytes level in a body. The treatment principles based on etiotropic, pathogenetic and symptomatic therapy are considered in manuscript.

Adolescents and primary herpetic gingivostomatitis: an Italian overview.

AIM: The aim of this study was to investigate the therapies administered to Italian adolescents with primary herpetic gingivostomatitis (PHGS) METHODS: The medical records of 74 adolescents with PHSG were reviewed. The following data were recorded: age, gender, day of onset, type of treatment, lesions' severity, pain scoring, eating, and drinking ability. The oral examination was performed at the first evaluation (T0) and after one week (T1). RESULTS: All patients showed up at the first visit at least 48 h after the onset of symptoms. No patient was prescribed an antiviral therapy. An antibiotic therapy was prescribed in order to prevent secondary bacterial infections. Fifteen patients had been treated with non alcoholic chlorhexidine rinses (group A), 29 patients with non alcoholic chlorhexidine rinses plus hyaluronic acid gel (group B); 30 patients with non alcoholic chlorhexidine rinses plus Mucosyte® (group C). A significant improvement of the pain scoring and lesions' severity was noted in group C. CONCLUSION: In Italian adolescents, PHGS is diagnosed at least 48 h after onset and the antibiotic therapy is widely prescribed in order to prevent overinfections. Among topical therapies, an association of verbascoside and sodium hyaluronhate seems to favour a faster healing.

EFFECTІVENESS OF LASER THERAPY ІN COMPLEX TREATMENT OF HERPETIC STOMATITIS.

OBJECTIVE: The aim: The purpose of research is to improve the effectiveness of treatment by applying laser in complex treatment in patients with herpetic stomatitis. PATIENTS AND METHODS: Materials and methods: Were examined 47 people (22 men and 25 women) with acute herpetic stomatitis. The patіents' age was from 20 to 72 years. All patients underwent immunological tests such as (T-lymphocytes (CD3 +), T-helpers (CD4 +), cytotoxic T-lymphocytes (CD8 +), the content of immunoglobulins IgM, IgG, IgA and slgA in saliva to assess the іmmunological reactivity of the organism. RESULTS: Results: Clinical observations have shown that when using laser therapy, the results of treatment were better than in the control group. Positive dynamics was observed as early as 1-2 days after the start of laser use and was more pronounced when used in the early stages of the disease. The use of the laser promoted a more rapid suspension of new lesions, a decrease in pain syndrome, and a more rapid regression of herpetic lesions. We have found significant improvements in the arameters of cellular and humoral іmmunity in patients of the main group. CONCLUSION: Conclusions: Treatment of herpetic stomatitis is relevant and requires further improvement and the search for new methods. The use of a laser in the complex treatment of herpetic stomatitis has a positive effect on the course and іmmunological status of patients with herpetic stomatіtis. The manifestations of the disease healed faster, and the pain syndrome was less severe. Duration between іllness and treatment decreased on 19.7% and 26%. It is advіsable to include the method of treatment using a laser in the complex therapy of herpetic stomatitis.

Prevalence and Likelihood Ratio of Six Objective Signs among Good Responders to Natrum muriaticum: Multi-centre Observational Assessment.

BACKGROUND: The reliability of homeopathic prescriptions may increase through resource to objective signs and guiding symptoms with significant positive likelihood ratio (LR). We estimated LR for six objective signs attributed to the homeopathic medicine Natrum muriaticum (Nat-m). METHODS: In this multi-centre observational assessment, we investigated the prevalence of six signs in the general patient population and among good responders to Nat-m in daily homeopathic practice. Next, we calculated LR for these six signs. RESULTS: Data from 36 good responders to Nat-m and 836 general population patients were compared. We found statistically significant positive LR (95% confidence interval) for signs such as lip cracks (1.94; 1.15 to 3.24), recurrent herpes (2.29; 1.20 to 4.37), hairline eruptions (2.07; 1.03 to 4.18), and dry hands (2.13; 1.23 to 3.69). CONCLUSIONS: Objective signs with significant positive LR might increase the reliability of homeopathic prescriptions. Further studies are warranted to confirm the validity of this approach.

Severe oral stomatitis due to reactivation of herpes simplex virus type 1 in a methotrexate-treated patient with dermatomyositis.

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.

Gingivoestomatitis herpética severa en paciente con cardiopatía congénita; reporte de caso clínico / Gengivoestomatite herpética grave em paciente com cardiopatia congênita; relato de caso clínico / Severe herpetic gingivostomatitis in a patient with congenital heart disease; clinical case report

La gingivoestomatitis herpética corres-ponde a la manifestación primaria de la infección por virus herpes simple tipo I que se presenta con mayor frecuencia en lactantes mayores y preescolares. Objeti-vo: describir abordaje y manejo de gingi-vo estomatitis herpética en una paciente con cardiopatía congénita y cuadro de desnutrición severa. El caso se refiere a paciente femenina de 16 meses de edad a quien le fue realizado anamnesis, exa-men clínicoe interconsultas con servicios de pediatría, patología, medicina bucal, infectología. El diagnóstico incluyó co-municación intraventricular, desnutrición severa y gingivoestomatitis herpética. Se realizó tratamiento paliativo para el dolor, terapia antiviral (aciclovir en suspensión 1cc cada 6 horas por 7 días) y tratamiento tópico (sucralfato en suspensión 1g/5ml mezclado en partes iguales con cetirizina en suspensión. 5 mg / 5 ml, 3 veces al día directamente sobre las lesiones) durante 14 días logrando reducción de la sintoma-tologia. Conclusiones: el correcto manejo multidisciplinario permitió lograr dismi-nución en tamaño y número de las lesio-nes en cavidad oral, orientación dietética y canalización apropiada.

A gengivoestomatite herpética correspon-de à manifestação primária da infecção pelo vírus herpes simplex tipo I, que ocorre com mais frequência em bebês e em idade pré-escolar. Objetivo: descrever a aborda-gem e o tratamento da estomatite herpética gengival em um paciente com cardiopatia congênita e desnutrição grave. O caso re-fere-se a uma paciente de 16 meses de ida-de, submetida a anamnese, exame clínico e interconsultas com serviços de pediatria, patologia, medicina bucal, infectologia. O diagnóstico incluiu comunicação intraven-tricular, desnutrição grave e gengivosto-matite herpética. Foram realizados trata-mento paliativo para dor, terapia antiviral (suspensão de aciclovir 1cc a cada 6 horas por 7 dias) e tratamento tópico (suspensão de sucralfato 1g / 5ml misturado em partes iguais com suspensão de cetirizina 5mg / 5ml, 3 vezes ao dia diretamente. lesões) por 14 dias, alcançando redução dos sintomas. Conclusões: o correto manejo multidisci-plinar permitiu diminuir o tamanho e o número de lesões na cavidade oral, orien-tação alimentar e canalização adequada.

Herpetic gingivostomatitis is the pri-mary manifestation of herpes simplex virus type I infection, common in older infants and preschoolers. Objective: to describe the approach and management of herpetic stomatitis in a patient with congenital heart disease and severe mal-nutrition. The case refers to a 16-mon-th-old female patient who underwent an anamnesis, clinical examination, and inter-consultations with pediatric, pa-thological, oral medicine services, and Diagnosis included intraventricular communication, severe malnutrition, and herpetic gingivostomatitis. Palliati-ve treatment for pain, antiviral therapy (acyclovir suspension 1cc every 6 hours for 7 days) and topical treatment (sucral-fate suspension 1g / 5ml mixed in equal parts with cetirizine suspension 5mg / 5ml, 3 times a day directly, were perfor-med. about injuries) for 14 days. Conclu-sions: multidisciplinary, management, allowed to obtain, clinical diagnosis and establish a treatment plan with positive outcome,decreasing oral cavity dietary guidance and appropriate channeling.

Ozonoterapia en el tratamiento de la Gingivo estomatitis herpética aguda. Presentación de caso / Ozone therapy in the treatment of acute herpetic gingivo stomatitis. Case presentation

El ozono presenta actividad antiparasitaria por su potente acción bactericida. En el presente estudio experimental se evaluó la efectividad del ozono en el tratamiento de la gingivoestomatitis herpética aguda (GEHA) en una paciente diagnosticada con esta enfermedad. La paciente recibió dos curas de OLEOZON® oral diaria, en toda la cavidad oral y en sus labios donde se extendía la enfermedad. Los resultados muestran que la aplicación de oleozón oral logró la sanación completa de la zona donde apareció la lesión sin dejar huellas en un periodo de 3-7 días, el dolor alivió aproximadamente a los tres minutos de aplicado el medicamento y desapareció a las 24 horas., mejorando las condiciones de la cavidad bucal y facilitando su alimentación. Se pudo comprobar el efecto antiparasitario, fungicida y virucida del Ozono ante la presencia de las lesiones herpéticas, así como cicatrizante y estimulante de la circulación mejorando la llegada de elementos nutritivos y oxígeno a la mucosa bucal y encía, contribuyendo a la mejoría de la paciente ya que el dolor se alivió aproximadamente a los tres minutos de aplicado el medicamento y desapareció a las 24 horas.

[STUDY OF ANTIVIRAL AND IMMUNECORRECTIVE EFFECTS OF LAZOLEX IN PATIENTS WITH RECURRENT HERPETIC STOMATITIS].

At present, our country continues intensive research to find and introduce into practice new natural medicinal preparations made from ecologically clean endemic plants of Georgia. An example of such studies in the Iveria-Pharma company is the domestic drug Lazolex (extract of the pericarpium of an unripe walnut), which has passed the necessary preclinical tests and began to be used in the clinic as an antiherpetic agent. On healthy volunteers, we found positive immunotropic effects of Lazolex. Therefore, we considered it necessary to study the antiviral effect of the drug and its immunomodulatory properties in a clinical setting, specifically in chronic herpetic stomatitis. First of all, it was shown that the state of the patients' immune system was in a clear correlation with the severity of the herpes process, i.e. the most severe immunosuppression was recorded in patients with severe stomatitis. The double effect of the drug is to significantly increase the results of antiviral treatment and immunorehabilitation of patients. As a result of a parallel study of Zovirax and Lazolex, a high clinical activity of both drugs was recorded. However, the presence of pronounced immuno-corrective properties in Lazolex manifested itself in an improvement in the quality of patient treatment: active tissue regeneration and a significant decrease in the timing of exacerbation of local herpetic lesions, an increase in the duration of remission. Conducted clinical, laboratory and immunological studies allow us to recommend Lazolex for active use in dental practice for viral diseases.

Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children.

BACKGROUND: Primary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically. We conducted a study to define the clinical features of PHGS in children. METHODS: Between January 2012 and December 2016, 282 inpatients aged less than 19 years with cell culture-confirmed herpes simplex virus (HSV) infection in a medical center were identified from the virologic laboratory logbook. Clinical data were retrospectively collected. RESULTS: Among the 282 inpatients, 185 cases were considered as PHGS and were included for analysis. Fever was present in 99.5%. The mean duration of fever was 5.11 days (±2.24) with the longest being 17 days. Common oral manifestations included oral ulcers (84.3%), which equally resided in the anterior and posterior part of the oral cavity (65.4% vs. 63.2%), gum swelling and/or bleeding (67.6%), and exudate coated tonsils (16.8%). Leukocytosis (WBC count > 15,000/uL3) was noted in 52 patients (28.1%) and a serum C-reactive protein level > 40 mg/L in 55 patients (29.7%). Fixty-five patients (35%) were diagnosed with PHGS on admission and were significantly more likely to have ulcers over the anterior oral cavity (76.1% vs. 26.7%) and gum swelling/bleeding (76.2% vs. 7.5%, p-value all < 0.001) on admission and were significantly less likely to receive antibiotic treatment (16.9 vs. 36.7%, p-value < 0.01) than others. Forty-six patients (25%) undiagnosed as PHGS on discharge were significantly more likely to have exudate coated on the tonsils, to receive antibiotic treatment and significantly less likely to have gum swelling/bleeding and oral ulcers (all p-values < 0.01). CONCLUSIONS: Meticulously identifying specific oral manifestations of gum swelling/bleeding and ulcers over the anterior oral cavity in children can help making the diagnosis of PHGS earlier and subsequently reduce unnecessary prescription of antibiotics.