Impact of Photobiomodulation on IL1ß and TGFß-1 concentrations in patients with aphthous stomatitis.

Laser therapy has shown effectiveness in promoting wound healing by influencing various physiological factors such as blood flow, cytokines, histamine, nerve signals, lymphocyte function, tissue oxygenation, and cell growth. This study aims to evaluate the therapeutic efficacy of Photobiomodulation (PBM) treatment, by using diode laser, in modifying the levels of interleukin-1 beta (IL1ß) and transforming growth factor beta-1 (TGFß-1) in patients diagnosed with aphthous stomatitis. A before-after interventional design was conducted over 10 months with 20 subjects. Data on demographic details and serum concentrations of IL1ß and TGFß-1 were collected pre-treatment and on Days 3 and 7 post-treatments. The intervention involved a single session of four 30-second applications of a QuickLase dual-wavelength laser operating at 980 nm. Results show significant reductions in IL1ß and TGFß-1 levels after 7 days of treatment, indicating a time-dependent effect of PBM therapy on these inflammatory markers. The findings suggest that PBM therapy holds promise as an intervention for reducing inflammation associated with aphthous stomatitis.

Topical medications for the treatment of recurrent aphthous stomatitis: A network meta-analysis.

BACKGROUND: The present network meta-analysis aims to answer the question "what is the best topical intervention for the treatment of recurrent aphthous stomatitis that can provide an acceptable pain relief and promote wound healing?" METHODS: From inception to October 2022, PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched to identify all potentially eligible randomized controlled trials. The primary outcomes were pain scores and/or healing time, while the secondary outcomes were the associated side effects. The Bayesian network meta-analysis accompanied by a random effect model and 95% credible intervals were calculated. RESULTS: Forty-three randomized controlled trials with a total of 3067 participants, comparing 20 different topical medications, were included. Concerning pain reduction, the network meta-analysis failed to show any statistically significant differences when different topical treatments were compared together or even with a placebo at different time intervals. Except for doxycycline, which showed a statistically significant difference in terms of accelerating healing time, other topical interventions showed no statistically significant differences when compared with placebo or with each other. CONCLUSION: Within the limitations of the current network meta-analysis, it seems that: A low to moderate quality of evidence showed no superiority of any topical treatment over others concerning pain reduction, although rank probability tests revealed sucralfate, doxycycline, hyaluronic acid, and chamomile as the most efficacious treatment options at different evaluation times. Hence, further well-designed clinical trials with larger sample sizes are warranted. Topical doxycycline was shown to be the most efficacious intervention in promoting healing of recurrent aphthous stomatitis.

Atorvastatin mucoadhesive tablets in the management of recurrent aphthous stomatitis: a randomized clinical study.

BACKGROUND: Aphthous stomatitis is one of the most common oral mucosal diseases. Due to the commonness of recurrent aphthous stomatitis and considering the anti-inflammatory, analgesic, and tissue regenerative properties of atorvastatin and the lack of a study on the effect of statins on minor recurrent aphthous stomatitis, this study investigates the effect of atorvastatin mucoadhesive tablets as a topical treatment on reduction of symptoms and duration of this disease. METHODS: This study is a randomized, double-blinded clinical trial. Patients were divided into two groups, atorvastatin and, placebo; each of the patients received three mucoadhesive tablets daily in the morning, noon, and night. Finally, the patients were examined on days 0 (baseline), 3, 5, and 7 to determine the diameter of the inflammatory halo. The VAS scale was used to evaluate pain intensity for up to 7 days after each meal. The data was entered into SPSS 24 software and analyzed. RESULTS: The halo diameter did not significantly differ between the two groups on baseline (P > 0.05). However, on the study's third, fifth, and seventh days, the difference between the two groups was remarkable, so in the atorvastatin group, the size of the lesions decreased in shorter healing time (P < 0.05). In addition, the patient's pain intensity (VAS) also showed a significant decrease in the atorvastatin group except on the first, second, and seventh days of the study (P < 0.05). CONCLUSION: Atorvastatin mucoadhesive tablets effectively reduce the pain of patients with minor recurrent aphthous stomatitis and reduce the size and healing time of the lesions, so their application should be considered in treating minor recurrent aphthous stomatitis. The present study was approved by the Medical Ethics Committee of Mazandaran University of Medical Sciences with the ethics code IR.MAZUMS.REC.1400.8346. Also, this study received code IRCT20170430033722N4.

Combined signatures of serum proteome and transcriptome in patients with recurrent aphthous ulcer.

OBJECTIVES: Recurrent aphthous ulcer (RAU) is a common oral disease with unclear mechanism. This study aimed to explore the serum signatures of RAU patients via proteomic and transcriptomic analysis. METHODS: This study was based on clinical observation. Part of serum was used for clinical tests, while the rest was processed for isobaric tags for relative and absolute quantitation (ITRAQ) labeling coupled with two-dimensional liquid chromatography-tandem mass spectrometry (2D LC-MS/MS) combined with microRNA (miRNA) microarrays. Bioinformatic analysis was then used to obtain significant signatures, which was verified by ELISA, qRT-PCR, and dual-luciferase reporter gene assays. RESULTS: Clinical data showed that triglyceride level, white blood cell count, and neutrophils percentage were increased in RAU group, while lymphocytes percentage was decreased. ITRAQ-2D LC-MS/MS identified 22 upregulated and 33 downregulated proteins in RAU group. Simultaneously, miRNA microarrays identified 64 upregulated and 31 downregulated miRNAs. After integrative bioinformatic analysis and verification, three miRNA-protein pairs, mainly involved in oxidative stress and inflammation responses, were obtained. Additionally, the interaction network indicated the crucial role of complement and coagulation cascade pathway in RAU. CONCLUSIONS: Our study revealed that complement and coagulation cascade pathway, oxidative stress, and inflammation responses may act as vital factors in pathogenesis of RAU.

The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials.

This systematic review was undertaken with the main aim of assessing the therapeutic effects of herbal medicines in recurrent aphthous stomatitis (RAS). A comprehensive search was performed in PubMed, Scopus, ISI Web of Science, and Google Scholar up to July 2021 to identify randomized clinical trials investigated the effects of herbal medicines on RAS. Thirty-three papers comprising 2,113 patients met the eligibility criteria, of which 30 studies had a high quality based on the Jadad scale. Totally, 22 out of 30 studies which assessed the pain showed that herbal agents significantly decreased the pain compared with the control group or placebo. In 17 out of 25 studies that evaluated ulcer size, herbal agents significantly reduced the size of ulcers compared with the control or placebo groups. In 15 out of 18 studies that assessed the healing time, herbal agents significantly reduced healing time in the intervention groups compared with the placebo or control groups. Few adverse events were reported only in four studies. Findings of the current review indicated medicinal plants and phytochemicals as effective and safe agents that for the treatment of RAS.

Evaluation of diode laser versus topical corticosteroid in management of Behcet's disease-associated oral ulcers: a randomized clinical trial.

OBJECTIVES: The current trial was conducted to assess the effect of diode laser therapy compared to topical corticosteroid in management of oral ulcers of BD. MATERIALS AND METHODS: Fifty patients were divided randomly into two parallel groups. The first group received 980 nm diode laser; the second group received topical corticosteroid (0.1% triamcinolone acetonide). The outcome measures included oral ulcer activity index (composite index), pain (VAS), number of oral ulcers, healing time, and oral health-related quality of life (OHIP-14). The collected data were analyzed for any statistical significance. RESULTS: A statistically significant difference was detected between laser and corticosteroid groups favoring laser on comparing composite index and VAS scores on the first and third days and on comparing number of ulcers on the third and fifth days. A statistically significant difference was detected between laser and corticosteroid groups on comparing scores of the questions assessing discomfort with eating food, irritability with other people, taste worsening, unsatisfactory diet, and painful aching on the first and/or third days. No adverse effects were reported by participants of both groups. CONCLUSIONS: Diode laser is efficient safe treatment modality for management of BD-associated oral ulcers. Diode laser was more efficient than triamcinolone acetonide in controlling pain and reducing oral ulcer activity. CLINICAL RELEVANCE: Laser therapy is efficient safe modality that could spare BD patient from adding a new medication to their long list, being just one visit compared to other regular daily regimen medications. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT03771768.

Evaluation of cinnamaldehyde mucoadhesive patches on minor recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND & OBJECTIVE: The use of herbal medicines to treat common oral diseases increases rapidly. Recurrent aphthous stomatitis is one of the most common oral mucosal diseases, which has an unclear etiology and could lead to severe pain and dysfunction. Cinnamaldehyde is a major component of cinnamon bark oil. Biological properties of cinnamaldehyde, such as antioxidant, antitumor, antifungal, cytotoxic, and anti-mutational characteristics, have been identified. Considering the prevalence of recurrent aphthous stomatitis and the importance of using herbal resources for treatment, the present study aimed to evaluate the effect of mucosal adhesive patches containing Cinnamaldehyde on minor recurrent aphthous stomatitis lesions. MATERIAL & METHODS: In this randomized, double-blind clinical trial, patients were divided into two groups. The intervention group received three daily mucosal adhesive patches to be used in the morning, afternoon, and night. The control group also did the same with a placebo. To evaluate the healing and determine the diameter of the lesions, patients were clinically examined on days zero, 3, 5, and 7. The VAS scale evaluated pain at baseline and after each meal for seven days. The Fisher's exact test, t-test, Shapiro Wilk test, Friedman test, and the Mann-Whitney test were used to analyze the data using the SPSS 20 software. RESULTS: There was no statistically significant difference in the mean diameter of the inflammatory lesion and pain intensity in the two groups in the baseline (p > 0.05). However, the ulcer size was significantly reduced in the cinnamaldehyde group on the third, fifth, and seventh days of the study. Except for baseline, the mean pain intensity significantly decreased in the cinnamaldehyde group compared to the placebo group (p < 0.05). CONCLUSION: Cinnamaldehyde mucoadhesive patches effectively reduced and improved aphthous lesions and pain intensity in patients and can be considered a treatment for RAS. REGISTRATION NUMBER: IRCT20180312039060N2-First registration date: 20/07/2018. The present study was registered as a retrospective study.

The effectiveness of olibanum orally disintegrating tablet in the treatment of oral aphthous ulcers: A randomized, double-blind, placebo-controlled clinical trial.

Background: Boswellia serrata oleo-gum-resin (frankincense; olibanum) has anti-inflammatory, analgesic, and antimicrobial effects. This study aimed to evaluate the clinical effectiveness of frankincense extract in the treatment of oral aphthous ulcers. Materials and Methods: In a randomized, double-blind, placebo-controlled clinical trial, patients with aphthous ulcers were randomly assigned to either experimental (Frankincense extract) or placebo groups to use orally disintegrating tablets (ODT) of frankincense and placebo, respectively, four times a day for 3 days. The size of aphthous ulcers and the pain severity by visual analogue scale were recorded at days 0, 2, and 4 and compared between the groups. Results: Twenty-five patients in each group completed the study. Olibanum extract ODT significantly reduced the ulcer size on the second (P < 0.001) and fourth (P < 0.001) days as well as the pain score on the second (P = 0.002) and fourth (P < 0.001) days of the intervention compared to placebo. Furthermore, at the end of the intervention, the number of patients with complete ulcer healing and pain relief in the experimental group was significantly more than the placebo group (5 vs. 0, P = 0.02; and 11 vs. 0, P < 0.001, respectively). Conclusion: Taking olibanum extract ODTs reduces the ulcer size and pain severity and accelerates the healing process in the oral aphthous lesions.

The Clinical Use of Curcumin for the Treatment of Recurrent Aphthous Stomatitis: A Systematic Review of Clinical Trials.

Recurrent aphthous stomatitis (RAS) lesions are inflammatory painful oral ulcers with uncertain etiology. Curcumin acts as an effective anti-inflammatory and antibacterial agent in the treatment of various oral diseases. This systematic review aimed to assess the effects of curcumin on RAS. A systematic search of the medical databases, PubMed, Scopus, ISI, Science Direct, and Google Scholar was performed up to March 30, 2020, to identify clinical trials assessing the effect of curcumin on aphthous ulcers. Nine studies comprising of 469 participants met all criteria and were analyzed. Treatment with curcumin significantly reduced aphthous ulcer size (seven studies), pain intensity (eight studies), number of aphthous ulcers (three studies), erythematous halo (one study), and erythema and exudate of the aphthous (one study). In four studies, the effect of curcumin on aphthous ulcer was assessed in comparison to the effects of the standard medication, triamcinolone. In all of these studies, curcumin had similar beneficial effects on the aphthous ulcer as measured by ulcer size, number, and pain. Only three studies were categorized as high quality using the Jadad scale. Within the limitations of this review, it can be concluded that curcumin may have a beneficial role in the treatment of recurrent aphthous ulcers. However, more randomized clinical trials are needed to validate these findings.

Oral and dental manifestations of celiac disease in children: a case-control study.

BACKGROUND: Celiac disease (CD) is an immune-mediated enteropathy. CD may also involve complications with the oral cavity, which can result in various dental and oral pathologies. There are currently a limited number of studies on the oral manifestation of CD. This study aims to compare the oral manifestations of children with CD against healthy controls in Saudi Arabia. MATERIALS AND METHODS: This study includes 208 children aged 6-14 years, distributed equally into CD patients and healthy controls. A parent completed and validated the interview questionnaire, which included the child's personal information and medical history. A dental examination was undertaken to measure possible recurrent aphthous stomatitis (RAS), dental enamel defects (DEDs), dental caries experience, and dental malocclusion. Data were analyzed using descriptive statistics and bivariate and multivariate analysis. RESULTS: Two hundred and eight participants were included (104 CD patients and 104 controls). The mean age for CD patients was 10.67 ± 2.39 years and 10.69 ± 2.36 for the healthy controls. CD children had more RAS than controls (42.3% vs. 15.4%, P < 0.001) (OR = 4.03, 95% CI = 2.09-7.81) and more DEDs than healthy controls (70.2% vs. 34.6%, P < 0.001) (OR = 4.45, 95% CI = 2.48-7.97). No significant difference was found in the frequency of malocclusion between cases and controls. CONCLUSION: Saudi Arabian children with CD had a greater number of clinical findings of RAS and DEDs than healthy controls. Pediatric dentists should consider the possibility of CD in child patients presenting with RAS or DEDs.

Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review.

The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7-90 for the laser and 5-90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO2 laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean = 1.0) for studies analysing pain relief and between 0 and 3 (mean = 1.1) for studies evaluating wound healing. The use of lasers (CO2 laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).

Vitamin D status in recurrent aphthous stomatitis.

INTRODUCTION: Recurrent aphthous stomatitis (RAS) is a common chronic inflammatory oral mucosa disease with an unknown cause. However, dysregulation of the immune response seems to play an important role in this disease. AIM: To evaluate the vitamin D status in RAS patients and its effects on RAS severity, given the likely immunomodulatory function of vitamin D in the human organism. MATERIAL AND METHODS: Sixty-six patients with RAS and 66 controls were examined. Immunomodulatory or immunosuppressive treatment and other ulcerative oral diseases were used as exclusion criteria. The severity of RAS was assessed according to the clinical classification of the disease, the number of lesions per flare-up and the length of intervals between the attacks. The serum vitamin D level was established in each participant. RESULTS: The mean serum vitamin D (25(OH)D) levels were found to be 16.81 ng/ml in the study group and 19.22 ng/ml in the control group, with no statistically significant difference between the two groups. In the study group, 5 (7.6%) participants were diagnosed with the "normal" vitamin D levels, while 16 (24.2%) had "insufficient" levels and 45 (68.2%) had "deficient" levels. The corresponding distribution in the control group was 8 (12.1%), 18 (27.3%) and 40 (60.6%), respectively. There was no statistical significance in the difference of vitamin D deficits between the study and the control groups. No correlation was detected between the severity of RAS and the serum vitamin D level. CONCLUSIONS: Vitamin D does not seem to be a trigger factor for RAS occurrence and does not appear to influence the severity of the disease in the studied group.

Increased beta 2 defensin in recurrent aphthous ulcer.

OBJECTIVES: It was hypothesized that beta 2 defensin (BD-2) is increased in RAU lesions compared with healthy controls to promote anti-microbial host defence. METHODS: RAU and control mucosa samples were subjected to quantitative real-time PCR and immunostained for BD-2, CD68, mast cell tryptase and 4-hydroxynonenal (4HNE). The effect of tumour necrosis factor-α (TNF-α) ± interleukin-17C (IL-17C), without and with vitamin K3, was studied on BD-2 expression in epithelial SCC-25 cells. RESULTS: Although BD-2 mRNA did not differ between healthy and RAU mucosa, BD-2 stained strongly in acute-phase RAU epithelium (P = 0.001). In controls, subepithelial BD-2(+) cells were mast cells and macrophages, whereas in RAU, most infiltrating leucocytes were BD-2(+) (P = 0.004). In cell culture, BD-2 was increased 124-fold by TNF-α (P < 0.0001) and 208-fold synergistically together with IL-17C (P < 0.0001). 4HNE staining of RAU epithelium was not significantly increased, and vitamin K3-induced reactive oxygen species (ROS) did not affect BD-2. CONCLUSIONS: Anti-microbial BD-2 was not affected by oxidative stress but was highly increased in the epithelial and immigrant cells in the acute-phase RAU lesions, probably in part synergistically by TNF-α and epithelial IL-17C, which are known to be induced by activation of danger-signal receptors by pathogen- and/or damage-associated molecular patterns.

IL-17C and its receptor IL-17RA/IL-17RE identify human oral epithelial cell as an inflammatory cell in recurrent aphthous ulcer.

BACKGROUND: Recurrent aphthous ulcer (RAU) is an ulcerative disease of non-keratinized oral mucosa. Colon and bronchial epithelial cells produce interleukin-17C (IL-17C) upon stimulation of Toll-like receptor 2 (TLR2), TLR3 and TLR5, which are highly expressed in epithelial cells in RAU lesions. We therefore investigated the eventual presence and function of IL-17C in cultured human oral keratinocytes (HOK) and control biopsies compared to RAU lesions. METHODS: Expression of IL-17A, IL-17C, IL-17RA and IL-17RE was analysed in cultured HOK cells using quantitative real-time polymerase chain reaction (qRT-PCR). HOK cells were stimulated with IL-17C and analysed for IL-8 and tumour necrosis factor-α (TNF-α) using qRT-PCR. Control mucosa (n = 5) was immunostained for IL-17A, IL-17C, IL-8, TNF-α and mast cell tryptase and compared with RAU lesions (n = 5) using the mean grey scale value. RESULTS: IL-17C, but no IL-17A, mRNA was found in cultured HOK cells. Components of the heterodimeric IL-17RA/IL-17RE receptor for IL-17C were also highly expressed. Stimulation of HOK with IL-17C increased TNF-α mRNA (P = 0.03; IL-8 increase was not statistically significant). HOK in RAU lesions stained intensively for IL-17C compared to controls (P = 0.006). This was associated with increased epithelial immunostaining of TNF-α (P = 0.04) and IL-8 (P = 0.02). Most of the inflammatory cells which stained for IL-17A in control mucosa and RAU lesions were also mast cell tryptase positive. CONCLUSION: IL-17C is highly expressed in epithelial cells in RAU lesions, where it seems to stimulate oral keratinocytes via IL-17RA/IL-17RE to produce pro-inflammatory cytokines. Human oral epithelial cells are probably important inflammatory cells in RAU.

The Efficacy of Triphala in the Management of Minor Aphthous Ulcers: A Case Report.

Aphthous ulcers, also known as canker sores, are the most frequently encountered lesions in the oral cavity by clinicians and particularly by dentists. It might affect populations of all age groups, although common in the younger age group. Though multifactorial causes are known to be associated with the occurrence of aphthae, the most common etiologies are stress, inadequate sleep, and improper digestion. They can appear on the oral mucosa, palate, gingiva, labial mucosa, and tongue. They can be very uncomfortable during mastication, speech, and deglutition. Generally, the management relies on identifying the cause and prescribing medications such as the local application of anesthetic, steroid ointments specifically for refractory cases, and multivitamin tablets to relieve the symptoms. Ayurvedic preparations such as Triphala oral rinse can prove to be really effective in relieving pain and burning sensation and also cause the lesions to subside, although, like other allopathy medications, it is not known to reduce the frequency of episodes. In this article, we present a case of a male patient aged 21 years who came with a complaint of ulcers on the right lateral border of the tongue. He was prescribed Triphala oral rinse and Triphala ingestion for 15 days, and on the follow-up visit, the patient reported the complete resolution of ulcers.

Treatment of aphthous ulcers with photodynamic therapy: A randomized controlled clinical study.

BACKGROUND: This study aims to assess whether photodynamic therapy (PDT) offers a clinically effective alternative for treating oral aphthous ulcers, contributing to the ongoing quest for methods to expedite their treatment process amidst the limited understanding of their etiology. MATERIALS AND METHOD: The study involved thirty volunteers with aphthous ulcers, split equally between a control group and a PDT group. Patients in the PDT group received laser treatment using Indocyanine green upon admission, while the control group received no intervention. Lesion diameter was measured at presentation and on the 3rd, 5th, and 7th days for all patients, with wound healing assessed on the 7th day. Additionally, pain levels were evaluated using the Visual Analog Scale (VAS) preoperatively and on the 1st, 3rd, 5th, and 7th days for the PDT group, and on the corresponding days for the control group. RESULTS: Lesion diameters in the PDT group showed a significant reduction over time (p = 0.001), particularly from preoperative to final measurements. The control group also exhibited a decrease, albeit slower (p = 0.001). The 7th-day healing scores favored the PDT group significantly (p = 0.012). VAS scores in the PDT group decreased significantly over time (p = 0.001), indicating pain reduction. A similar trend was observed in the control group, albeit slower. Between-group differences in healing data and pain data were statistically significant. CONCLUSION: PDT proves effective in reducing aphthous ulcer diameters and pain intensity, facilitating faster healing than the control group. These results advocate for PDT as a viable treatment option for aphthous lesions.

Can the mucosal attacks of Behçet's disease be predicted?

The primary objective of this study was to investigate the association between disease activity and serum and salivary procalcitonin (Pct) levels in patients with Behçet's disease (BD). The study included patients diagnosed with BD and age-matched healthy volunteers (N: 48, N: 32). Serum and salivary Pct levels were quantified using enzyme-linked immunosorbent assay (ELISA) in the laboratories of Diskapi Yildirim Beyazit Training and Research Hospital. No significant disparity was observed in serum and salivary Pct levels between the patient and control groups (p > 0.05). Furthermore, there was no noteworthy correlation between disease activity and serum and salivary Pct values (p > 0.05). However, the serum Pct level in patients with active oral ulcers was significantly elevated compared to those without active oral ulcers (p: 0.003). Serum Pct emerges as a valuable marker for monitoring oral aphthous ulcer attacks within the patient population.

Oral Mucosal Lesions in Patients Attending Dermatology Outpatient Department of a Tertiary Care Center in Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: Oral mucosal lesions though mostly benign, may impair the quality of life of patients. Some may even progress to malignancies. Many physicians, including dermatologists, tend to skip oral examinations, missing many important diagnoses. Understanding the frequency and types of oral mucosal lesions in dermatological settings can help in early diagnosis, referral and adequate treatment. This study was done to determine demographic characteristics and clinical presentations of patients with oral mucosal lesions presenting to the out-patient department (OPD) of dermatology in Nepal Armed Police Force (APF) Hospital, Kathmandu. METHODS: This cross-sectional descriptive study was conducted after obtaining the ethical approval from the Institutional Review Committee of Nepal APF Hospital. Retrospective data of 264 patients presenting with oral mucosal lesions to the dermatology OPD were collected from 1st January 2021 to 31st December 2023 by using a pre-formed proforma. Data was entered in SPSS software and descriptive statistics were computed. RESULTS: Out of 13,832 cases, oral mucosal lesion was seen in 264 (1.90%) cases among which 153 (57.96%) cases were males with male female ratio of 1.37:1. Most common age group affected was 31-45 years 96 (36.36%). Buccal mucosa 86 (32.57%) was the commonest site involved followed by tongue 73 (27.65%). Aphthous ulcer 82 (31.06%) was the commonest lesion found followed by oral candidiasis 25 (9.46%) and oral lichen planus 24 (9.09%). CONCLUSIONS: Aphthous ulcer was the commonest oral mucosal lesion seen in patients visiting dermatology outpatient department of Nepal APF Hospital, with buccal mucosa being the commonest site affected.

Plants with Anti-Ulcer Activity and Mechanism: A Review of Preclinical and Clinical Studies.

Ulcer disorders including the oral mucosa, large intestine, and stomach mucosa, cause significant global health burdens. Conventional treatments such as non-steroid anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), histamine H2 receptor antagonists (H2RAs), and cytoprotective agents have drawbacks like mucosal injury, diminish gastric acid secretion, and interact with concurrent medications. Therefore, alternative therapeutic approaches are needed to tackle this health concern. Plants are rich in active metabolites in the bark, roots, leaves, fruits, and seeds, and have been utilized for medicinal purposes since ancient times. The use of herbal therapy is crucial, and regulations are necessary to ensure the quality of products, particularly in randomized studies, to assess their efficacy and safety in treating ulcer disorders. This study aims to explore the anti-ulcer activity of medicinal plants in treating peptic ulcer disease, ulcerative colitis, and aphthous ulcers. Articles were searched in Scopus and PubMed, and filtered for publication from 2013 to 2023, resulting in a total of 460 from Scopus and 239 from PubMed. The articles were further screened by title and abstract and resulted in 55 articles. Natural products, rich in active metabolites, were described to manage ulcer disease by protecting the mucosa, reducing ulcer effects, inhibiting pro-inflammatory factors, and reducing bacterial load, thus improving patients' quality of life. Natural extracts have proven effective in managing other health problems, including ulcers by reducing pain and decreasing lesions. This review provides an overview of preclinical and clinical studies on medicinal plants, focusing on their effectiveness in treating conditions like peptic ulcers, ulcerative colitis, and aphthous ulcers.

NASPAG Clinical Consensus on Nonsexually Acquired Genital Ulcers (Vulvar Aphthous Ulcers).

The objective of this document is to provide guidance on the recognition, diagnosis and management of non-sexually acquired genital ulcers in the pediatric and adolescent patient. Commonly known as genital or vulvar aphthous ulcers, lesions are typically seen in the peri­menarchal population, are exquisitely painful, generally self-limited and managed with supportive care. Details of ulcer physical appearance, proposed etiology and options for management are provided to familiarize clinicians with this entity, which can be alarming for patients and families.