Therapeutic response of oral chronic graft-versus-host disease to topical corticosteroids according to the 2014 National Institutes of Health (USA) consensus criteria / Respuesta terapéutica de la enfermedad de injerto contra huésped crónica oral a los corticosteroides tópicos según los criterios de consenso de los Institutos Nacionales de Salud (EE. UU.) de 2014

Background: Chronic graft-versus-host-disease (cGVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. The oral cavity is one of the most frequently affected anatomic sites and is affected in 70% of all patients who develop cGVHD. The objective of this study was to determine the therapeutic response to topical corticosteroids and clinical outcome of patients with oral cGVHD using the 2014 NIH consensus criteria. Material and Methods: The oral manifestations of cGVHD were collected at the first and the follow-up (FU) visits after the therapeutic treatment of oral GVHD. The FU intervals were: FU0, first visit; FU1, 0-1 month; FU2, 1-3 months; FU3, 3-6 months; FU4, 6-9 months; and FU5, 9-12 months. The oral cGVHD activity was assessed using the NIH modification of the Schubert Oral Mucosa Rating Scale (OMRS) and Thongprasom sign score. The functional impact was assessed by the organ-specific severity score. Results: Fourteen patients (93.3%) at FU0 were being treated with at least one form of systemic immunosuppressive therapy, i.e., prednisolone, cyclosporin, and tacrolimus. The OMRS was reduced between FU0 and FU3 (p < 0.001), FU0 and FU4 (p < 0.001), and FU0 and FU5 (p = 0.004). The organ-specific severity scores were also reduced between FU0 and FU4 (p = 0.016), and FU0 and FU5 (p = 0.001). There was no significant difference in the highest Thongprasom sign score between all follow-up intervals (FU0-FU5) (p = 0.201). One patient (6.7%) at FU4 and three patients (20.0%) at FU5 did not receive topical corticosteroid therapy for oral cGVHD....(AU)

Clinical characteristics of oral chronic graft-versus-host disease according to the 2014 National Institutes of Health (USA) consensus criteria

Background: Chronic graft-versus-host disease (cGVHD) is a serious and common complication of allogeneic hematopoietic cell transplantation (alloHCT). The oral cavity is the second most common site affected by cGVHD. In 2014, the 2005 National Institutes of Health (NIH) consensus criteria were revised to address areas of controversy. The aim of this study was to evaluate the clinical characteristics of oral cGVHD using the 2014 NIH consensus criteria. Material and methods: The baseline data of oral manifestation of patients, who were diagnosed with oral cGVHD, in the first dental visit were analyzed (n=22). The oral mucosal disease was evaluated by NIH modified Oral Mucosa Rating Scale (OMRS) and Thongprasom sign score. The salivary gland disease and sclerotic disease were determined by the presence of signs and symptoms. The functional impact was assessed by the organ-specific severity score. Results: The median time from transplant to oral cGVHD diagnosis was 11.9 months. White striae with an erosive area was found in 72.7% of the patients. The mean ± SD of NIH modified OMRS was 6.1 ± 3.0. The most common and severely affected site of lichen planus-like features was buccal mucosa. Xerostomia, superficial mucocele and limited mouth opening were found in 18.2%, 9.1%, and 9.1%, respectively, of the patients. Almost all patients (90.9%) had partial limitation of oral intake. There were no significant differences in NIH modified OMRS or organ-specific severity score among the patient characteristic groups. Moreover, there was no association between the oral manifestations of cGVHD and the patient characteristics. Conclusions: The most common oral manifestation of cGVHD was white striae with an erosive area of oral mucosal disease, followed by xerostomia, superficial mucocele, and limited mouth opening. The 2014 NIH consensus criteria for diagnostic and severity assessment are informative and feasible in real-world practice. (AU)

Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: A Review of the Literature.

Oral ulcers are the most common mucosal sign in juvenile-onset systemic lupus erythematosus (JSLE). The ulcers are one of the key clinical features; however, the terminology of oral ulcers, especially in JSLE patients, is often vague and ill-defined. In fact, there are several clinical manifestations of oral ulcers in JSLE, and some lesions occur when the disease is active, indicating that early management of the disease should be started. Oral ulcers are classified as lupus erythematosus (LE) specific, where the lesional biopsy shows a unique pattern of mucosal change in LE, and LE nonspecific, where the ulcers and their histopathological findings can be found in other oral diseases. Here, the clinical manifestations, diagnosis and management of oral ulcers in JSLE patients are reviewed.

Effect of daily drinking of Aloe vera gel extract on plasma total antioxidant capacity and oral pathogenic bacteria in healthy volunteer: a short-term study.

BACKGROUND: The aim of this study was to investigate the effect of Aloe vera gel extract on plasma total antioxidant capacity (TAC) and oral pathogenic bacteria in healthy volunteer. METHODS: Fifty-three healthy volunteers were participated and interviewed for history of allergy, current systemic diseases and medications. Participants were received 250 mL of A. vera gel extract daily for 14 consecutive days. At days 0 and 15 of the experiment, blood samples were collected and analyzed for biochemical markers. The plasma TAC was evaluated by ferric reducing ability of plasma technique. The biochemical markers, including aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), total protein (TP), serum albumin (ALB), serum globulin (GLB), total bilirubin (TB), blood urea nitrogen (BUN), serum creatinine (Cr) and creatinine clearance (CrCl) were measured. The antibacterial effect of A. vera gel extract against Lactobacillus spp. and Streptococcus mutans was also investigated. Statistical analysis was performed using paired t-test to compare between baseline and 14 days post-intervention. RESULTS: Neither allergy nor side effects of A. vera gel extract was detected. After 14 days of A. vera gel extract consumption, plasma TAC was significantly greater than that of baseline (p = 0.001). ALP, TB, TP and GLB were significantly increased (p < 0.05) which were still within normal range. AST, ALT, ALB, BUN, Cr and CrCl were not significantly different. A. vera gel extract significantly reduced the number of Lactobacillus spp. (p < 0.05), not S. mutans. CONCLUSIONS: Our data revealed that A. vera gel extract significantly increased plasma TAC, and decreased the number of Lactobacillus spp. without any clinical side effects.

Oral lichenoid lesions and serum antinuclear antibodies in Thai patients.

OBJECTIVES: The aim of this study was to investigate the presence of serum antinuclear antibodies (ANA) in Thai oral lichenoid drug reaction (OLDR) and oral lichen planus (OLP) patients. MATERIALS AND METHODS: This study comprised 20 patients diagnosed with OLDR, 23 patients with OLP, and 24 healthy control subjects. Participants' blood samples were assayed for ANA staining patterns and serum ANA titer levels by immunofluorescence using human epithelial type 2 (HEp-2) as a substrate. The serum ANA titer levels were defined as low (1:40-1:80), medium (1:160-1:320), and high (>1:640). RESULTS: Serum ANA were detected in 73.9%, 70%, and 25% of OLP, OLDR, and control subjects, respectively. There was a statistically significant difference between the number of serum-ANA-positive subjects in the OLP or OLDR groups and the control group (P < 0.01), but no significant difference between the OLP and OLDR groups. The speckled pattern was the most commonly found staining pattern, present in 60.9%, 55.0%, and 20.8% of the OLP, OLDR, and control subjects, respectively. The number of subjects with low ANA titers in the OLP and OLDR groups was significantly higher than that of the control group (P < 0.01). Medium ANA titers were found in 15%, 4.4%, and 4.2% of the OLDR, OLP, and control subjects, respectively, while high ANA titers were not found in any group. CONCLUSIONS: The number of serum-ANA-positive OLP and OLDR patients was significantly higher than the control group. Speckled pattern and low titer levels were the most common findings in both OLP and OLDR groups.