Oral Pemphigoid Recalcitrant Lesion Treated with PRGF Infiltration. Case Report

Mucous membrane pemphigoid (MMP) is a heterogeneous group of chronic autoimmune subepithelial blistering diseases. Oral involvement is present in almost all patients, may represent the onset of the disease, and causes different degrees of pain, dysphagia, soreness, and bleeding. Treatment is based on systemic and/or oral corticoids, or other immunosuppressants. Occasionally, oral lesions can show a poor response to standard treatments. We present the case of a 61-year-old female patient with a painful extensive MMP oral ulcerative lesion recalcitrant to previous systemic azathioprine and local triamcinolone treatment, which was successfully treated in a novel way using PRGF infiltrations as adjuvant. After four weekly infiltrations, pain was reduced from 10 to 0 in a VAS and the lesion was completely healed. The patient continued with a low dose maintenance immunosuppressive treatment (prednisone 5 mg/day PO), and after 13 months of follow-up, there was no relapse of the lesion and no side effects. Although future research is necessary to confirm these observations, PRGF could be a useful adjuvant for the management of extensive mucous membrane pemphigoid oral lesions.

SYSTEMIC IMMUNOLOGICAL DISEASES WITH ORAL &MUCOCUTANEOUS MANIFESTATIONS – A FOCUS ON PEMPHIGUS -- AN INSTITUITIONAL STUDY (Preprint)

BACKGROUND Oral mucosal lesions manifest as a first sign of immune mediated disorders. Lichen planus, pemphigus &pemphigoid are the most frequent immunologically mediated mucocutaneous diseases with oral involvement OBJECTIVE A dental surgeon is the first person to come across these lesions that have similar clinical characteristics, therefore their identification based solely on oral lesions is a challenging issue for dentists, leading to a delay in the establishment of a correct diagnosis and suitable management of the patient. METHODS Clinical information was retrieved from records and histopathologic features were reviewed from archives dated 1997 – 2018. ( n = 6300 ). RESULTS Out of 6300 specimens, these immunologically mediated diseases accounted for 105 (1.66%) cases, of which 86 (1.36%) were lichen planus, 4 (0.06%) were pemphigus and 15 (0.23%) were pemphigoid. CONCLUSIONS From the results of this study, it can be inferred that immune-mediated diseases with oral manifestations are comparatively scarce among oral lesions. The present study comprises the retrospective assessment of oral immunologically mediated diseases, in which data regarding the 3 diseases were extracted and analyzed altogether

ORAL SECONDARY INFECTION IN STEVENS-JOHNSON SYNDROME PATIENT WITH ORAL INVOLVEMENT: A CASE REPORT

ABSTRACTBackground: Stevens-Johnson syndrome (SSJ) is a hypersensitivity reaction that is often triggered by drugs but this case is rare. These reactions result in uncontrolled keratinocyte damage to the skin and mucosa throughout the body, including the oral mucosa, and are often life-threatening. The use of high doses of corticosteroids is a treatment that is often given but it can trigger secondary infections of fungal and viral in the oral cavity. Purpose: This case report discusses the management of oral manifestations and secondary infections in SSJ patients, and becomes guidance for health professionals. Case: A-42-years-old male patient was consulted from the Department of Dermatology and Venereology (DV) due to oral pain and eating difficulties. The severity-of-illness-score for toxic-epidermal-necrolysis (SCORTEN) was 1. Erosive serosanguinous crusts, tend to bleed were found on the lips. Intraoral clinically presented wide erosive lesions and multiple ulcers, accompanied by a pseudomembranous plaque, and teeth decay. Hematologic examination showed an increase in leukocytes, neutrophil segments, monocytes, SGOT, urea, and creatinine as well as decreased hemoglobin, hematocrit, erythrocytes, MCHC, protein, and albumin. Anti-HSV1 IgG increased almost 6 times than normal values. The patient was diagnosed with SJS with oral involvement, secondary infections of pseudomembranous candidiasis, and herpetic stomatitis. Case Management: Systemic therapy given were intravenous dexamethasone, ranitidine, calcium, and cetirizine, from the DV Department, while hydrocortisone lip ointment, Chlorhexidine digluconate 0.12%, and Nystatin oral suspension for oral problems. The lesions progressed in 24 days. Conclusion: Oral secondary infections may occur in SJS patients due to high-dose corticosteroid therapy.Keywords: Herpetic Stomatitis, Oral Manifestation, Oral Secondary Infection, Pseudomembranous Candidiasis, Stevens-Johnson Syndrome.

Prevalence of desquamative gingivitis in dermatological lesions - A retrospective institution based study

The oral cavity is considered to be the window to your body because oral manifestations accompany many systemic diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. The aim of this study is to find the correlation of these formative gingiva along with dermatological lesions. Details of patients reported with dermatological lesions to the dental hospital with oral manifestations were obtained from a detailed patient record. The data collected is tabulated graphically via SPSS for statistical analysis. 24 patients were reported with various dermatological lesions. 70% of female predilection was observed, and maximum patients carried the lesion for about 12 months. Out of the 24 patients, 70% show the presence of desquamative gingiva clinically. Histopathological diagnosis shows that 75% of the dermatological lesions present in the oral cavity is lichen planus. According to the current study population, dermatological lesions are the common cause of desquamative gingiva. The prevalence of oral lichen planus was higher and commonly seen along with desquamative gingiva.