LA CONSULTA SEMANAL

MAYO 2000

CONSULTA:

Ann Dermatol Venereol 2000 Feb;127(2):155-8 [Texto completo en formato PDF] 
[Analysis of the literature about drug-induced aphthous ulcers]. 
Boulinguez S, Cornee-Leplat I, Bouyssou-Gauthier ML, Bedane C, Bonnetblanc JM Service de Dermatologie, CHU Dupuytren, 87042 Limoges, Cedex, France. 
OBJECTIVES: Analysis of the literature on drug-induced aphthous ulcers and mucosal ulcerations and evidence-based grading. MATERIAL AND METHODS: Four literature sources were analyzed. Three groups of key words were used: 1) oral, buccal, genital, mucosal; 2) ulcer, ulceration, aphthous, aphthosis; 3) induced, drug, adverse-effects, with cross-overs. Four grading patterns were used: presence of aphthous term or synonym, typical clinical description of aphthous ulcer, presentation suggesting diagnosis of aphthous ulcer, criteria defining likelihood of drug causality. RESULTS: We examined 66 of the 220 publications responding to our selection criteria. Typical clinical description of aphthous ulcer and/or clinical presentation suggesting the diagnosis of aphthous ulcer were noted for 8 compounds with likely or palausible patterns of causality. For 21 compounds, we found only aphthous term or synonym without a clinical description or presentation. DISCUSSION: Our review of the literature individualized a group of 8 compounds where the diagnosis of aphthous ulcers was plausible and another group of 21 compounds where the diagnosis of aphthous ulcers requires confirmation. The clinical relevance and limitations of this analysis are discussed. CONCLUSION: Drug-induced aphthosis is probably a real phenomenon. Causality of the 8 compounds in the first group is simply more fully documented than for the 21 compounds in the second group. A low evidence level may not confirm these hypotheses. Some drugs may have been incorrectly ruled out due to lack of information. 
Publication Types: 
· Review 
· Review, tutorial 

Oral Diseases (2000) 6, 25-30 [Texto completo en formato PDF] 
Oral tuberculosis: a clinical evaluation of 42 cases 
MD Mignogna1, LLO Muzio1, G Favia2, E Ruoppo1, G Sammartino3, C Zarrelli3 & E Bucci1 
1Division of Oral Medicine, Faculty of Medicine, University Federico II, Naples, Italy 2Division of Oral Medicine, Faculty of Medicine, University of Bari, Naples, Italy 3Division of Oral Surgery, Faculty of Medicine, University Federico II, Naples, Italy 
OBJECTIVES: A retrospective review of a large series of oro-facial cases of tuberculosis to analyse clinical, histopathological, and radiological aspects, as well as those of chemotherapy.  MATERIALS AND METHODS: A total of 42 cases of tuberculosis of the oro-facial region were examined. Thirteen patients had a primary form and 29 a secondary form of the disease. Diagnosis was based on careful clinical examination, Mantoux reaction, histopathological examination, microbiological cultures and immunological investigation with the detection of antibodies against Mycobacteria in the patients’ serum (ELISA).  RESULTS: Cases examined consisted of 27 males and 15 females. The age range was 3 to 73 years (mean age 31 years). Clinical manifestations comprised oral ulcers in 69.1%, bone involvement in 21.4%, and salivary gland and/or lymph node involvement in 14.3%. A total of 79.4% patients with secondary disease had pulmonary lesions, 15 of whom showed clinical and radiological signs of activity; there was one case of bilateral renal lesions and two of skin lesions.  CONCLUSIONS: Oro-facial tuberculosis is often difficult to diagnose and it should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity. The most important diagnostic tools remain a careful clinical evaluation, biopsy for histologic study, as well as acid-fast stains, culture, and immunological assays, and skin testing. 

Ann Med Interne (Paris) 1999 Nov;150(7):535-41 [Texto completo en formato PDF] 
[Dermato-mucosal manifestations of Behcet's disease]. 
Frances C 
Service de Medecine Interne, Hopital de la Pitie, Paris. 
Oral and genital aphthae are the main clinical dermatologic manifestations of Behcet's disease. They look like those that occur in other aphthosis. Cutaneous lesions include pseudofolliculitis, folliculitis, erythema nodosum-like lesions, Sweet's-like lesions and pyoderma gangrenosum-like lesions. Histologically, these lesions are frequently perivascular with proeminent infiltrates of neutrophils and/or lymphocytes. Hypersensibility to needle pricks is explored by the pathergy test which sensibility is highly variable depending on the countries. When there is no systemic lesions requiring oral corticosteroids or immunosuppressive therapy, colchicine, aspirine, or dapsone may be prescribed. Thalidomide is sometimes required if aphthosis is refractory to other treatments despite its neurotixic and teratogenic effects. 
Publication Types: 
· Review 
· Review, tutorial 

Infect Dis Clin North Am 1999 Dec;13(4):879-900 
Oral infections and other manifestations of HIV disease. 
Patton LL, van der Horst C 
Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, USA. Lauren_Patton@Dentistry.unc.edu 
Oral lesions are important in the clinical spectrum of HIV/AIDS, arousing suspicion of acute seroconversion illness (aphthous ulceration and candidiasis), suggesting HIV infection in the undiagnosed individual (candidiasis, hairy leukoplakia, Kaposi's sarcoma, necrotizing ulcerative gingivitis), indicating clinical disease progression and predicting development of AIDS (candidiasis, hairy leukoplakia), and marking immune suppression in HIV-infected individuals (candidiasis, hairy leukoplakia, necrotizing periodontal disease, Kaposi's sarcoma, long-standing herpes infection, major aphthous ulcers). In addition, oral lesions are included in staging systems for HIV disease progression and as entry criteria or endpoints in clinical trials of antiretroviral drugs. Recognition and management of these oral conditions is important for the health and quality of life of the individual with HIV/AIDS. In keeping with this, the U.S. Department of Health Services Clinical Practice Guideline for Evaluation and Management of Early HIV Infection includes recommendations that an oral examination, emphasizing oral mucosal surfaces, be conducted by the primary care provider at each visit, a dental examination by a dentist should be done at least two times a year, and patients should be informed of the importance of oral care and educated about common HIV-related oral lesions and associated symptoms.  
Publication Types: 
· Review 
· Review, tutorial 

Dent Update 1998 Dec;25(10):478-84 
Orofacial disease: update for the dental clinical team: 2. Ulcers, erosions and other causes of sore mouth. Part I.  
Scully C, Porter S 
Eastman Dental Institute for Oral Health Care Sciences, University of London. 
Mouth ulcers are one of the most common oral complaints. The term ulcer is used usually where there is damage to both epithelium and lamina propria, and a crater, sometimes made more obvious clinically by swelling caused by oedema or proliferation in the surrounding tissue. The term erosion is usually used where the damage is somewhat more superficial. Most ulcers/erosions are due to local causes such as trauma or burns. Some are caused by aphthae or malignant neoplasms, and a few have aetiology in obvious systemic disease. Ulcers of local cause, drugs, aphthous ulcers, Behcet's syndrome and malignant ulcers are discussed in this article. The next two articles discuss the ulcers due to systemic disease including disorders of the blood, gastrointestinal disorders, skin diseases, connective tissue disease and infective diseases. 
Publication Types: 
· Review 
· Review, tutorial 

J Am Acad Dermatol 1999 Jan;40(1):1-18; quiz 19-20 
Behcet's disease and complex aphthosis. 
Ghate JV, Jorizzo JL 
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. 
Behcet's disease is a complex multisystem disease diagnosed by means of clinical criteria. Clinical features include oral and genital aphthae, pustular vasculitic cutaneous lesions, and ocular, gastrointestinal, and vascular manifestations. We believe that complex aphthosis, characterized by oral or oral and genital ulcers, may be a forme fruste of Behcet's disease. Although the pathogenesis of both Behcet's disease and complex aphthosis remain unknown, immune factors, infectious agents, and effector mechanisms are implicated. Treatment is based on the severity of systemic involvement and includes topical therapies as well as colchicine, dapsone, thalidomide, and immunosuppressive agents. 
Publication Types: 
· Review 
· Review, tutorial 

Ann Dermatol Venereol 1999 Nov;126(11):853-9 
[Oral mucosa ulcerations]. 
Vaillant L, Jan V, Huttenberger B 
Service de Dermatologie et Consultation de Dermatologie Buccale, Hopital Trousseau, CHU Tours, 37044 Tours Cedex 01.vaillant@med.univ-tours.fr 

Mt Sinai J Med 1998 Oct-Nov;65(5-6):383-7 
Diagnosis of oral ulcers. 
Schneider LC, Schneider AE 
Department of Oral Pathology, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark 07103, USA. 
Ulcers commonly occur in the mouth. Their causes range from minor irritation to malignancies and systemic diseases. Innocent solitary ulcerations, which result from trauma and infections, must be distinguished from squamous cell carcinomas, which also typically present as solitary ulcers. Multiple oral ulcers may be classified as acute, recurrent and/or chronic. The most common causes of rapid-onset oral ulcers include acute necrotizing ulcerative gingivitis, allergies and erythema multiforme. The two
common forms of acute (short-term) recurrent oral ulcers, "cold sores" or "fever blisters," which are caused by the herpes simplex virus, and recurrent aphthous ulcers ("canker sores"), may be distinguished largely on the basis of their location. Most types of multiple chronic oral ulcers are associated with disturbances of the immune system. They include erosive lichen planus, mucous membrane pemphigoid and pemphigus vulgaris. Clinical criteria which are most useful in identifying the cause of oral ulcers are vesicles or bullae, which may not be seen because they rupture rapidly in the oral environment; constitutional signs and symptoms; and lesions on the skin and/or other mucosa. In some cases, diagnosis depends upon culture or biopsy, particularly with the application of immunofluorescence to the surgical specimen. 
Publication Types: 
· Review 
· Review, tutorial 

Arch Dermatol 1997 Sep;133(9):1162-3, 1165-6 
Recurrent scarring ulcers of the oral mucosa. Sutton disease (periadenitis mucosa necrotica recurrens. 
Chung JY, Ramos-Caro FA, Ford MJ, Mullins D 
University of Florida College of Medicine, Gainesville, USA. 
Publication Types: 
· Review 
· Review of reported cases 

Lancet 1996 Sep 14;348(9029):729-33 
HIV-related oral disease. 
Greenspan D, Greenspan JS 
Department of Stomatology, School of Dentistry, University of California San Francisco 94143-0422, USA. 
Few people with HIV infection fall to experience oral lesions during the course of their disease. Oral mucosal and salivary gland manifestations include several that were not seen before the AIDS epidemic, while others are more severe in this population. Oral lesions reflect HIV status and the stage of immunosuppression, are important elements in HIV staging and classification schemes, raise pertinent questions about mucosal aspect of immunosuppression, and provide therapeutic challenges. Their pervasive nature and biological significance emphasise the importance of a careful oral examination as part of the general clinical evaluation. 
Publication Types: 
· Review 
· Review, tutorial 

Dermatol Clin 1996 Apr;14(2):243-56 
Recurrent aphthous stomatitis. 
Rees TD, Binnie WH 
Stomatology Center, Baylor College of Dentistry, Dallas, Texas, USA. 
Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease in North America. In some instances, RAS represents the central feature of the multisystem disease complex Behcet's syndrome. This article reviews the clinical features, contributing etiologic factors, and etiopathogenesis of RAS and Behcet's syndrome and describes therapeutic considerations and strategies essential to management of patients suffering from recurrent mouth ulcers. 
Publication Types: 
· Review 
· Review, tutorial