Erythematous Halo Research Articles

Oral Aphthous-like Ulcers Response to Topical Therapy in Young Adult Woman with Beta-Thalassemia Intermedia

Background: Beta thalassemia may have some oral manifestations. Oral mucosa ulcer may be one of the oral manifestations of beta-thalassemia. The oral ulcer may resemble recurrent aphthous stomatitis (RAS). This current case report aims to present an aphthous oral ulcer as a manifestation in young adult women with beta-thalassemia. Case report: A 28-year-old woman complained of recurrent painful oral ulcers in the labial mucosa. She was diagnosed with beta-thalassemia intermedia three years before. The ulcer may take 3-4 weeks to heal completely. Intraoral examination revealed two yellowish ulcers, 5 mm and 10 mm, surrounded by an erythematous halo, regular margin on left lips mucosa, oral ulcer pain scale measured medium level by visual analogue scale (VAS). The oral aphthous-like ulcer was taken for diagnosis in this case. Topical treatment was given to the oral ulcer using chlorine dioxide gel three times daily. After 10 days, the oral aphthous-like ulcer was healed. Conclusion: An oral aphthous-like ulcer may be the oral manifestation in beta-thalassemia patients, and the oral ulcer may respond well to topical treatment commonly used in recurrent aphthous stomatitis (RAS) patients. Hence, it is important to recognize oral conditions as one clinical manifestation in beta-thalassemia patients and choose the appropriate treatment to accelerate oral ulcer healing.

Giant major aphtha.

Major aphthae are usually located on the dorsum of the tongue, the mucosal surface of the lips and the palate. They are large, round or oval ulcers, with a whitish-grey bed, well-defined borders and erythematous halo. They are very often accompanied by severe pain. Major aphthae can take up to four months to heal, often with a scar. Relapses are possible. We present a case of giant major aphtha that was previously diagnosed as squamous cell carcinoma.

Clinicopathological and molecular approaches to the diagnosis of oral lesions in Mpox: Case report.

Mpox virus infection (MPXV) has recently been recognized as a public health emergency by the World Health Organization. While several studies have described the clinical characteristics of MPXV-oral lesions, there remains a dearth of information regarding the histological and ultrastructural oral findings. A 24-year-old HIV-positive man presented with a shallow ulcer, covered by a fibrinoid membrane, and surrounded by an erythematous halo in the hard and soft palate. The clinical appearance of the lesion raised suspicion of a viral infection; thus, the diagnosis was based on histological and electronic microscopy findings and confirmed by RT-PCR testing in the skin specimen. This case report aims to offer comprehensive insights into the clinical, histopathological, and ultrastructural features of oral lesions caused by MPXV in an individual with HIV. This report provides valuable information about the characteristics of MPXV infection in the oral mucosa, particularly in people living with HIV.

Expression of Salivary Ceramide Synthase 1 (CERS1) in Recurrent Aphthous Stomatitis (RAS): A Cross-Sectional Institutional Study.

Background The increased rate of apoptosis is one of the major causes of ulcer formation. A variety of factors can influence the rate of apoptosis. Ceramide (CER) is one such factor that has been proposed to play a role in signaling apoptosis induced by extracellular agents. Recurrent aphthous stomatitis (RAS) is a common condition that initially presents in children or adolescents. Multiple recurrent small, round, or ovoid ulcers with erythematous haloes and circumscribed margins are its characteristic features. Its pathogenesis is still a mystery. Ceramide synthase 1 (CERS1) aids in the production of C18 CER. Although the role of CERS1 in aphthous is well understood, its possible intricate role in pathogenesis remains unknown. Aim To evaluate the expression of salivary CERS1 in patients with RAS and healthy individuals. Materials and methods 30 patients were included in the present study. Ethical clearance for this study was obtained, and there were no gender or age limits for enrollment. After obtaining informed consent, 30 salivary samples were collected from patients with RAS (n=15) and from healthy individuals (n=15). Enzyme-linked immunosorbent assay (ELISA) was performed using the CERS1 kit by MyBioSource Inc (San Diego, USA) and the results were recorded. The Chi-square test and Independent t-test were used for statistical analysis with SPSS v23.0 (IBM, Chicago, USA) with a significant p-value of <0.05. Results CERS1 expression was identified in the saliva of all participants. There was a decrease in the salivary CERS1 level in RAS patients (7.6 +/- 2.0 pg/ml) when compared to healthy individuals (8.3 +/- 1.8 pg/ml) but it did not achieve statistical significance. Conclusion We found that salivary CERS1 levels decreased in RAS patients. More research is required to understand CERS1's pathogenetic role.

AFATINIB-RELATED ORAL ULCERATION

Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement. Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement.

Assessment of Healing after Diode Laser Gingivectomy Prior to Prosthetic Procedures

The current pilot study investigates the effects following removal of excessive gingival tissue, which is often necessary in fixed prosthodontic cases. The aim of the study is to assess gingival healing after diode laser gingivectomy prior to prosthetic procedures. Materials and methods: The healing process of the gingiva after the diode laser gingivectomy of 41 teeth was assessed. The following parameters were examined: recovery time of the gingiva, possibility to take the impression at the same visit, duration of the manipulation, bleeding during the procedure, tissue adherence to the instrument, postoperative hemorrhage on probing, postoperative pain, and wound healing in regard to tissue color, tissue contour, and appearance of the wound. Results: At the 24th hour, all gingival wounds were covered with fibrinous plaque and an erythematous halo. At the 72nd hour, in two cases (4.9%), this wound’s characteristic had already passed through to the next healing stage—granulated surface and normal pale pink color. A granulated surface in the 1st week was reported in 10 (24.4%) cases, and in all of the other 31 (75.6%) cases, complete healing was reported. In the second week, all wound surfaces had a normal pale pink color. Bleeding was self-limiting in most of the cases and negligible from a clinical point of view. The postoperative pain levels were low or nonexistent. There was lack of postoperative hemorrhage on probing after the first week in all examined cases. Tissue recovery in terms of tissue contour, color, and appearance of the wound was asymptomatic. Conclusion: within the limitations of this pilot study, the outcomes of the wound healing after laser gingivectomy aided the clinicians to perform the prosthetic procedures in the same visit.

Neurological manifestations of scrub typhus: Encephalitis and Acute Inflammatory Demyelinating Polyneuropathy (AIDP) (P2-10.002)

<h3>Objective:</h3> We report a case of a young male with serologically confirmed scrub typhus presenting with fever, eschar, altered sensorium, and progressive quadriplegia to illustrate the neurological complications (central and peripheral) of scrub typhus. <h3>Background:</h3> A young male presented to the emergency with complaint of high-grade fever for the past 12 days and altered sensorium. From the 10th day of illness, he started complaining of worsening weakness in all four limbs. A black, crusted plaque with an erythematous halo, giving a ‘cigarette-burn’ appearance suggestive of an eschar, was noted on the right forearm. On neurological examination, the patient was disoriented to time and place. Neck rigidity was absent. Reduced power of 3/5 in upper limbs and 1/5 in lower limbs was noted. Deep Tendon Reflexes were absent, and plantars were mute. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> CSF analysis revealed no cells, mildly raised proteins (75 mg/dl), and normal glucose. CSF Grams staining, culture, India Ink preparation, and GeneXpert for Tuberculosis, was negative. Blood cultures were sterile. Scrub typhus IgM antibodies were detected using Enzyme-Linked-Immunosorbent-Assay (ELISA). Abdominal ultrasound revealed hepatomegaly. MRI-Brain revealed diffuse gyral swelling and hyperintensity on T2-weighted and FLAIR sequences involving bilateral lobes with no diffusion restriction, consistent with encephalitis. No abnormal post-contrast enhancement was noted. MRI-Spine was normal. Nerve Conduction Studies (NCS) were suggestive Acute Motor Axonal Neuropathy (AMAN) variant of Guillain-Barré-Syndrome (GBS). The patient received doxycycline. IVIG was added after NCS results. His condition gradually improved, and there was regaining of muscle strength in the following weeks with physiotherapy. <h3>Conclusions:</h3> Scrub typhus induced neurological complications are widely reported, with meningoencephalitis being the most common manifestation. However, PNS complications such as GBS are infrequent, and a high degree of clinical suspicion with prompt appropriate therapy and supportive care may prevent morbidity and mortality. <b>Disclosure:</b> Ms. Sood has nothing to disclose. Mr. Modi has nothing to disclose. Dr. Arora has nothing to disclose. Dr. Moudgil has nothing to disclose.

Prevalence of Recurrent Aphthous Ulcers (RAUs) in the Population of Ludhiana

Introduction: Recurrent aphthous ulcer (RAU) is one of the most common oral mucosal disorders characterized by recurrent and painful ulcerations on movable or nonkeratinized oral mucosa. It affects approximately 20% of the general population. These present as recurrent, multiple, small, round, or ovoid ulcers with circumscribed margins, having yellow or gray floors, surrounded by erythematous halos. Aims and Objectives: To compare the prevalence and occurrence of RAU among the age group from 20 to 80 years. To compare the prevalence and occurrence among the gender. To correlate the causes of the recurrent aphthous stomatitis (RAS). To check for tobacco and its role in the occurrence of RAS. Materials and Methods: A cross-sectional study was conducted, and a total of 600 questionnaire forms were distributed and filled by students (undergraduates and postgraduates), staff, skilled workers, and patients reporting to the department over a period of 3 years. Results and Discussions: In total, 71.1% had experienced oral aphthous ulcerations. When both the genders were compared, RAS more commonly affected females (60.33%) than males (39.67%). The regression coefficient for gender revealed that females were more prone to RAS than males. Conclusion: Understanding the prevalence and distribution of recurrent aphthous ulceration among the population of Ludhiana gives an indication of the section of people who suffer from the condition. Based on the results of our study, females were more commonly affected than males, and the second- and third-decades age groups were affected.

Self-Reported Prevalence of Recurrent Aphthous Stomatitis among UiTM Dental Students

Recurrent aphthous stomatitis (RAS) is a common mucosal disease characterized by multiple recurrent, small, round, or oval ulcers with circumscribed margins, erythematous haloes, and yellow grey base. Although the exact etiology is unknown, various factors can trigger RAS development. Objectives: This study aims to determine the prevalence of self-reported RAS and to evaluate the associated risk factors of RAS among dental students. Material and methods: A set of validated questionnaires was distributed among the dental students in the Faculty of Dentistry, UiTM. The questionnaire comprises socio-demographic characteristics, nature of ulcers, risk factors, and treatment modalities. Data obtained from the questionnaire were analyzed using Chi-square statistical test SPSS version 27. Results: A total of 299 dental students participated in the questionnaire survey. The prevalence of RAS among dental students was 90.3 %. There was no significant relationship between the socio-demographic background of participants with self-reported RAS. The most common site affected was the buccal mucosa 64.1%, followed by the lips 55.2%. Risk factors frequently associated with RAS are injury (trauma) and stress 47.8% and 28.1%, respectively. Most dental students (69.3%) do not get any treatment to treat their ulcers, and only 1.5% seek treatment from the dentist. Conclusions: This study highlights the high prevalence of self-reported RAS among dental students and common risk factors reported associated with the occurrence of RAS. Therefore, this data assists the clinician in identifying common associated risk factors of RAS and subsequently improve management and efficient therapeutics.

Ecthyma gangrenosum as a presenting feature of X-linked agammaglobulinemia: A case study.

A previously healthy 5-year-old boy presented with symptoms of fever, vomiting, and diarrhea for three days. He had extensive erythematous skin lesions mainly over his bilateral lower limbs. His parents were nonconsanguineous, and his two younger sisters were healthy. On arrival, he was in septic shock, thus requiring multiple fluid boluses, triple inotropes, and ventilation. The skin lesions started as macules that enlarged into papules and vesicles. Over the next 24 h, they rapidly evolved into multiple hemorrhagic bullae (Fig. 1A), which ruptured to form a gangrenous ulcer with gray-black eschar surrounded by an erythematous halo (Fig. 1B).

ORAL OPPORTUNISTIC INFECTIONS IN ONCOHEMATOLOGICAL PATIENTS

Antineoplastic treatments, such as chemotherapy, favor a series of opportunistic infections in the oral cavity due to immunosuppression. The aim of the present study is to report the case of a 44-year-old male patient diagnosed with acute myelomonocytic leukemia who, during chemotherapy, presented ulcerations with an erythematous halo on the hard palate, cleft lip commissure bilaterally, and increased volume in the region sublingual gland with pain and purulent discharge from the oral cavity. The diagnostic hypotheses were herpes simplex, angular cheilitis, and bacterial sialadenitis, respectively. The therapeutic measures adopted were the introduction of systemic acyclovir associated with antimicrobial photodynamic therapy for the treatment of herpetic lesions, topical antifungal for angular cheilitis, and antibiotic therapy to control sialadenitis. In these cases, opportunistic infections present exacerbated and painful lesions. Such conditions have a negative impact on patients' quality of life and general condition, and dental management and follow-up are essential.

Necrotic ulcers in an immunocompromised patient

A 68-year-old man presented to dermatology clinic with extensive ulcers for one-week duration. Patient had underlying uncontrolled Type II Diabetes Mellitus and pemphigus foliaceous. His medications were metformin 1 g twice daily, prednisolone 30 mg daily and azathioprine 50 mg daily. He denied fever, prior trauma or insect bites. On examination, there were multiple necrotic ulcers of varying sizes present on the anterior trunk and extensors of left knee (Fig. 1A & B). Some of the lesions were exudative with serous discharge. The surrounding skin was erythematous. Blood investigation revealed leucocytosis at 15,000 cells per cubic millimetre and a raised C-Reactive Protein (CRP) at 8 mg/dL. Patient was empirically started on intravenous piperacillin-tazobactam 4.5 g thrice daily to cover for bacterial skin infection. Four days later, swab from the lesion yielded Pseudomonas Aeruginosa with sensitivity towards ceftazidime. Blood culture revealed no growth. Antibiotic therapy was changed to intravenous ceftazidime 1 g thrice daily. Surgical debridement of the necrotic patches was done twice, followed by bactigrass and duoderm dressing. After 1 week of therapy, patient remained well with no new ulcers formed. Inflammatory markers such as total white cell counts and CRP have normalised too. Hence, he was discharged home. What is the diagnosis? Ecthyma gangrenosum. Ecthyma gangrenosum (EG) is a haemorrhagic and necrosing vasculitis of the small vessels, commonly associated with Pseudomonas Aeruginosa [[1]Vaiman M. et al.Ecthyma gangrenosum and ecthyma-like lesions: review article.Eur J Clin Microbiol Infect Dis. 2015; 34: 633-639https://doi.org/10.1007/s10096-014-2277-6Crossref PubMed Scopus (112) Google Scholar]. Risk factors include neutropenia, malignancies, immunosuppressive treatments and diabetes mellitus. [[1]Vaiman M. et al.Ecthyma gangrenosum and ecthyma-like lesions: review article.Eur J Clin Microbiol Infect Dis. 2015; 34: 633-639https://doi.org/10.1007/s10096-014-2277-6Crossref PubMed Scopus (112) Google Scholar, [2]Bettens S. et al.Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature.Acta Clin Belg. 2008; 63: 394-397https://doi.org/10.1179/acb.2008.081Crossref PubMed Scopus (18) Google Scholar] EG presents with painless erythematous macules, with or without vesicles. Within 12–24 h, the lesions become indurated with haemorrhagic blisters. Finally, deep-necrotic ulcers with a grey-black eschar formed with a surrounding erythematous halo. [[2]Bettens S. et al.Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature.Acta Clin Belg. 2008; 63: 394-397https://doi.org/10.1179/acb.2008.081Crossref PubMed Scopus (18) Google Scholar] Most common affected sites are perineal (57%), distal extremities (30%), facial and truncal (12%)[[2]Bettens S. et al.Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature.Acta Clin Belg. 2008; 63: 394-397https://doi.org/10.1179/acb.2008.081Crossref PubMed Scopus (18) Google Scholar]. Clinical assessment is sufficed to diagnose EG. Culture from tissue or swab of lesion may identify the causative pathogen. [[1]Vaiman M. et al.Ecthyma gangrenosum and ecthyma-like lesions: review article.Eur J Clin Microbiol Infect Dis. 2015; 34: 633-639https://doi.org/10.1007/s10096-014-2277-6Crossref PubMed Scopus (112) Google Scholar, [2]Bettens S. et al.Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature.Acta Clin Belg. 2008; 63: 394-397https://doi.org/10.1179/acb.2008.081Crossref PubMed Scopus (18) Google Scholar] Blood culture is recommended if bacteraemia is suspected. [[1]Vaiman M. et al.Ecthyma gangrenosum and ecthyma-like lesions: review article.Eur J Clin Microbiol Infect Dis. 2015; 34: 633-639https://doi.org/10.1007/s10096-014-2277-6Crossref PubMed Scopus (112) Google Scholar] Empirical treatment with anti-pseudomonal antibiotic is recommended if the diagnosis of EG is suspected. [[1]Vaiman M. et al.Ecthyma gangrenosum and ecthyma-like lesions: review article.Eur J Clin Microbiol Infect Dis. 2015; 34: 633-639https://doi.org/10.1007/s10096-014-2277-6Crossref PubMed Scopus (112) Google Scholar, [2]Bettens S. et al.Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature.Acta Clin Belg. 2008; 63: 394-397https://doi.org/10.1179/acb.2008.081Crossref PubMed Scopus (18) Google Scholar] Once the causative organism and its sensitivity are identified, targeted therapy of a single antimicrobial agent is administered until improvement of lesions is observed. Surgical debridement is indicated in extensive cutaneous lesions, abscess or non-responsive to medical therapy alone. [[1]Vaiman M. et al.Ecthyma gangrenosum and ecthyma-like lesions: review article.Eur J Clin Microbiol Infect Dis. 2015; 34: 633-639https://doi.org/10.1007/s10096-014-2277-6Crossref PubMed Scopus (112) Google Scholar, [2]Bettens S. et al.Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature.Acta Clin Belg. 2008; 63: 394-397https://doi.org/10.1179/acb.2008.081Crossref PubMed Scopus (18) Google Scholar] This case emphasizes the need to recognise EG and deliver suitable treatment early. Delay in diagnosis may result in fatal outcome as the mortality rate ranges from 38% to 77%. [[2]Bettens S. et al.Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature.Acta Clin Belg. 2008; 63: 394-397https://doi.org/10.1179/acb.2008.081Crossref PubMed Scopus (18) Google Scholar] Informed consent of the patient has been obtained to publish his case and images in the manuscript. The authors declare that they have no competing interests.

Recurrent aphthous stomatitis: A comprehensive review and recommendations on therapeutic options.

Recurrent aphthous stomatitis (RAS) is a common chronic disease in the oral mucosa that affects about 20% of the population. It is characterized by solitary or multiple, recurrent, small ulcers with erythematous haloes and yellow/gray floors. RAS can be managed through a wide variety of preventative measures and therapies, intending to reduce ulcer pain, stimulate ulcer healing, and/or prevent ulcer recurrence. First-line treatment options include topical medications in the form of corticosteroids (triamcinolone acetonide), anti-inflammatory drugs (amlexanox), antibiotics (doxycycline), and antiseptics (lidocaine). In more severe cases of RAS where local treatment is insufficient, systemic drugs in the form of corticosteroids (prednisone), immunomodulatory drugs (thalidomide), and antibiotics/antimicrobials (clofazimine) can prove effective. This review will summarize current treatment options for RAS with discussion of prevention, topical measures, natural treatments, systemic therapies, and new potential therapies. Furthermore, this review will provide recommendations on therapeutic options for RAS based on disease severity and patient circumstances.

Fire needle for recurrent aphthous stomatitis: A protocol for systematic review and network meta-analysis.

Background:Recurrent aphthous stomatitis (RAS), are common inflammatory lesions of the oral mucous, usually round or ovoid, circumscribed by erythematous haloes with a yellow-grey floor and mostly painful. The purpose of this study was to evaluate the efficacy and safety of fire needle in the treatment of RAS.Methods:PubMed, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database were searched by 2 reviewers from the inception until December 2021. The original study that randomized control trials of fire needle for RAS will be selected and is not limited by country or language. In addition, researches in progress, the reference lists and the citation lists of identified publications will be retrieved similarly. Study selection, data extraction, and assessment of the quality will be performed independently by 2 reviewers who have been trained prior to data extraction. A meta-analysis will be conducted if the quantity and quality of the original studies included are satisfactory; otherwise, a descriptive analysis will be conducted. Review Manager V5.4 software will be using for data synthesis and assessment of the risk of bias according to Cochrane Handbook.Results:This study will provide a comprehensive review of current evidence for the treatment of fire needle on RAS.Conclusion:The conclusion of this study will provide a judging basis that whether the treatment of RAS with fire needle is effective.INPLASY registration number:INPLASY2021120118.

The Articulate Canker-Aphthous Ulcer

Aphthous ulcer occurs as a frequent, idiopathic, painful, singular, multiple or reoccurring oral ulceration. Of obscure aetiology, oral trauma, stress, anxiety, diverse systemic diseases as coeliac disease, Crohn’s disease, Behçet’s syndrome, reactive arthritis or infection with human immune deficiency virus (HIV), drugs such NSAIDs, β-blockers, angiotensin converting enzyme (ACE) inhibitors, deficiencies of vitamins and trace elements as zinc, iron, B12, folate or sensitivity to food and chemicals may engender the ulcer. Contingent to magnitude, aphthous ulcer is subcategorized into minor ulcer, major ulcer or herpetiform ulcer. Aphthous ulcer manifests upon non-keratinized oral mucosa as a well circumscribed, centric, necrotic ulcer circumscribed by a grey, fibrinous exudate and an erythematous halo. The ulcer requires a segregation from contact dermatitis, lichen planus, oral carcinoma, infection with herpes simplex virus (HSV), various drug induced lesions or autoimmune diseases. Aphthous ulcer can be evaluated with clinical examination, complete blood count with nutritional deficiencies of iron, folate or vitamin B12, neutropenia, serum anti-endomysial antibodies and transglutaminase (tTg-IgA) for coeliac disease and investigations for HIV. Cogent therapeutic options are local anaesthetics, coating or occlusive agents as bismuth subsalicylate, sucralfate, 2-octyl cyanoacrylate, bio-adherent emollient pastes, oral antiseptics as chlorhexidine gluconate, hydrogen peroxide, antiinflammatory agents as glucocorticoids, metalloprotease inhibitors, antimicrobials as tetracycline, doxycycline, minocycline, honey, immunomodulatory agents as amlexanox, colchicine, cyclosporine, cyclophosphamide, dapsone, methotrexate, montelukast, thalidomide or retinoids.

Therapeutic Evaluation of 5% Topical Amlexanox Paste and 2% Curcumin Oral Gel in the Management of Recurrent Aphthous Stomatitis- A Randomized Clinical Trial

Background: Recurrent aphthous stomatitis (RAS) minor is a painful oral condition that is characterized by shallow ulcers with an erythematous halo. These ulcers cause difficulty in mastication and speech and have a high recurrence rate. Objective: The present study aims to compare the size of the ulcer, erythema, pain score, and recurrence rates in patients using 5% topical amlexanox and 2% curcumin oral paste in the management of RAS minor. Materials and Methods: The present study was conducted among 48 participants who were randomly assigned into two groups. Group A comprised participants who were given 5% topical amlexanox paste and Group B comprised participants who were given 2% curcumin oral gel for application. The participants were evaluated on days 1, 4, and 7 for the size of ulcers, erythema level, and pain score. They were reviewed on days 30, 60, 90, and 180 and recurrence episodes were documented. Results: There was a significant reduction in erythema (0.041) and pain scores (0.012) in Group B participants who used curcumin. The size of the ulcer had reduced in both the groups though there was no significance. Recurrence rates were high in participants who used amlexanox (92%) and were comparatively low in the curcumin using group (50%). Conclusions: Curcumin is a potent, safe substitute in the management of RAS minor for its effectiveness in reducing erythema, pain, and recurrence rates. Further studies should be conducted for evaluating the efficacy of curcumin in various clinical types of RAS.

A UNIQUE CASE OF XANTHOMATOSIS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hypertriglyceridemia (TGL) is the abnormal concentration of triglycerides in the blood associated with atherosclerosis. It is known to cause skin lesions when the blood levels are more than 3000 mg/dl. It is also associated with 1 to 10 percent cases of acute pancreatitis and 10 to 20 percent when levels are higher than 2000 mg/dl. CASE PRESENTATION: A 36-year old morbidly obese man with medication non-compliance was evaluated by a dermatologist via a video tele visit due to COVID19 Pandemic. He has a history of uncontrolled IDDM, hypertriglyceridemia status post plasmapheresis a year ago associated with pancreatitis. He has no family history of hypertriglyceridemia. He reported rashes on his forearms and thighs for 3 weeks and was advised to go to the Emergency Department to rule out cutaneous manifestation of his underlying conditions. He initially reported epigastric pain radiating to his back, but his lipase and CT abdomen were negative for pancreatitis. He was vitally stable, and his exam was significant for yellowish papules on his forearms, legs bilaterally with erythematous borders. Labs: TGL 1618, total cholesterol 647, Glucose 223, A1c 12.6%, no Anion Gap.Imaging: Splenomegaly with Hepatic Steatosis likely due to TGL deposition.Patient was placed on Insulin drip to prevent pancreatitis and was started on fenofibrate, fish oil and rosuvastatin. Kept NPO initially with dextrose infusion to increase insulin drip & metabolize the triglycerides. Triglycerides gradually improved, and insulin drip was d/c. Shave Biopsy confirmed Eruptive Xanthoma. DISCUSSION: Eruptive xanthomas are characterized by an eruption of yellowish skin papules, encircled by an erythematous halo, most commonly arising over the extensor surfaces of the extremities, buttocks and shoulders in the setting of high triglyceride levels secondary to diabetes, diet or familial causes. The lipid deposits in these xanthomas are derived from circulating plasma lipoproteins. CONCLUSIONS: This case was unique as our patient developed eruptive xanthomas even at TGL level under 2000 mg/dl which is rarely seen. Clinically diagnosing Xanthomas are extremely important in order to treat hypertriglyceridemia in order to prevent pancreatitis, which has a grim prognosis. It is also important for reducing CAD risk. Xanthomas should be evaluated to prevent pancreatitis and long-term cardiac events rather than the lipid deposit itself. They can also be the only signs of underlying metabolic diseases like diabetes. Management should include pharmacological agents, counseling for compliance, nutrition & lifestyle modifications. All these patients with high TGLs will benefit from E3/E4 genotype testing as it is associated with higher cardiac disease and low response to statins. REFERENCE #1: Severe hypertriglyceridemia presenting as eruptive xanthomatosisSameera S Vangara, Kyle D Klingbeil, Raymond M Fertig, Jason L RadickDepartment of Internal Medicine, University of Miami Miller School of Medicine, Florida, USA REFERENCE #2: Eruptive Xanthomas as a cutaneous Manifestation of HypertriglyceridemiaA Case ReportMichael Digby, Md, Robert Belli, MS, Timothy McGraw, and Abigail Lee, MD DISCLOSURES: no disclosure on file for Moses Bachan; no disclosure on file for Zinobia Khan; No relevant relationships by Robert Siegel, source=Web Response No relevant relationships by Goutham Talluri, source=Web Response

Keratosis pilaris atrophicans faciei: An observational, descriptive, retrospective clinical study.

Keratosis pilaris atrophicans faciei (KPAF) is a hereditary follicular disorder, an atrophicans subtype of keratosis pilaris (KP) with a highly elusive diagnosis. Clinically, it presents with follicular, horny papules surrounded by an erythematous halo of the cheeks, forehead, chin and eyebrows, and it is followed by a gradual hair loss on the lateral margins of the eyebrows. The onset is as early as a few months after birth, but it is mainly diagnosed in children and adolescents and it can persist through adulthood. At present, the natural progression of the disease is poorly understood, which makes a correct diagnosis highly unlikely. The aim of the present study was to describe the clinical characteristics of KPAF in patients encountered in daily practice, in order to find common characteristics that may aid in the earlier recognition of the disease. An observational, descriptive, retrospective study was performed on 14 patients diagnosed with KPAF between January 2000 and December 2020. The mean age at diagnosis was 17.04 years and the onset of clinical symptoms appeared at a mean age of 4.85 years. The first clinical symptom was KP involving either the upper or lower limbs, or both. Then, erythema of the face appeared at a mean age of 7.21 years, keratotic papules on the face at a mean age of 8.35 years and, finally, loss of hair on the lateral margins of the eyebrows at a mean age of 14 years. The patients also had concomitant xerosis cutis, multiple mole syndrome, acne, contact dermatitis and Laugier-Hunziker syndrome. Evidence of disease progression, associations, as well as efficacious treatment measures are lacking. An earlier diagnosis potentially allows for a more efficacious, targeted treatment option. Either topical emollients, systemic retinoids or laser therapy may prove effective for each patient individually.

Hematological study of patients with recurrent aphthous stomatitis - Case control study

Background and Objectives: Recurrent aphthous stomatitis is common oral condition, characterized by multiple, recurrent, small, round, or ovoid ulcers with circumscribed, erythematous haloes, and yellow or grey floors. Its etiology and pathogenesis is not entirely clear linked to systemic diseases and among these, anemia, iron deficiency, folic- acid, and vitamin B12 deficiencies. The aim of this study to investigate the association between recurrent aphthous stomatitis and hemoglobin, serum ferritin, folic acid, and vitamin B12 deficiency. Patient and Methods: This prospective cross sectional case control clinical study was conducted on 50 patients with recurrent aphthous stomatitis. The control group composed of 50 healthy age and sex-matched subject. The patient demography about family history of recurrent aphthous stomatitis, and smoking was recorded, also the hemoglobin, serum levels of ferritin, folic acid, and vitamin B12 has been investigated.Results: The low hemoglobin was reported in 30% and vitamin B 12 deficiency in 31% of the patient so low hemoglobin and B12 deficiency have significant correlation with recurrent aphthous stomatitis. Patients with low hemoglobin, vitamin B12 deficiency , positive family history, and non smoker have been found to have the highest risk for having recurrent aphthous stomatitis. Conclusion: Recurrent aphthous stomatitis is a multifactorial disease. Positive family history, low hemoglobin level , vitamin B12 deficiency, and nonsmoking status are among the important predisposing factors. Routine hematological screening and tests for iron status, folic acid, and vitamin B12 status should be assessed in all patients with recurrent aphthous stomatitis.

Correlation between Salivary Cotinine Levels and Cigarette Smoking with Recurrent Aphthous Stomatitis

Introduction: Recurrent aphthous stomatitis (RAS) is a widespread oral mucosal disease typified by thepresence of a yellowish-grey base with high margins and flanked by an erythematous halo. RAS typicallycrops up in the lining or nonkeratinized mucosa. It has been found that smoking and salivary cotinine (ametabolic product of nicotine) levels have a protective effect against the occurrence of RAS by increasingkeratinization of the oral mucosa.Objectives: To identify the effect of smoking and nicotine level on the occurrence of RAS.Patients and Methods: the study was conducted on 92 male students studying at different Universities ofBaghdad, Iraq, in the period between January to December 2018. The students were thoroughly questionedabout the yearly recurrence rate and healing period of RAS. Data about smoking history; method, averagedaily dose, and period of the behaviour were recorded for each student. Salivary Cotinine levels weremeasured by the Human Cotinine ELISA Kit and utilising the competitive ELISA technique based on theprotocol of the manufacturer salimetrics assay #1-2002.Results: The study subjects comprised of 92 male students. Their ages were from 18 to 25 years; theaverage age was 21.04 ± 2.2. Forty-two of them were light smokers, and 50 were heavy smokers. They weresubdivided into subgroups according to the duration of smoking (less or more than five years). The annualrecurrence rates and healing period were lower in those who smoked for more than five years than those whosmoked for less than five years with a significant difference in light smokers. Salivary cotinine levels weresignificantly higher in a heavy smoker than in light smokers. Period of healing and yearly recurrence rateswere significantly lower in those who had salivary cotinine level more than 200ng/ml than in those with alevel.Conclusion: The protecting impact of smoking on RAS was solely identified when individuals were heavysmokers or smoked for longer durations of time and correlated with cotinine levels, according to the availableliterature.