Evaluation of hypoxia, angiogenesis, and lymphangiogenesis in actinic cheilitis.

PubMed

Barbosa, Natália G; Souza, Lélia B; Nonaka, Cassiano F W; Silveira, Ericka J D

2016-11-01

Actinic cheilitis is a potentially malignant condition caused mainly by chronic sun exposure. Here we aim to evaluate the role of hypoxia, angiogenesis, and lymphatic density in the clinical and morphological progression of a series of cases of actinic cheilitis. Immunohistochemistry was used to evaluate positivity to hypoxia-inducible factor (HIF)-1α, vascular endothelial growth factor (VEGF)-C, and D2-40 in 40 cases of actinic cheilitis of the lower lip. The cases studied exhibited variable degrees of positivity to the markers. The median number of lymphatic vessels was 3.2, 2.4, and 3.0 in lesions showing no epithelial dysplasia (NED) and with mild (MED) and moderate (MOED) epithelial dysplasia, respectively. The median VEGF-C positivity index was 82.44% (NED), 92.74% (MED), and 82.83% (MOED), and the median HIF-1α positivity index was 11.57% (NED), 5.26% (MED), and 13.55% (MOED). No significant differences in lymphatic density or median VEGF-C and HIF-1α positivity indices were observed between histological grades or clinical presentations of actinic cheilitis (P > 0.05). Although representing early events in lip carcinogenesis, the present results suggest that hypoxia, angiogenesis, and lymphangiogenesis do not influence the morphological or clinical progression of actinic cheilitis. © 2016 The International Society of Dermatology.

Oral medicine case book 51: actinic cheilitis in a patient with oculocutaneous albinism.

PubMed

Wood, N H; Moodley, A

2013-07-01

Patients with oculocutaneous albinism are more prone to sun-induced damage due to the lack of melanin. Actinic cheilitis is a potentially malignant disorder that occurs due to chronic UV-B radiation to the vermillion region of the lip, a region that is already at risk due to its morphology. A case of actinic cheilitis in a patient with oculocutaneous albinism is presented with a literature review.

Actinic Cheilitis: A Case Report and a Review of the Literature

PubMed Central

Wood, Neil Hamilton; Khammissa, Razia; Meyerov, Robin; Lemmer, Johan; Feller, Liviu

2011-01-01

In actinic cheilitis, the current view is that the keratinocytes have undergone transformation forming a field of epithelium with the potential for neoplastic transformation. Clinical features include diffuse and poorly demarcated atrophic, erosive or keratotic plaques that may affect some parts of, or the entire vermilion border. Fair-complexioned people, those with albinism and people with eversion of the lip are all subject to actinic cheilitis. Prophylactic measures against all forms of sunlight-induced lesions must include limitation of exposure to the sun during peak sunlight hours, the use of appropriate protective clothing, and the use of a sunscreen cream. In this article, a case of albinism is used to illustrate the nature of actinic cheilitis, its clinical features and its treatment. PMID:21228959

Treatment of actinic cheilitis with the Er:YAG laser.

PubMed

Armenores, Paul; James, Craig L; Walker, Patrick C; Huilgol, Shyamala C

2010-10-01

Actinic cheilitis is a common condition with the potential to develop into squamous cell carcinoma. Current treatments have varying cure rates and complications. The role of the erbium:yttrium-aluminum-garnet (Er:YAG) laser in the treatment of actinic cheilitis has not been widely published, despite offering theoretical advantages over current treatment modalities. To evaluate the outcome of a series of patients treated with the Er:YAG laser for actinic cheilitis. This was a retrospective, interventional, nonrandomized, sequential case series set in a tertiary referral, dermatologic surgery unit. Ninety-nine consecutive patients with actinic cheilitis treated with the Er:YAG laser between January 2001 and June 2008 underwent a case note review, of which 77 went on to a structured telephone interview. The main outcome measures were a subjective improvement in lip symptoms related to actinic cheilitis and objective improvement in the lips at routine follow-up. Mean time to interview follow-up was 65.7 months. Of those interviewed, 92.2% believed there had been an improvement in the cosmetic appearance of their lips; one hundred percent believed the function of their lips had improved or remained unchanged; and 84.8% remained completely disease free at the time of follow-up. The majority of patients (93.5%) were satisfied with the laser treatment. Scarring as a direct result of the laser occurred in 5.1% of patients. Retrospective nature of data collection; inability to interview all patients who underwent treatment. The Er:YAG laser is a successful modality for the treatment of actinic cheilitis with good functional and cosmetic results and only a small risk of long-term scarring. It should be considered as a first-line treatment for the disease. Copyright © 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Gangrenous cheilitis associated with all-trans retinoic acid therapy for acute promyelocytic leukemia.

PubMed

Tanaka, Mariko; Fukushima, Noriyasu; Itamura, Hidekazu; Urata, Chisako; Yokoo, Masako; Ide, Masaru; Hisatomi, Takashi; Tomimasu, Rika; Sueoka, Eisaburo; Kimura, Shinya

2010-01-01

A 67-year-old Japanese woman who presented with erythema on the abdomen and pancytopenia was found to have acute promyelocytic leukemia (APL). A skin biopsy revealed invasion of APL cells. She was started on induction treatment with all-trans retinoic acid (ATRA) at 45 mg/m(2). On day 4, the leukemic cell number had increased to over 1.0 x 10(9)/L. Consequently, chemotherapy with idarubicin and cytarabine was initiated. On day 10, dryness of the lips appeared. The lower lip swelled and developed painful black eschars. A high fever was also present. Despite discontinuing ATRA on day 20 and administering antibiotics, an anti-fungal agent and valaciclovir, these signs did not improve. Histopathologically, the biopsied lip revealed infiltration of neutrophils and vasculitis. The patient was given ATRA on days 29 and 30 due to an increase in APL cell numbers, after which the gangrenous cheilitis extended over the whole lip. On day 49, the patient was started on re-induction treatment with arsenic trioxide. She achieved complete remission and the gangrenous cheilitis slowly healed over the following 8 weeks. Since the clinical features of the gangrenous cheilitis in this case were similar to those of ATRA-associated scrotal ulcers, it appears that activated neutrophils derived from differentiated APL cells may have caused the gangrenous cheilitis. Physicians should be alert to the development of gangrenous cheilitis during treatment with ATRA.

Actinic cheilitis in dental practice.

PubMed

Savage, N W; McKay, C; Faulkner, C

2010-06-01

Actinic cheilitis is a potentially premalignant condition involving predominantly the vermilion of the lower lip. The aim of the current paper was to review the clinical presentation of actinic cheilitis and demonstrate the development of management plans using a series of cases. These are designed to provide immediate treatment where required but also to address the medium and long-term requirements of the patient. The authors suggest that the clinical examination of lips and the assessment of actinic cheilitis and other lip pathology become a regular part of the routine soft tissue examination undertaken as a part of the periodic examination of dental patients. Early recognition of actinic cheilitis can allow the development of strategies for individual patients that prevent progression. These are based on past sun exposure, future lifestyle changes and the daily use of emollient sunscreens, broad-brimmed hats and avoidance of sun exposure during the middle of the day. This is a service that is not undertaken as a matter of routine in general medical practice as patients are not seen with the regularity of dental patients and generally not under the ideal examination conditions available in the dental surgery.

Cheilitis granulomatosa associated with lupus erythematosus discoid and treated with methotrexate: report of a case*

PubMed Central

Nazzaro, Gianluca; Muratori, Simona; Carrera, Carlo Giovanni; Coggi, Antonella; Gianotti, Raffaele

2015-01-01

We present the rare case of a 47-year-old patient, suffering from cheilitis granulomatosa and lupus erythematosus discoid: this association is really exceptional because only once reported in English literature. In addition, the treatment of cheilitis granulomatosa is a challenge for the dermatologist: the gold standard, represented by steroids, is in fact designed as a short-time option. Our report confi rms the good efficacy of methotrexate as a steroid-sparing agent. PMID:26312716

Isotretinoin and vitiligo: can chronic cheilitis cause koebnerization?

PubMed

Garner, Michael L; McShane, Diana B; Burkhart, Craig N; Morrell, Dean S

2015-01-01

Vitiligo after trauma through koebnerization is a widely reported phenomenon. Herein we present a case of vitiligo in an area of chronic cheilitis after isotretinoin treatment. © 2015 Wiley Periodicals, Inc.

[Photodynamic therapy for actinic cheilitis].

PubMed

Castaño, E; Comunión, A; Arias, D; Miñano, R; Romero, A; Borbujo, J

2009-12-01

Actinic cheilitis is a subtype of actinic keratosis that mainly affects the lower lip and has a higher risk of malignant transformation. Its location on the labial mucosa influences the therapeutic approach. Vermilionectomy requires local or general anesthetic and is associated with a risk of an unsightly scar, and the treatment with 5-fluorouracil or imiquimod lasts for several weeks and the inflammatory reaction can be very intense. A number of authors have used photodynamic therapy as an alternative to the usual treatments. We present 3 patients with histologically confirmed actinic cheilitis treated using photodynamic therapy with methyl aminolevulinic acid as the photosensitizer and red light at 630 nm. The clinical response was good, with no recurrences after 3 to 6 months of follow-up. Our experience supports the use of photodynamic therapy as a good alternative for the treatment of actinic cheilitis.

A systematic review of the literature of the three related disease entities cheilitis granulomatosa, orofacial granulomatosis and Melkersson - Rosenthal syndrome.

PubMed

Wehl, Goetz; Rauchenzauner, Markus

2018-05-14

Melkersson Rosenthal syndrome (MRS) is a rare disorder of unknown etiology and comprises the triad: orofacial edema, recurrent facial paralysis and lingua plicata. In the current literature confusing heterogeneity exists, mixing together the historically grown terms cheilitis granulomatosa or granulomatous cheilitis, Melkersson Rosenthal syndrome and the umbrella term orofacial granulomatosis (OFG). We provide a systematic review comprising all three disease entities of orofacial granulomatosis using the computerized database "Pubmed Medline" entering the key words "orofacial granulomatosis" (141 references), "Melkersson-Rosenthal syndrome" (207 references), "granulomatous cheilitis" or "cheilitis granulomatosa" (102 references) back to 1956. Full text journals and case studies were included, and data synthesis was performed individually. Etiology remains unclear for all three disease entities. Etiological relatedness to chronic inflammatory bowel disease is under discussion and effectiveness was found for different treatments, e.g. local triamcinolone injections, antibiotics, surgical interventions, TNF alpha blockers or exclusive enteral nutrition. No randomized controlled trial concerning the therapy of orofacial granulomatosis was found. As a consequence, therapeutic conclusions are drawn mainly from small case series, thus limiting the evidence of therapeutic interventions. OFG with the sub-entities MRS and cheilitis granulomatosa is an etiological obscure disease process with various possible therapeutic interventions potentially alleviating the disease course but to broaden treatment knowledge further study in randomized controlled trials are needed. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Evaluation of actinic cheilitis using fluorescence lifetime spectroscopy

NASA Astrophysics Data System (ADS)

Saito Nogueira, Marcelo; Cosci, Alessandro; Pratavieira, Sebastião.; Takahama, Ademar; Souza Azevedo, Rebeca; Kurachi, Cristina

2016-03-01

Actinic cheilitis is a potentially malignant disorder that mostly affects the vermilion border of the lower lip and can lead to squamous cell carcinoma. Because of its heterogeneous clinical aspect, it is difficult to indicate representative biopsy area. Late diagnosis is a limiting factor of therapeutic possibilities available to treat oral cancer. The diagnosis of actinic cheilitis is mainly based on clinical and histopathological analysis and it is a time consuming procedure to get the results. Information about the organization and chemical composition of the tissues can be obtained using fluorescence lifetime spectroscopy techniques without the need for biopsy. The main targeted fluorophores are NADH (nicotinamide adenine dinucleotide) and FAD (flavin adenine dinucleotide), which have free and bound states, each one with different average lifetimes. The average lifetimes for free and bound NADH and FAD change according to tissue metabolic alterations and allow a quick and non-invasive clinical investigation of injuries and to help clinicians with the early diagnosis of actinic cheilitis. This study aims to evaluate the fluorescence lifetime parameters at the discrimination of three degrees of epithelial dysplasia, the most important predictor of malignant development, described in up to 100% of actinic cheilitis cases.

Excimer laser therapy and narrowband ultraviolet B therapy for exfoliative cheilitis.

PubMed

Bhatia, Bhavnit K; Bahr, Brooks A; Murase, Jenny E

2015-06-01

Exfoliative cheilitis is a condition of unknown etiology characterized by hyperkeratosis and scaling of vermilion epithelium with cyclic desquamation. It remains largely refractory to treatment, including corticosteroid therapy, antibiotics, antifungals, and immunosuppressants. We sought to evaluate the safety and efficacy of excimer laser therapy and narrowband ultraviolet B therapy in female patients with refractory exfoliative cheilitis. We reviewed the medical records of two female patients who had been treated unsuccessfully for exfoliative cheilitis. We implemented excimer laser therapy, followed by hand-held narrowband UVB treatments for maintenance therapy, and followed them for clinical improvement and adverse effects. Both patients experienced significant clinical improvement with minimal adverse effects with excimer laser therapy 600-700 mJ/cm 2 twice weekly for several months. The most common adverse effects were bleeding and burning, which occurred at higher doses. The hand-held narrowband UVB unit was also an effective maintenance tool. Limitations include small sample size and lack of standardization of starting dose and dose increments. Excimer laser therapy is a well-tolerated and effective treatment for refractory exfoliative cheilitis with twice weekly laser treatments of up to 700 mJ/cm 2 . Transitioning to the hand-held narrowband UVB device was also an effective maintenance strategy.

Plasma Cell Cheilitis: A Clinicopathological and Immunohistochemical Study of 13 Cases

PubMed Central

Lee, Jin Yong; Kim, Kwang Ho; Hahm, Ji Eun; Ha, Jae Won; Kwon, Won Joo; Kim, Chul Woo

2017-01-01

Background Plasma cell cheilitis is an unusual benign plasma cell proliferative disease of an unknown etiology that typically presents on the lip. Objective The aim of this study was to investigate the clinicopathological characteristics of 13 cases of plasma cell cheilitis. Methods The present study investigated the clinical manifestations, treatment modalities, and outcome of 13 patients diagnosed with plasma cell cheilitis from 2011 to 2016 at Kangdong Sacred Heart Hospital and Hallym University Sacred Heart Hospital. Biopsy specimens of the all cases were evaluated using conventional hematoxylin and eosin staining with kappa and lambda immunoglobulin light chain immunohistochemistry. Results The age of the patients ranged from 39 to 86 years (mean, 64.7 years), with male predominance. Histopathologically, 61.5% and 38.5% of patients showed band-like and pan dermal plasmacytic infiltrates, respectively. Eosinophilic infiltration was noted in 69.2% of patients. All cases showed both kappa and lambda immunoglobulin light chain reactivities, and kappa predominance was confirmed in 9 patients (69.2%). A majority of the patients was treated with local therapy, such as intralesional steroid injection with topical tacrolimus. Among the 13 patients, plasma cell cheilitis completely resolved, partially resolved, and recurred in 3 (23.1%), 5 (38.5%), and 5 patients (38.5%), respectively. Conclusion Plasma cell cheilitis presented as erosive edematous circumscribed patches or plaques affecting mainly the lower lip of elderly male patients. The majority of histopathology cases showed characteristic plasma cell aggregation on the upper dermis that was immunopositive for immunoglobulin light chain, with kappa predominance. PMID:28966508

Actinic cheilitis and squamous cell carcinoma of the lip: clinical, histopathological and immunogenetic aspects.

PubMed

Vieira, Renata Aparecida Martinez Antunes Ribeiro; Minicucci, Eliana Maria; Marques, Mariangela Esther Alencar; Marques, Silvio Alencar

2012-01-01

Actinic cheilitis is the main precancerous lesion of the lip. Squamous cell carcinoma of the lip is reported together with oral carcinomas in the Brazilian official statistics. Overall, they account for 40% of the head and neck carcinomas. In general, physicians and dentists know little about what causes oral tumor development and progression. Tumor suppressor genes and cell proliferation regulatory proteins play a role in the progression of actinic cheilitis to squamous cell carcinoma and in its biological behavior. Knowledge on prognostic and diagnostic markers has a positive impact on the follow-up of these patients.

Improvement of Cheilitis granulomatosa after Dental Treatment

PubMed Central

Sasaki, Ryosuke; Suzuki, Kayoko; Hayashi, Teppei; Inasaka, Hiroshi; Matsunaga, Kayoko

2011-01-01

A 38-year-old male suffered from swelling of the lower lip for 3 months. Neither facial nerve palsy nor fissuring of the tongue was present. Histological examination of a biopsy taken from the lower lip revealed non-caseous epithelioid cell granulomas, suggestive of cheilitis granulomatosa. Patch testing revealed positive reactions to mercury chloride and amalgam. His symptoms markedly improved 3 months after treatment of the apical periodontitis and replacement of dental crowns. As his dental crowns did not contain mercury, we believe that the cheilitis granulomatosa may have been related to the focal dental infection. PMID:21941479

p53 AND MDM2 PROTEIN EXPRESSION IN ACTINIC CHEILITIS

PubMed Central

de Freitas, Maria da Conceição Andrade; Ramalho, Luciana Maria Pedreira; Xavier, Flávia Caló Aquino; Moreira, André Luis Gomes; Reis, Sílvia Regina Almeida

2008-01-01

Actinic cheilitis is a potentially malignant lip lesion caused by excessive and prolonged exposure to ultraviolet radiation, which can lead to histomorphological alterations indicative of abnormal cell differentiation. In this pathology, varying degrees of epithelial dysplasia may be found. There are few published studies regarding the p53 and MDM2 proteins in actinic cheilitis. Fifty-eight cases diagnosed with actinic cheilitis were histologically evaluated using Banóczy and Csiba (1976) parameters, and were subjected to immunohistochemical analysis using the streptavidin-biotin method in order to assess p53 and MDM2 protein expression. All studied cases expressed p53 proteins in basal and suprabasal layers. In the basal layer, the nuclei testing positive for p53 were stained intensely, while in the suprabasal layer, cells with slightly stained nuclei were predominant. All cases also tested positive for the MDM2 protein, but with varying degrees of nuclear expression and a predominance of slightly stained cells. A statistically significant correlation between the percentage of p53 and MDM2-positive cells was established, regardless of the degree of epithelial dysplasia. The expression of p53 and MDM2 proteins in actinic cheilitis can be an important indicator in lip carcinogenesis, regardless of the degree of epithelial dysplasia. PMID:19082401

p53 and MDM2 protein expression in actinic cheilitis.

PubMed

de Freitas, Maria da Conceição Andrade; Ramalho, Luciana Maria Pedreira; Xavier, Flávia Caló Aquino; Moreira, André Luis Gomes; Reis, Sílvia Regina Almeida

2008-01-01

Actinic cheilitis is a potentially malignant lip lesion caused by excessive and prolonged exposure to ultraviolet radiation, which can lead to histomorphological alterations indicative of abnormal cell differentiation. In this pathology, varying degrees of epithelial dysplasia may be found. There are few published studies regarding the p53 and MDM2 proteins in actinic cheilitis. Fifty-eight cases diagnosed with actinic cheilitis were histologically evaluated using Banóczy and Csiba (1976) parameters, and were subjected to immunohistochemical analysis using the streptavidin-biotin method in order to assess p53 and MDM2 protein expression. All studied cases expressed p53 proteins in basal and suprabasal layers. In the basal layer, the nuclei testing positive for p53 were stained intensely, while in the suprabasal layer, cells with slightly stained nuclei were predominant. All cases also tested positive for the MDM2 protein, but with varying degrees of nuclear expression and a predominance of slightly stained cells. A statistically significant correlation between the percentage of p53 and MDM2-positive cells was established, regardless of the degree of epithelial dysplasia. The expression of p53 and MDM2 proteins in actinic cheilitis can be an important indicator in lip carcinogenesis, regardless of the degree of epithelial dysplasia.

Angular cheilitis, part 2: nutritional, systemic, and drug-related causes and treatment.

PubMed

Park, Kelly K; Brodell, Robert T; Helms, Stephen E

2011-07-01

Angular cheilitis (AC) is associated with a variety of nutritional, systemic, and drug-related factors that may act exclusively or in combination with local factors. Establishing the underlying etiology of AC is required to appropriately focus treatment efforts.

Topical Calendula officinalis L. successfully treated exfoliative cheilitis: a case report

PubMed Central

2009-01-01

Authors describe a case of recurrent exfoliative cheilitis that responded to treatment with a standardized topical preparation of Calendula officinalis L. An eighteen-year-old man was referred to UNESP - São Paulo State University, Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School to investigate a chronic dry scaling lesion on his lips. The patient's main chief was aesthetic compromising. Corticoid therapy was suspended and Calendula officinalis ointment 10% for ad libitum use has been prescribed. The results presented allow the authors to consider Calendula officinalis L. as a potential therapy in cases of cheilitis exfoliative. PMID:20062714

Evaluation of the efficacy of photodynamic therapy for the treatment of actinic cheilitis.

PubMed

Chaves, Yuri N; Torezan, Luis Antonio; Lourenço, Silvia Vanessa; Neto, Cyro Festa

2017-01-01

Actinic cheilitis (AC) is a lip intraepithelial neoplasia, whose cells present alterations similar to those presented by invasive squamous cell carcinomas (SCCs). To conduct clinical and laboratory evaluation by histopathology and immunohistochemistry of the efficacy of actinic cheilitis treatment using photodynamic therapy (PDT) with methyl aminolevulinate (MAL) and noncoherent red light. Patients with actinic cheilitis detected by histopathological examination were submitted to two sessions of photodynamic therapy with a two-week interval between them. They were examined immediately after the sessions, four, six, and twelve weeks after beginning treatment when a new biopsy was carried out. Clinical histopathological and immunohistochemical parameters were evaluated before and after treatment. Of the 23 patients who underwent biopsy, 16 completed two photodynamic therapy sessions and the material of one patient was insufficient for immunohistochemistry. Complete clinical response was achieved in 62.5% (10 of 16 patients) and 37.5% still remained with clinical evidence of AC. In spite of this, no case of cure by histopathological analysis was found. There was no significant statistical change among the values of Ki-67, survivin, and p53 observed before and after treatment. Photodynamic therapy, as carried out in this trial, was not an efficacious therapeutic option for treating patients with actinic cheilitis included in this sample. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Successful treatment of Miescher's cheilitis in Melkersson-Rosenthal syndrome with betamethasone injections and doxycycline

PubMed Central

Oudrhiri, Lamia; Chiheb, Soumiya; Marnissi, Farida; Zamiati, Soumaya; Benchikhi, Hakima

2012-01-01

We report a case of a 19-year-old girl who presented with 5-year history of swelling of upper lip and fissured tongue treated with dapsone then oral steroids without any improvement. Clinical examination found peripheral facial nerve paralysis and Labial mucosa biopsy showed non-necrotizing giganto-epithelioid granuloma. Diagnosis of Melkersson-Rosenthal syndrome was retaind because of association of cheilitis, lingua plicata and facial paralysis. Given the failure of dapsone and oral steroid we suggested an association of betamethasone injection and doxycycline. Gradual and permanent reduction of the upper lip volume was observed. One year follow up objectified no reactivation of cheilitis. PMID:23397029

[Tuberculous cheilitis revealing pulmonary tuberculosis].

PubMed

Bricha, Myriem; Slimani, Hajar; Hammi, Sanae; Bourkadi, Jamal Eddine

2016-01-01

Tuberculosis of the oral cavity is rare. It is associated with clinical polymorphism and poses above all a diagnostic problem. We report the case of a 42-year-old male patient with tubercular cheilitis. This study aims to focus attention on tuberculosis that can be detected exceptionally in specific locations, such as the oral lip.

Value of videoroscopy in the detection of alterations of  Actinic Cheilitis and the selection of biopsy areas

PubMed Central

Miranda, Ana-Maria; Ferrari, Thiago; Domingos, Tabata; Cunha, Karin; Dias, Eliane

2015-01-01

Background To demonstrate the value of videoroscopy in identifying lesions and alterations not seen by oroscopy and to select the area for biopsy. Material and Methods Eighty patients were subjected to anamnesis, physical exam, videoroscopy exam, toluidine blue test and biopsy. A diagram of the lips was created to record the exact location where the lesion was found. Results Physical exam identified 287 lesions, and videoroscopy identified 587 lesions; erythema and white lesions were the most common lesions associated with actinic cheilitis. Of the 59 performed biopsies, 32 (52.4%) cases were identified by videoroscopy that showed lesions that were not detected during physical examination. Conclusions The establishment of a diagram of the lip permitted registration of the precise location of the lesion. Videoroscopy was effective in locating lesions not seen by oroscopy. Both videoroscopy and the diagram of the lips allowed for better and earlier diagnosis and better patient follow-up for those with actinic cheilitis. Key words: Actinic cheilitis, potentially malignant disorder, videoroscopy, dermatoscopy, lip. oroscopy, diagram of lip. PMID:25662549

Link between immunoexpression of hMLH1 and hMSH2 proteins and clinical-epidemiological aspects of actinic cheilitis*

PubMed Central

Sarmento, Dmitry José de Santana; Godoy, Gustavo Pina; Miguel, Márcia Cristina da Costa; da Silveira, Éricka Janine Dantas

2016-01-01

Background The studies found in the literature associate the immunoexpression of hMLH1 and hMSH2 proteins with histologic aspects, but do not correlate it with clinical and epidemiological data. Objective To evaluate the immunoexpression of hMLH1 and hMSH2 in actinic cheilitis, correlating it with clinical characteristics. Methods We analyzed 40 cases. Histological and immunohistochemical analyses were performed. The following clinical variables were evaluated: gender, age range, ethnicity, clinical aspect and occupational sunlight exposure. Statistical evaluation included the Student t-test, while the significance level was set at 5%. Results Greater immunoexpression of hMLH1 and hMSH2 was observed in females, individuals aged over 40, and mixed-race/black patients. Furthermore, the immunoexpression of these proteins was greater in actinic cheilitis with a white-colored appearance and in patients without occupational sunlight exposure. No statistical differences were observed for the variables studied. Conclusion This study uncovered variations of hMLH1 and hMSH2 protein expression upon evaluation of clinical aspects in actinic cheilitis. PMID:27579741

Paying more than lip service to lip lesions.

PubMed Central

Bentley, Janna M.; Barankin, Benjamin; Lauzon, Gilles J.

2003-01-01

OBJECTIVE: To review the epidemiology, etiology, diagnosis, management, and prognosis of the most common, potentially lethal, lip lesions: leukoplakia, actinic cheilitis, and squamous cell carcinoma (SCC). QUALITY OF EVIDENCE MEDLINE: was searched from 1966 to 2002 for English-language articles on prevalence of lip lesions. No articles for a family physician audience were found. MEDLINE was searched again using the terms "leukoplakia," "actinic cheilitis," and "squamous cell carcinoma." Randomized, controlled trials were selected; non-blinded trials, population-based studies, and systematic reviews were also used. MAIN MESSAGE: Leukoplakia, actinic cheilitis, and SCC of the lips are relatively common presentations that can cause substantial morbidity and, more rarely, mortality. Any abnormality of the lips can be an embarrassment. Because of the seriousness and frequency of lip disease, it is important to look for, diagnose, and treat lip lesions to prevent morbidity and mortality and also to maintain social acceptance and self-esteem. CONCLUSION: Knowledge of leukoplakia, actinic cheilitis, and SCC of the lips will aid family physicians in diagnosing and managing these lesions and in preventing associated morbidity and mortality. PMID:14526863

Link between immunoexpression of hMLH1 and hMSH2 proteins and clinical-epidemiological aspects of actinic cheilitis.

PubMed

Sarmento, Dmitry José de Santana; Godoy, Gustavo Pina; Miguel, Márcia Cristina da Costa; Silveira, Éricka Janine Dantas da

2016-01-01

The studies found in the literature associate the immunoexpression of hMLH1 and hMSH2 proteins with histologic aspects, but do not correlate it with clinical and epidemiological data. To evaluate the immunoexpression of hMLH1 and hMSH2 in actinic cheilitis, correlating it with clinical characteristics. We analyzed 40 cases. Histological and immunohistochemical analyses were performed. The following clinical variables were evaluated: gender, age range, ethnicity, clinical aspect and occupational sunlight exposure. Statistical evaluation included the Student t-test, while the significance level was set at 5%. Greater immunoexpression of hMLH1 and hMSH2 was observed in females, individuals aged over 40, and mixed-race/black patients. Furthermore, the immunoexpression of these proteins was greater in actinic cheilitis with a white-colored appearance and in patients without occupational sunlight exposure. No statistical differences were observed for the variables studied. This study uncovered variations of hMLH1 and hMSH2 protein expression upon evaluation of clinical aspects in actinic cheilitis.

Successful treatment with 308-nm monochromatic excimer light and subsequent tacrolimus 0.03% ointment in refractory plasma cell cheilitis.

PubMed

Yoshimura, Kazuhiro; Nakano, Shunji; Tsuruta, Daisuke; Ohata, Chika; Hashimoto, Takashi

2013-06-01

Plasma cell cheilitis is a chronic inflammatory disease that presents with erythema, erosions, ulcers and occasional nodules within the mucosa, including the lips. It is histopathologically characterized by dense plasma cell infiltration in the lamina propria of the mucous membranes. Several treatments for plasma cell cheilitis have been reported, including topical steroids, topical antibiotics or topical tacrolimus. However, 308-nm monochromatic excimer light (MEL) has never been reported as a treatment option, while it was reported to be very effective in treating erosive oral lichen planus. We report a 62-year-old man who had chronic plasma cell cheilitis on the lower lip, which was refractory to topical and systemic corticosteroid. The lesion and severe pain were significantly improved by the treatment with nine sessions of 308-nm MEL twice per week with a total dose of 1120 mJ/cm(2). However, the lesion gradually worsened after treatment frequency was reduced to once per month. Subsequent tacrolimus 0.03% ointment cleared the lesion completely in a month and no recurrence was observed a year later. Refractory plasma cell cheilitis and concomitant severe pain quickly responded to 308-nm MEL when administrated twice per week. Because the long interval between each MEL treatment seemed ineffective to improve the lesion, appropriate frequency and adequate total dose of MEL treatment may be necessary for a successful treatment. © 2013 Japanese Dermatological Association.

Pattern of galectins expression in actinic cheilitis with different risks of malignant transformation.

PubMed

Lopes, Maria Luiza Diniz de Sousa; Nonaka, Cassiano Francisco Weege; Queiroz, Lélia Maria Guedes; de Souza, Lélia Batista; Miguel, Márcia Cristina da Costa; da Silveira, Éricka Janine Dantas

2016-09-01

Actinic cheilitis (AC) is a chronic inflammatory lesion that in some situations can turn into squamous cell carcinoma of the lip. The molecular mechanisms involved in this process are not yet completely understood. This study aimed to investigate the expression pattern of galectins in actinic cheilitis according to the histopathological grading. Immunoexpression of galectin-1, galectin-3, galectin-7, and galectin-9 was semiquantitatively analyzed in 65 cases of actinic cheilitis graded as low risk (n = 40) or high risk (n = 25) of malignant transformation. Association between the location of the galectins in the cellular compartments and histopathological grading was analyzed. Galectin-1 was mainly observed in the cell cytoplasm, and was elevated (score 3) in 60% of cases, regardless of the histopathological grade (P > 0.05). Galectin-3 expression was higher in high-risk group than in the low-risk group (P < 0.05), with a predominant expression in the cytoplasm and nucleus of low-risk (67.5%), and only in the cytoplasm of high-risk cases (60%) (P < 0.05). Galectin-7 expression did not show significant differences between low-risk and high-risk groups (P > 0.05). With respect to galectin-9, 89.2% of cases were positive, showing decrease in median of scores as there was an increase in histological grade (P < 0.001), with predominant expression in the nucleus and cytoplasm. This study is the first indication of galectins involvement in the pathogenesis and morphologic progression of actinic cheilitis, particularly galectin-3 and galectin-9. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Photodynamic therapy for actinic cheilitis: a systematic review.

PubMed

Yazdani Abyaneh, Mohammad-Ali; Falto-Aizpurua, Leyre; Griffith, Robert D; Nouri, Keyvan

2015-02-01

Actinic cheilitis (AC) is a premalignant lesion of the lips that can progress to squamous cell carcinoma and metastasize. Actinic cheilitis is difficult to treat because surgical treatments have significant adverse effects whereas less invasive procedures have uncertain efficacy. Photodynamic therapy (PDT) may offer a noninvasive yet effective treatment option for AC. To systematically review the safety and efficacy of PDT for AC. The terms "photodynamic," "actinic," "solar," "cheilitis," and "cheilosis" were used in combinations to search the PubMed database. Studies were considered for inclusion based on eligibility criteria, and specific data were extracted from all studies. The authors identified 15 eligible case series encompassing a total of 242 treated subjects. Among studies that evaluated subjects for complete clinical response, 139 of 223 subjects (62%) showed complete response at final follow-ups ranging from 3 to 30 months. Among studies that evaluated subjects for histological outcome, 57 of 121 subjects (47%) demonstrated histological cure at final follow-ups ranging from 1.5 to 18 months. Cosmetic outcomes were good to excellent in the majority of subjects, and adverse events were well tolerated. Photodynamic therapy is safe and has the potential to clinically and histologically treat AC, with a need for future randomized controlled trials.

Case of cheilitis granulomatosa associated with apical periodontitis.

PubMed

Kawakami, Tomoko; Fukai, Kazuyoshi; Sowa, Junko; Ishii, Masamitsu; Teramae, Hiroyuki; Kanazawa, Koutetsu

2008-02-01

The etiology of cheilitis granulomatosa is unknown. In some cases, rapid improvement and/or complete elimination of swelling of the lips after dental treatment has been reported. Here, we describe another case of improvement following dental treatment. A 57-year-old woman had developed asymptomatic swelling of the lower lip 2 months previously. Histological examination revealed non-caseous giant cell granulomas. Neither facial nerve palsy nor fissuring of the tongue was present. Patch testing for metal allergy revealed only mild irritation to zinc ion. Although topical corticosteroid ointment and oral tranilast for 4 months were ineffective, rapid and remarkable improvement of the swelling was noted soon after treatment of two lesions of apical periodontitis. Thorough examination for foci of infection is necessary when treating a patient with cheilitis granulomatosa.

Actinic cheilitis: aesthetic and functional comparative evaluation of vermilionectomy using the classic and W-plasty techniques.

PubMed

Rossoe, Ed Wilson Tsuneo; Tebcherani, Antonio José; Sittart, José Alexandre; Pires, Mario Cezar

2011-01-01

Chronic actinic cheilitis is actinic keratosis located on the vermilion border. Treatment is essential because of the potential for malignant transformation. To evaluate the aesthetic and functional results of vermilionectomy using the classic and W-plasty techniques in actinic cheilitis. In the classic technique, the scar is linear and in the W-plasty one, it is a broken line. 32 patients with clinical and histopathological diagnosis of actinic cheilitis were treated. Out of the 32 patients, 15 underwent the W-plasty technique and 17 underwent the classic one. We evaluated parameters such as scar retraction and functional changes. A statistically significant association between the technique used and scar retraction was found, which was positive when using the classic technique (p = 0.01 with Yates' correction). The odds ratio was calculated at 11.25, i.e., there was a greater chance of retraction in patients undergoing the classic technique. Both techniques revealed no functional changes. We evaluated postoperative complications such as the presence of crusts, dry lips, paresthesia, and suture dehiscence. There was no statistically significant association between complications and the technique used (p = 0.69). We concluded that vermilionectomy using the W-plasty technique shows better cosmetic results and similar complication rates.

Glycerin Borax Treatment of Exfoliative Cheilitis Induced by Sodium Lauryl Sulfate: a Case Report

PubMed Central

2016-01-01

This paper reports on the results of a case study of a 19-year-old female who presented to the Oral Medicine clinic with a chief complaint of scaly and peeling lips. The lesions had persisted on her lips for more than 7 years and were refractory to previous treatment. Her physician’s diagnosis was contact dermatitis. We diagnosed this patient as having exfoliative cheilitis (EC). A patch test using the toothpaste containing sodium lauryl sulfate (SLS) was positive and the patient discontinued using it. Instead, she started using a toothpaste not containing SLS. One year after treating her lesions with hydrogen peroxide mouthwash 1% and glycerin borax, a gradual improvement was observed until returning to normal. Glycerin borax was safe, low cost and simple to use in treatment of refractory exfoliative cheilitis. SLS may have been a precipitating factor in EC in this case. PMID:27789914

Glycerin Borax Treatment of Exfoliative Cheilitis Induced by Sodium Lauryl Sulfate: a Case Report.

PubMed

Thongprasom, Kobkan

2016-06-01

This paper reports on the results of a case study of a 19-year-old female who presented to the Oral Medicine clinic with a chief complaint of scaly and peeling lips. The lesions had persisted on her lips for more than 7 years and were refractory to previous treatment. Her physician's diagnosis was contact dermatitis. We diagnosed this patient as having exfoliative cheilitis (EC). A patch test using the toothpaste containing sodium lauryl sulfate (SLS) was positive and the patient discontinued using it. Instead, she started using a toothpaste not containing SLS. One year after treating her lesions with hydrogen peroxide mouthwash 1% and glycerin borax, a gradual improvement was observed until returning to normal. Glycerin borax was safe, low cost and simple to use in treatment of refractory exfoliative cheilitis. SLS may have been a precipitating factor in EC in this case.

Cheilitis Glandularis of Both Lips: Successful Treatment with a Combination of an Intralesional Steroid Injection and Tacrolimus Ointment

PubMed Central

2018-01-01

Cheilitis glandularis (CG) is an inflammatory condition of unknown cause that predominantly affects the minor salivary glands of the lips. Although a diagnosis of CG is not difficult, its treatment is a challenge. This article highlights the clinical presentation of the disease together with a case of successful management of this disease using a combination of a steroid injection followed by a topical immunosuppressor. PMID:29744227

Altered β-catenin expression related to cancer progression on actinic cheilitis and squamous cell carcinoma of the lip.

PubMed

Schussel, Juliana L; Pinto, Décio Dos Santos; Martins, Marília Trierveiler

2011-02-01

β-Catenin is a bifunctional protein related to cell adhesion and gene transcription when activated by Wnt pathway. Altered expression of β-catenin was related to loss of differentiation, more aggressive phenotype, increase of tumor invasion, and poor prognosis in a number of different cancers. Actinic cheilitis is caused by excessive exposure to ultraviolet radiation and has a high potential to suffer malignant transformation into squamous cell carcinoma (SCC) of the lip, the most frequent oral malignancy. Studies of oral cancer have shown the correlation of β-catenin expression and oral SCC prognosis, and loss of membrane expression may be considered as a potential marker for early tumor recurrence. Thirty-five cases of actinic cheilitis and 12 cases of SCC of the lip were select and submitted to immunohistochemical staining using β-catenin antibody. β-Catenin was positive on the membrane for all cases. Eighty-five percent of actinic cheilitis cases showed cytoplasmatic staining, and 22% nuclear staining. Eighty-three percent of SCC was positive for β-catenin, and none of them had nuclear staining. Cytoplasmatic and nuclear staining of β-catenin on studied cases point to pathway alterations. Results demonstrated that β-catenin expression is altered on epithelial dysplasia, and it is related to degree of alterations. Copyright © 2011 Elsevier Inc. All rights reserved.

Cheilitis glandularis: Case report with respect to immunohistochemical findings

PubMed Central

Friedrich, Reinhard E.; Löning, Thomas

2016-01-01

Cheilitis glandularis (CG) is a rare benign affection of the lip mucosa. The etiology and pathogenesis of CG are unknown. Surgical measures are the leading therapeutic options to treat CG. This case report on a 55-year-old female illustrates the recurrent affection of the lips over several years and local therapy. Furthermore, the study of the resected glands intends to differentiate the lesions with respect to the recently introduced concept of immunoglobulin G4-related diseases. PMID:26816670

Ingenol mebutate gel treatment for actinic cheilitis: report of four cases.

PubMed

Barrado Solís, Nerea; Molés Poveda, Paula; Lloret Ruiz, César; Pont Sanjuan, Virginia; Velasco Pastor, Manel; Quecedo Estébanez, Esther; Miquel Miquel, Javier

2015-01-01

Actinic cheilitis (AC) are premalignant lesions that have an increased risk of malignant transformation. Their treatment, therefore, is essential to prevent carcinogenesis. However, optimal therapy is not well established and different modalities yield variable results. Ingenol mebutate gel has recently been approved by the US Food and Drug Administration for topical treatment of actinic keratosis, with high clearance rates. On the basis of these findings, we report our experience with this drug for the treatment of AC. © 2014 Wiley Periodicals, Inc.

Diclofenac in hyaluronic acid gel: an alternative treatment for actinic cheilitis

PubMed Central

LIMA, Giana da Silveira; da SILVA, Gabriela Ferrari; GOMES, Ana Paula Neutzling; de ARAÚJO, Lenita Maria Aver; SALUM, Fernanda Gonçalves

2010-01-01

Objective Actinic cheilitis (AC) is a precancerous lesion of the lip vermillion caused by prolonged exposure to ultraviolet light. The aim of this study was to evaluate the effect of 3% diclofenac in 2.5% hyaluronic acid gel in the treatment of AC. Methods Thirty-four patients with chronic AC were treated twice a day with topical diclofenac during a period of 30 to 180 days. The individuals were followed up every 15 days by means of clinical examination and digital photographic documentation. Results Of the 27 patients that completed the study, 12 (44%) showed complete remission of the whitish plaques and exfoliative areas, and 15 (56%) had partial remission of the clinical picture of cheilitis. The latter group was submitted to excision of the leukoplakic areas which diagnosis varied from mild to moderate epithelial dysplasia. Conclusion The results suggest a promising role for diclofenac in hyaluronic acid gel in the treatment of AC. This treatment has the advantages of not being invasive and showing few side effects. PMID:21085813

Value of videoroscopy in the detection of alterations of actinic cheilitis and the selection of biopsy areas.

PubMed

Miranda, Ana-Maria; Ferrari, Thiago; Leite, Taiana; Domingos, Tabata; Cunha, Karin; Dias, Eliane

2015-05-01

To demonstrate the value of videoroscopy in identifying lesions and alterations not seen by oroscopy and to select the area for biopsy. Eighty patients were subjected to anamnesis, physical exam, videoroscopy exam, toluidine blue test and biopsy. A diagram of the lips was created to record the exact location where the lesion was found. Physical exam identified 287 lesions, and videoroscopy identified 587 lesions; erythema and white lesions were the most common lesions associated with actinic cheilitis. Of the 59 performed biopsies, 32 (52.4%) cases were identified by videoroscopy that showed lesions that were not detected during physical examination. The establishment of a diagram of the lip permitted registration of the precise location of the lesion. Videoroscopy was effective in locating lesions not seen by oroscopy. Both videoroscopy and the diagram of the lips allowed for better and earlier diagnosis and better patient follow-up for those with actinic cheilitis.

Cheilitis granulomatosa associated with allergic contact dermatitis to betel quid.

PubMed

Chiu, Cheng-Sheng; Tsai, Yi-Lun

2008-04-01

Cheilitis granulomatosa (CG) is a rare disorder of unknown origin, which is characterized clinically by painless, recurrent or persistent swelling of 1 or both lips. Betel quids, composed of betel nuts (seeds of the Areca catechu), slake lime, and Piper betel leaf/or Piper betel inflorescence, are widely used in Asia and strongly associated with oral mucosal disease. It has also been found to be a cause of contact leukomelanosis because of its ingredients of various chemicals. We describe a case of CG induced by betel quid chewing.

In vivo reflectance confocal microscopy evaluation of cheilitis glandularis: a report of 5 cases.

PubMed

Lourenço, Silvia V; Kos, Eliana; Borguezan Nunes, Thais; Bologna, Sheyla B; Sangueza, Martin; Nico, Marcello M S

2015-03-01

Cheilitis glandularis (CG) is an uncommon condition of unknown origin; it is clinically characterized by variable degrees of macrocheilia associated with red dilated ostia of minor salivary glands on the vermilion area, which secrete viscous saliva. Histopathological characteristics of CG are comprised of chronic sialadenitis with engorged acinar lobules and dilated ducts; CG also features chronic sun damage (actinic cheilitis and squamous cell carcinoma). These changes may be localized, and a punch biopsy specimen might fail to reveal enough criteria to support the diagnosis of CG. Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that enables an in vivo en face visualization of tissues with a resolution close to conventional histopathology. Its use allows analysis of the entire lip, without excision. We reported the evaluation of 5 cases of CG based on clinical RCM and histopathological correlation. RCM examination of the lip vermilion mainly revealed a bright aspect of the superficial epithelial layers, which corresponded to labial keratosis. Alteration of the classical epithelial honeycomb pattern was observed in RCM, which corresponded to epithelial changes in actinic cheilitis at histopathology. Round, dark empty spaces intermingling the epithelium, corresponded to the ectopic excretory salivary gland ducts that open their ostia within the lip vermilion. In the lamina propria, the most striking feature was superficial salivary gland lobules, seen as dark gray lobular structures. Our study, demonstrated the use of RCM in the evaluation of CG, showing that a correlation between the clinical, digital RCM images and histopathology improved the diagnostic skills in CG evaluation.

Allergic contact cheilitis from a lipstick misdiagnosed as herpes labialis: Subsequent worsening due to Zovirax contact allergy.

PubMed

Ozkaya, Esen; Topkarci, Zeynep; Ozarmağan, Güzin

2007-08-01

A 29-year-old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax cream. Patch tests were positive to Zovirax cream, propylene glycol, the patient's favourite lipstick and propyl gallate. No reaction was seen with Zovirax ophthalmic ointment and Zovirax tablet. The propylene glycol component of the Zovirax cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.

Non-invasive diagnosis and monitoring of actinic cheilitis with reflectance confocal microscopy.

PubMed

Ulrich, M; González, S; Lange-Asschenfeldt, B; Roewert-Huber, J; Sterry, W; Stockfleth, E; Astner, S

2011-03-01

Actinic cheilitis (AC) represents the equivalent of actinic keratosis on the lip. Various treatment modalities are available and the efficacy of diclofenac in hyaluronic acid has recently been described. Reflectance confocal microscopy (RCM) is a non-invasive imaging technique which has recently been applied for the diagnosis of actinic keratoses. Herein, we describe the applicability of RCM for the diagnosis of AC and for monitoring of treatment response of AC to diclofenac in hyaluronic acid. Ten Caucasian patients with clinical suspicion for AC were included in this study. To obtain a non-invasive diagnosis, RCM was performed at baseline, followed by biopsy and respective confocal-histopathological correlation. Six patients with a histological diagnosis of AC were treated with diclofenac in hyaluronic acid, whereby monitoring was performed by RCM. Reflectance confocal microscopy was able to correctly identify 6/7 cases of AC and 3/3 cases of benign lesions. The most important RCM criteria for diagnosis of AC were cellular atypia at the stratum spinosum and granulosum with atypical honeycomb pattern. One patient with AC was misclassified as inflammatory cheilitis by RCM as it showed marked inflammatory response and lacked clear signs of cellular atypia on RCM imaging. Following topical treatment with diclofenac gel, 5/6 patients (83%) showed a good treatment response with regression of dysplasia on consecutive RCM examination. Reflectance confocal microscopy is a promising tool for the non-invasive diagnosis and monitoring of actinic cheilitis. However, marked inflammation represents a potential diagnostic pitfall. In this regard, biopsy should be performed in doubtful cases. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients.

PubMed

Ribeiro, Camila Ferrari; Souza, Fernanda Homem de Mello de; Jordão, Juliana Merheb; Haendchen, Letícia Cortes; Mesquita, Lismary; Schmitt, Juliano Vilaverde; Faucz, Luciana Lisboa

2012-01-01

Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. To assess the efficacy of a therapy and its cosmetic results. In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

Cheilitis Granulomatosa: A Case Report with Review of Literature

PubMed Central

Vibhute, Nupura A; Vibhute, Aniket H; Daule, Nilima R

2013-01-01

Cheilitis granulomatosa (CG) is a chronic swelling of the lip due to granulomatous inflammation. It is a rare inflammatory disorder first described by Miescher in 1945. It is a monosymptomatic form or an incomplete variant of Melkersson-Rosenthal syndrome; a triad of recurrent orofacial edema, recurrent facial nerve palsy and fissuring of the tongue. As the etiology remains unknown, treatment of CG is challenging. We present a case of CG in a 43-year-old female patient secondary to allergy to certain food items. The present case highlights the importance of thorough investigations in the diagnosis of this lesion as the findings mimic many other granulomatous conditions. PMID:23723497

Cheilitis Glandularis: Two Case Reports of Asian-Japanese Men and Literature Review of Japanese Cases

PubMed Central

Yanagawa, Toru; Yamaguchi, Akira; Harada, Hiroyuki; Yamagata, Kenji; Ishibashi, Naomi; Noguchi, Masayuki; Onizawa, Kojiro; Bukawa, Hiroki

2011-01-01

Cheilitis glandularis (CG) is a rare disorder characterized by swelling of the lip with hyperplasia of the labial salivary glands. CG is most frequently encountered in the lower lip, in middle-aged to older Caucasian men; however Asian cases were rarely reported. In this paper we present two cases of CG in Asian-Japanese men. One was a 23-year-old male with CG of the superficial suppurative type. The other was a 54-year-old male with deep suppurative type. We also reviewed the Japanese cases of CG in the literature and discussed about clinical feature of Japanese CG. PMID:21991474

Oral mucosal lesions and their association with sociodemographic, behavioral, and health status factors.

PubMed

Gheno, José Nicolau; Martins, Marco Antonio Trevizani; Munerato, Maria Cristina; Hugo, Fernando Neves; Sant'ana Filho, Manoel; Weissheimer, Camila; Carrard, Vinicius Coelho; Martins, Manoela Domingues

2015-01-01

The aim of this study was to evaluate the frequency of oral mucosal lesions and their associations with sociodemographic, health, and behavioral factors in a southern Brazilian population. Information was collected from participants (n = 801) using a structured questionnaire during an oral cancer screening campaign held at an agribusiness show in southern Brazil in 2009. Data were described using frequency distributions or means and standard deviations. Associations between independent variables and outcomes were assessed using the Chi-squared test. A total of 465 lesions were detected (actinic cheilitis: n = 204, 25.5%; candidiasis: n = 50, 6.2%; fibrous inflammatory hyperplasia: n = 42, 5.2%; ulceration, n = 33, 4.1%; hemangioma: n = 14, 1.7%; leukoplakia: n = 11, 1.4%). Candidiasis, actinic cheilitis, and fibrous inflammatory hyperplasia were associated significantly with literacy. Actinic cheilitis was also associated significantly with sun exposure and hat use, and leukoplakia was associated with smoking. The high frequency of oral mucosal lesions observed highlights the importance of education about risk factors. Additionally, training of health professionals, mainly those from public health services, in the use of preventive and community education strategies is needed.

Multicentre study of allergic contact cheilitis from toothpastes.

PubMed

Francalanci, S; Sertoli, A; Giorgini, S; Pigatto, P; Santucci, B; Valsecchi, R

2000-10-01

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially-targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop-restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Oral candidiasis and angular cheilitis.

PubMed

Sharon, Victoria; Fazel, Nasim

2010-01-01

Candidiasis, an often encountered oral disease, has been increasing in frequency. Most commonly caused by the overgrowth of Candida albicans, oral candidiasis can be divided into several categories including acute and chronic forms, and angular cheilitis. Risk factors for the development of oral candidiasis include immunosuppression, wearing of dentures, pharmacotherapeutics, smoking, infancy and old age, endocrine dysfunction, and decreased salivation. Oral candidiasis may be asymptomatic. More frequently, however, it is physically uncomfortable, and the patient may complain of burning mouth, dysgeusia, dysphagia, anorexia, and weight loss, leading to nutritional deficiency and impaired quality of life. A plethora of antifungal treatments are available. The overall prognosis of oral candidiasis is good, and rarely is the condition life threatening with invasive or recalcitrant disease.

Ingenol Mebutate for Recalcitrant Chronic Actinic Cheilitis.

PubMed

Tzika, Evangelia; Masouyé, Isabelle; Mühlstädt, Michael; Laffitte, Emmanuel

2016-01-01

We present the case of a healthy 76-year-old man with a whitish, hyperkeratotic lesion of the lower lip diagnosed as actinic cheilitis (AC) previously treated with classic red light photodynamic therapy 5 years ago. Initial treatment with 5% imiquimod cream - also with intensified application - failed. After 2 cycles thrice daily, consecutive applications of 150 μg/g ingenol mebutate gel at 3 weeks' interval, the lesions cleared completely. Surprisingly, no pustular or crusting reaction or other side effect occurred contrary to expectation. Remission was stable for 10 months, when recurrence occurred. Ingenol mebutate proved to be a feasible and safe treatment in this otherwise refractory case of AC. © 2016 S. Karger AG, Basel.

Apoptosis and apoptotic pathway in actinic prurigo by immunohistochemistry

PubMed Central

Cuevas-González, Juan-Carlos; García-Vázquez, Francisco-Javier; Rodríguez-Lobato, Erika; Farfán-Morales, José-Eduardo

2016-01-01

Background Actinic prurigo (AP) is an idiopathic photodermatosis, this entity requires exposure to UV-B and -A to develop lesions. Apoptosis is a physiological death program that can be initiated by a permanently active mechanism (extrinsic pathway) or irreparable damage (intrinsic pathway). Material and Methods Descriptive study, the sample size comprised 64 paraffin blocks of tissue with a diagnosis of AP. In H&E-stained slides, the diagnosis of AP was corroborated, and 1-µm-thick sections were processed for immunohistochemistry (IHC). A database was constructed with SPSS version 20, Inc., Chicago, IL, USA, and descriptive statistics were analyzed by X2 test and comparison of means. Results A total of 64 cases were processed, of which 40 (62.5%) were cheilitis AP and 24 (37.5%) were AP in the skin. Of the 40 cheilitis samples, 27 were positive for Bcl-2 and caspase 3 (67.5%), p53 was expressed in 30 (75%). Of the skin lesions,p53 and caspase 3 were expressed in 18 of 24 cases (75%), and 13 were positive for Bcl-2 (54%). Conclusions We propose that apoptosis is the last step in the type IV subtype a-b hypersensitivity response-activation of the intrinsic pathway indicates that external factors, such as UV-A and -B are the trigger. Key words:Apoptosis, actinic prurigo, cheilitis actinic prurigo. PMID:26615506

Potentially malignant oral lesions: clinicopathological correlations

PubMed Central

Maia, Haline Cunha de Medeiros; Pinto, Najara Alcântara Sampaio; Pereira, Joabe dos Santos; de Medeiros, Ana Miryam Costa; da Silveira, Éricka Janine Dantas; Miguel, Márcia Cristina da Costa

2016-01-01

ABSTRACT Objective To determine the incidence of potentially malignant oral lesions, and evaluate and correlate their clinical and pathological aspects. Methods The sample consisted of cases clinically diagnosed as oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, and oral lichen planus treated at a diagnostic center, between May 2012 and July 2013. Statistical tests were conducted adopting a significance level of 5% (p≤0.05). Results Out of 340 patients, 106 (31.2%) had potentially malignant oral lesions; and 61 of these (17.9%) were submitted to biopsy. Actinic cheilitis was the most frequent lesion (37.5%) and the lower lip was the most affected site (49.6%). Among 106 patients in the sample, 48 (45.3%) reported nicotine consumption, 35 (33%) reported alcohol intake and 34 (32.1%) sun exposure while working. When clinical and histopathological diagnoses were compared, oral erythroplakia and atypical ulcer were the lesions that exhibited greater compatibility (100% each). Conclusion In most cases, clinical and histopathological diagnoses were compatible. An association between the occurrence of erythroplakia, leukoplakia and erythroleukoplakia with smoking was observed. Similarly, an association between actinic cheilitis and sun exposure was noted. Erythroleukoplakia presented the highest malignancy grade in this study. Finally, dental surgeons should draw special attention to diagnosis of potentially malignant oral lesions, choose the best management, and control the lesions to avoid their malignant transformation. PMID:27074232

Study of MDM2 and SUMO-1 expression in actinic cheilitis and lip cancer.

PubMed

Oliveira Alves, Mônica Ghislaine; da Mota Delgado, Adriana; Balducci, Ivan; Carvalho, Yasmin Rodarte; Cavalcante, Ana Sueli Rodrigues; Almeida, Janete Dias

2014-11-01

Actinic cheilitis exhibits a potential of malignant transformation in 10-20 % of cases. The objective of this study was to compare the expression of MDM2 and SUMO-1 proteins between actinic cheilitis (AC) and squamous cell carcinoma (SCC) of the lip. The sample consisted of lower lip mucosa specimens obtained from cases with a clinical and histopathological diagnosis of AC (n = 26) and SCC (n = 25) and specimens of labial semi-mucosa (n = 15) without clinical alterations or inflammation. The tissue samples were stained with hematoxylin-eosin and anti-MDM2 and anti-SUMO-1 antibodies. Data were analyzed by the Kruskal-Wallis and Dunn's tests (5 %). The median expression of MDM2 (kW = 36.8565; df = 3-1 = 2; p = 0.0001) and SUMO-1 (kW = 32.7080; df = 3-1 = 2; p = 0.0001) was similar in cases of AC and SCC of the lip, but differed significantly from that observed for normal labial semi-mucosa. Despite the limitations of the present study, immunohistochemistry demonstrated the overexpression of important proteins (MDM2 and SUMO-1) related to regulatory mechanisms of apoptosis in AC and SCC of the lip, but further studies are needed.

Immunoexpression of HDAC1, HDAC2, and HAT1 in actinic cheilitis and lip squamous cell carcinoma.

PubMed

Chrun, E S; Modolo, F; Vieira, Dsc; Borges-Júnior, Áls; Castro, R G; Daniel, F I

2017-05-01

Acetylation and deacetylation are the most studied covalent histone modifications resulting in transcriptional regulation with histone deacetylases (HDAC) and histone acetyltransferases (HAT) as the main associated enzymes. These enzymes overexpression induces abnormal transcription of key genes that regulate important cellular functions, such as proliferation, cell cycle regulation, and apoptosis. Thus, the expression of different HATs and HDACs has been evaluated in various cancers. To investigate HDAC1, HDAC2 and HAT1 expression in lip squamous cell carcinoma (LSCC) and actinic cheilitis (AC) and to demonstrate their correlation with DNA metyltransferases (DNMTs). Thirty cases of lip squamous cell carcinoma (LSCC), thirty cases of actinic cheilitis (AC), and 28 cases of non-neoplastic epithelium as control were selected for immunohistochemical investigation. Nuclear HDAC2 immunopositivity was significantly higher in AC (75.07% ± 29.70) when compared with LSCC (51.06% ± 39.02). HDAC1 and HAT1 nuclear immunostaining were higher in AC, with no statistical significance. When comparing data with our previous study, we found a positive correlation between HDAC1 X DNMT1/DNMT3b, HDAC2 X DNMT3b, and HAT1 X DNMT1/DNMT3b for certain studied groups. This study showed higher levels of nuclear HDAC2 immunopositivity in AC, possibly indicating that this enzyme plays a key role in lip photocarcinogenesis early stages. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Immunohistochemical expression of DNA methyltransferases 1, 3a, and 3b in actinic cheilitis and lip squamous cell carcinomas.

PubMed

Daniel, Filipe I; Alves, Soraia R; Vieira, Daniella S C; Biz, Michelle T; Daniel, Inah W B S; Modolo, Filipe

2016-11-01

Epigenetic modifications, including DNA methylation of tumor suppressor genes carried out by DNA methyltransferases (DNMTs), are important events in carcinogenesis. Although there are studies concerning to its expression in several cancer types, DNMTs expression pattern is not known in photoinduced lip carcinogenesis. The aim of this study was to investigate the immunoexpression of DNMTs 1, 3a, and 3b in lip precancerous lesion (actinic cheilitis) and cancer. Thirty cases of actinic cheilitis (AC), thirty cases of lip squamous cell carcinoma (LSCC), and twenty cases of non-neoplastic tissue (NNT) were selected for immunohistochemical investigation of DNMTs 1, 3a, and 3b. Nuclear DNMT 1 immunoreactivity was significantly higher in the LSCC group (68.6%) compared with NNT (47%), and nuclear DNMT 3b was higher in LSCC (70.9%) than in NNT (37.9%) and in AC (44%). Only DNMT 3a showed both higher nuclear and cytoplasmic expression in AC (35.9% and 35.5%, respectively) than in NNT (4.4% and 16.1%, respectively) and LSCC (8.8% and 13.2%, respectively) (P < 0.05). The results suggested that DNMT 3a could play a key role in the methylation process of initial steps of UV carcinogenesis present in AC while DNMT 3b could be responsible for de novo methylation in already established lip cancer. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Treatment of actinic cheilitis by photodynamic therapy with 5-aminolevulinic acid and blue light activation.

PubMed

Zaiac, Martin; Clement, Annabelle

2011-11-01

Actinic cheilitis (AC), a common disorder of the lower lip, should be treated early to prevent progression to invasive squamous cell carcinoma. This study evaluated the safety and efficacy of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) activated by blue light for the treatment of AC. Fifteen patients with clinically evident or biopsy-proven AC received two treatments with ALA PDT with blue light activation. Treatments were spaced three to five weeks apart. Most patients achieved 65% to 75% clearance three to five weeks after the first treatment and all achieved more than 75% clearance one month after the second treatment. Three patients achieved complete clearance. Pain and burning during irradiation were absent or mild. All patients said they would repeat the procedure. ALA PDT with 417 nm blue light is a promising option for the treatment of AC of the lower lip.

Management of actinic cheilitis using ingenol mebutate gel: A report of seven cases.

PubMed

Flórez, Ángeles; Batalla, Ana; de la Torre, Carlos

2017-03-01

Actinic cheilitis (AC) can precede the development of squamous cell carcinoma of the lip, a location with high risk of invasiveness and metastasis. We communicate the good results that we obtained when treating seven patients suffering from AC with ingenol mebutate (IM) 0,015% concentration gel on three consecutive days. Three patients achieved complete clearance and four significant improvement. IM is a topical field treatment approved for actinic keratosis. To our knowledge, reported experience in the management of AC with IM is very limited. Local skin responses grade 3 were the main adverse event observed and they resolved in all patients without specific therapy within 1 to 2 weeks. IM is characterized by its rapid clinical effect, its favorable safety profile and its dosing period of only 3 days, shorter than with other field therapies. All these facts make it an attractive new therapy for AC, with need for further study.

Actinic cheilitis: proposition and reproducibility of a clinical criterion.

PubMed

Poitevin, Nádia Antunes; Rodrigues, Mariana Sudati; Weigert, Karen Loureiro; Macedo, Carmen Lúcia Rodrigues; Dos Santos, Rubem Beraldo

2017-01-01

The actinic cheilitis (AC) is a precancerous lip lesion seen as a consequence of chronic sun exposure. Clinically, the border between the lip's skin and the semimucosa could be blurred; in the more aggressive cases, leucoplakia and ulcers also represent its clinical feature. It seems that no clinical criterion is universally accepted for this disease yet. Therefore, this study was carried out to make a proposition of a clinical score to actinic cheilitis (Grade I starting from dryness of vermilion to endured ulcers representing Grade IV) and to assess its reproducibility. Fifty subjects were assessed, most of whom were male, Caucasian farmers, with an average age of 46.12 (18-74) years. The obtained data were analysed by means of descriptive statistics and by Kappa test to assess the inter-examiners and the clinical Golden-Pattern concordance (95% CI). During calibration, 15 patients were examined three times a week by each examiner (4) until Kappa test observed k =0.8 or more. In the main experiment, the inter-examiner concordance was classified between good ( k =0.779; P <0.05) and very good ( k =0.925; P <0.05) from the 35 examined subjects. With the Golden-Pattern, it was considered very good ( k =0.812; P <0.05 to k =0.925; P <0.05). Four examiners with different experiences could strongly suggest that after adequate calibration, it could be well applied by examiners with as much experience as a dental student. The authors concluded that the proposed classification was easily applied and had a very good reproducibility.

Actinic cheilitis: proposition and reproducibility of a clinical criterion

PubMed Central

Poitevin, Nádia Antunes; Rodrigues, Mariana Sudati; Weigert, Karen Loureiro; Macedo, Carmen Lúcia Rodrigues; dos Santos, Rubem Beraldo

2017-01-01

Objectives/Aims: The actinic cheilitis (AC) is a precancerous lip lesion seen as a consequence of chronic sun exposure. Clinically, the border between the lip’s skin and the semimucosa could be blurred; in the more aggressive cases, leucoplakia and ulcers also represent its clinical feature. It seems that no clinical criterion is universally accepted for this disease yet. Therefore, this study was carried out to make a proposition of a clinical score to actinic cheilitis (Grade I starting from dryness of vermilion to endured ulcers representing Grade IV) and to assess its reproducibility. Materials and Methods: Fifty subjects were assessed, most of whom were male, Caucasian farmers, with an average age of 46.12 (18–74) years. The obtained data were analysed by means of descriptive statistics and by Kappa test to assess the inter-examiners and the clinical Golden-Pattern concordance (95% CI). Results: During calibration, 15 patients were examined three times a week by each examiner (4) until Kappa test observed k=0.8 or more. In the main experiment, the inter-examiner concordance was classified between good (k=0.779; P<0.05) and very good (k=0.925; P<0.05) from the 35 examined subjects. With the Golden-Pattern, it was considered very good (k=0.812; P<0.05 to k=0.925; P<0.05). Discussion: Four examiners with different experiences could strongly suggest that after adequate calibration, it could be well applied by examiners with as much experience as a dental student. Conclusions: The authors concluded that the proposed classification was easily applied and had a very good reproducibility. PMID:29607086

Mast cells and matrix metalloproteinase 9 expression in actinic cheilitis and lip squamous cell carcinoma.

PubMed

Souza Freitas, Valéria; de Andrade Santos, Pedro Paulo; de Almeida Freitas, Roseana; Pereira Pinto, Leão; de Souza, Lélia Batista

2011-09-01

The aim of this study was to evaluate mast cell (MC) density and migration and their association with matrix metalloproteinase (MMP) 9 expression in squamous cell carcinoma (SCC) and actinic cheilitis (AC). Tryptase, c-Kit, and MMP-9 expression was evaluated in 20 cases of SCC, 20 cases of AC, and 7 cases of normal lip (control samples) by immunohistochemistry techniques. Tryptase(+) and c-Kit(+) MC densities were significantly higher in SCCs than in ACs and control samples (P < .001). However, no significant difference was found when comparing tryptase(+) and c-Kit(+) MC densities between ACs and control samples (P values .185 and .516, respectively). MMP-9 was strongly expressed in SCCs and moderately expressed in ACs and control samples. A highly significant association was found between tryptase(+) MC density and the expression of MMP-9 (P < .001). The increase in MC density associated with the strong expression of MMP-9 may favor SCC progression. Copyright © 2011 Mosby, Inc. All rights reserved.

Daylight photodynamic therapy with methyl-aminolevulinate for the treatment of actinic cheilitis.

PubMed

Fai, Dario; Romanello, Eugenio; Brumana, Marta Benedetta; Fai, Carlotta; Vena, Gino Antonio; Cassano, Nicoletta; Piaserico, Stefano

2015-01-01

Actinic cheilitis (AC) is a common premalignant condition that requires an effective treatment to reduce the risk of malignant transformation. Photodynamic therapy (PDT) has been recently added to the armamentarium available for AC treatment. Daylight PDT (D-PDT) is a novel PDT modality in which the activation of the topical photosensitizer is induced by the exposure to natural daylight instead of artificial light sources without preliminary occlusion. This simplified procedure was found to be more tolerated as compared to conventional PDT. We report our preliminary experience on the use of D-PDT using methyl-aminolevulinate cream in 10 patients with refractory AC of the lower lip. Patients received two consecutive D-PDT sessions with an interval of 7-14 days. At 3 months after therapy, a complete response was observed in seven patients, with sustained results in five patients over an observational period of 6-12 months. Treatment was well tolerated. © 2015 Wiley Periodicals, Inc.

Prevalence of actinic cheilitis in a population of agricultural sugarcane workers.

PubMed

Miranda, Ana M O; Soares, Léo G; Ferrari, Thiago M; Silva, Denise G; Falabella, Márcio E V; Tinoco, Eduardo M B

2012-01-01

Actinic cheilitis (AC) is a pre-malignant inflammatory reaction of the lips caused by continuous exposure to solar rays. The aim of this study was to assess the prevalence of AC in a population of sugarcane workers in Brazil. 1,539 individuals who were exposed to the sun during working hours and 150 individuals who were not exposed were screened for clinical signs of AC. The sample was classified according to years of exposure to the sun, ethnicity, gender smoking and severity of the lesion. A 9.16% (n= 141) prevalence of AC was observed among the population which had been exposed to the sun. The prevalence of AC lesions was significantly higher among individuals who had been exposed to the sun for more than 10 years than among those who had been exposed for less than 10 years, and among Caucasians and males than non-Caucasians and females. It was concluded that the severity of the lesions was associated with time of exposure to the sun.

Methyl-aminolevulinate photodynamic therapy for the treatment of actinic cheilitis: a retrospective evaluation of 29 patients.

PubMed

Fai, D; Romano, I; Cassano, N; Vena, G A

2012-02-01

Multiple treatment modalities have been proposed for actinic cheilitis (AC), and topical photodynamic therapy (PDT) has recently been included among these modalities. We report our experience with PDT using methyl-aminolevulinate (MAL) in AC. We performed a retrospective analysis of 29 patients who had undergone MAL-PDT for treatment of AC: 4 patients received one single session and 25 patients two consecutive weekly sessions. At 3 months, 21 patients (72%) obtained a complete clinical response, which was sustained over a follow-up period of 6-36 months (mean, 20 months) in 20 patients. Cosmetic outcome was generally rated as good or very good. Transient local adverse events related to the procedure were common and mild to moderate in the majority of cases. Our preliminary experience suggests that MAL-PDT may be considered a valid modality for the treatment of AC, although long-term follow-up studies in large patient series are required to obtain precise data about clinical and histological recurrences.

Characterization and management of exfoliative cheilitis: a single-center experience.

PubMed

Almazrooa, Soulafa A; Woo, Sook-Bin; Mawardi, Hani; Treister, Nathaniel

2013-12-01

Exfoliative cheilitis (EC) is a rare inflammatory condition affecting the vermilion of the lips and characterized by production of a thick keratin scale. Given the limited available data, the approach to optimal management of EC remains unclear. The objective of this retrospective study was to characterize the clinical features, management, and outcomes of a series of patients with EC. Fifteen patients with a median age of 59 years and a female-to-male ratio of 2:1 were diagnosed with EC from 2000 to 2010. Parafunctional lip licking (53%) and a history of psychiatric disorders (40%) were common. Ten patients (66%) returned for follow-up, with an overall response rate (partial or complete) of 80% at a median of 2 months, most frequently associated with the use of topical calcineurin inhibitors or moisturizing agents. Management of EC with topical calcineurin inhibitors and moisturizing agents is associated with clinical improvement, but prospective trials are needed. Copyright © 2013 Elsevier Inc. All rights reserved.

Oral mucosal manifestations in primary and secondary Sjögren syndrome and dry mouth syndrome

PubMed Central

Olewicz-Gawlik, Anna; Polańska, Adriana; Nowak-Gabryel, Michalina; Kocięcki, Jarosław; Witmanowski, Henryk; Sokalski, Jerzy

2016-01-01

Introduction One of the most important symptoms of Sjögren syndrome is xerostomia. The oral cavity deprived of saliva and its natural lubricative, protective and antibacterial properties is prone to a number of unfavourable consequences. Aim To present the most important lesions on the oral mucosa in primary and secondary Sjögren syndrome and in dry mouth syndrome. Material and methods The study group comprised 55 patients including 52 women and 3 men aged 20–72 years (average: 28.25 years). Results Basing on the accepted criteria, primary Sjögren syndrome was diagnosed in 22 (40%) patients, secondary Sjögren syndrome in 18 (32.7%) patients, and dry mouth syndrome in 15 (27.27%) patients. The physical examination and the examination of the mouth were performed and history was elicited from every patient. Conclusions The most common pathologies appearing on the oral mucosa in primary and secondary Sjögren syndrome are angular cheilitis, cheilitis, increased lip dryness as well as non-specific ulcerations, aphthae and aphthoid conditions. PMID:26985175

Clinicopathological profile and management of 161 cases of actinic cheilitis.

PubMed

Lopes, Maria Luiza Diniz de Sousa; Silva Júnior, Francisco Leonardo da; Lima, Kenio Costa; Oliveira, Patrícia Teixeira de; Silveira, Éricka Janine Dantas da

2015-01-01

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies.

Comparative study on the microbiological features of angular cheilitis in HIV seropositive and HIV seronegative patients from South India

PubMed Central

Krishnan, P Anitha; Kannan, Ranganathan

2013-01-01

Objective: This study was designed to compare the microbiological features of angular cheilitis (AC) in human immunodeficiency virus (HIV) seropositive and HIV seronegative individuals, in a group of south Indians. Materials and Methods: Swabs from oral commissures of 46 patients were obtained and inoculated on to Sabouraud's dextrose agar (SDA) supplemented with chloramphenicol, blood agar (BA) and MacConkey's agar (MCA) plates and cultured. α-hemolytic Streptococci, Staphylococcus albus, Staphylococcus aureus, Candida species, Klebsiella species and Pseudomonas species were cultured. Candidal colonies were further speciated by the conventional biotyping technique. Results: In AC of HIV seropositive patients Candida albicans and Staphylococcus aureus were more prevalent than that in HIV seronegative patients. Incidentally in patients with CD4 cell count less than 200 there was an increase in the incidence of Candidal and Staphylococcus aureus colonization when compared to patients with CD4 cell count higher than 200. Conclusion: The present study suggests a definite difference in the microbial flora of AC in HIV seropositive patients than that of HIV seronegative population. PMID:24574650

Prevalence of and risk factors for actinic cheilitis in Brazilian fishermen and women.

PubMed

de Oliveira Ribeiro, Artur; da Silva, Luiz Carlos Ferreira; Martins-Filho, Paulo Ricardo Saquete

2014-11-01

This study was conducted to investigate the prevalence of and risk factors for actinic cheilitis (AC) in Brazilian fishermen and women. A cross-sectional study was carried out in a representative sample (n = 210) of fishermen and women. Data related to age, skin color, cumulative and daily exposure to solar radiation, smoking, sun protection measures, and the presence of AC were collected. A Poisson regression model was created to estimate the prevalence ratio of variables. The prevalence of AC was 11.4% (95% confidence interval 7.8-16.4%). The disease was more prevalent in fishermen and women with fair skin and in those aged >50 years, those with cumulative exposure to solar radiation of >30 years, those with daily exposure of >4 hours, and those who did not use sunscreen. Brazilian fishermen and women constitute a population at risk for lip cancer. Public health programs that encourage the use of sunscreens and a lower daily exposure to solar radiation should be established. © 2014 The International Society of Dermatology.

Cutaneous applications of lasers.

PubMed

Ries, W R; Speyer, M T

1996-12-01

The cutaneous application of lasers today includes more selective and less damaging devices. Carbon dioxide, neodymium:yttrium-aluminum-garnet, potassium titanyl phosphate, argon, and yellow lasers are most prevalent in treating cutaneous lesions. Specific techniques in skin resurfacing, keloid excision, rhinophyma, actinic cheilitis ablation, and excision of superficial cutaneous tumors are discussed. Proper management of cutaneous vascular lesions is also presented.

Draft Genome Sequence of the First Documented Clinical Siccibacter turicensis Isolate in Austria.

PubMed

Lepuschitz, Sarah; Pekard-Amenitsch, Shiva; Haunold, Renée; Schill, Simone; Schriebl, Agnes; Mach, Robert; Allerberger, Franz; Ruppitsch, Werner; Forsythe, Stephen J

2018-05-03

The nonpathogenic species Siccibacter turicensis is closely related to members of the food-associated pathogenic genus Cronobacter and has been detected in fruit powders, formula, spices, and herbs. Here, we report on the first clinical isolate of S. turicensis , recovered from the labial angle of a patient with angular cheilitis. Copyright © 2018 Lepuschitz et al.

Non-invasive imaging of actinic cheilitis and squamous cell carcinoma of the lip.

PubMed

Lupu, Mihai; Caruntu, Ana; Caruntu, Constantin; Boda, Daniel; Moraru, Liliana; Voiculescu, Vlad; Bastian, Alexandra

2018-05-01

An early diagnosis is of overwhelming importance for the management and prognosis of mucocutaneous cancer. Actinic cheilitis (AC), defined by the clonal expansion of genomically unstable keratinocytes, is the most common potentially malignant lesion affecting the lips. Squamous cell carcinoma (SCC) is the most frequent oral malignancy, and there is strong evidence that the majority of the SCCs of the lip originate from AC. There is considerable difficulty in discerning between dysplasia and invasive carcinomas solely on a clinical basis. Although dermoscopy has become an essential tool for skin tumor evaluation, reflectance confocal microscopy (RCM) is a non-invasive imaging technology that has proved itself extremely useful in the diagnosis and monitoring of several skin diseases, including AC and SCC. The present study aimed to re-emphasize the usefulness of RCM in the early detection of malignant transformation, using AC and SCC of the lips as working examples. Due to the apparent innocuousness of AC for numerous patients, it is not possible to overstress the importance of a correct and early diagnosis, proper treatment and long-term patient follow-up as being essential for preventing the progression to lip SCC, or for its timely diagnosis.

Clinicopathological profile and management of 161 cases of actinic cheilitis*

PubMed Central

Lopes, Maria Luiza Diniz de Sousa; da Silva Júnior, Francisco Leonardo; Lima, Kenio Costa; de Oliveira, Patrícia Teixeira; da Silveira, Éricka Janine Dantas

2015-01-01

BACKGROUND Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. OBJECTIVES To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. METHODS Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. RESULTS There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). CONCLUSION This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies. PMID:26375219

Usefulness of tissue autofluorescence imaging in actinic cheilitis diagnosis.

PubMed

Takahama Junior, Ademar; Kurachi, Cristina; Cosci, Alessandro; Pereira Faustino, Isabel Schausltz; Camisasca, Danielle Resende; da Costa Fontes, Karla Bianca Fernandes; Pires, Fábio Ramôa; Azevedo, Rebeca Souza

2013-07-01

Actinic cheilitis (AC) is a potentially malignant disorder of the lips. Because of its heterogeneous clinical aspect, it is difficult to indicate representative biopsy area. The purpose of this study was to evaluate the usefulness of tissue autofluorescence in AC diagnosis. The system was composed of a 405-nm light-emitting diode, sent to the sample by a dichroic, that allows the fluorescence signal to reach a camera directly plugged in the system. Fifty-seven patients with clinical diagnosis of AC and 45 normal volunteers were selected. According to clinical and fluorescence features, one or more areas were selected for biopsies in the AC group and epithelial dysplasia (ED) grades were established. The autofluorescence images were processed by a clustering algorithm for AC automated diagnosis. The tissue autofluorescence image revealed a heterogeneous pattern of loss and increase of fluorescence in patients with AC. ED was found in 93% of the cases, and most of the areas graded as moderate or severe ED were chosen with the aid of autofluorescence. The processed autofluorescence images from AC patients showed a higher number of spots in an irregular pattern. Tissue autofluorescence image system is a useful technique in association with clinical examination for AC diagnosis.

Correlation between cell cycle proteins and hMSH2 in actinic cheilitis and lip cancer.

PubMed

Lopes, Maria Luiza Diniz de Sousa; de Oliveira, Denise Hélen Imaculada Pereira; Sarmento, Dmitry José de Santana; Queiroz, Lélia Maria Guedes; Miguel, Márcia Cristina da Costa; da Silveira, Éricka Janine Dantas

2016-04-01

This study aims to evaluate and verify the relationship between the immunoexpression of hMSH2, p53 and p21 in actinic cheilitis (AC) and lower lip squamous cell carcinoma (SCC) cases. Forty AC and 40 SCC cases were submitted to immunoperoxidase method and quantitatively analyzed. Expression was compared by Mann-Whitney test, Student t test or one-way ANOVA. To correlate the variables, Pearson's correlation coefficient was calculated. The expression of p53 and p21 showed no significant differences between histopathological grades of AC or lower lip SCC (p > 0.05). Immunoexpression of p53 was higher in SCC than in AC (p < 0.001), while p21 expression was more observed in AC when compared to SCC group (p = 0.006). The AC group revealed an inverse correlation between p53 and hMSH2 expression (r = -0.30, p = 0.006). Alterations in p53 and p21 expression suggest that these proteins are involved in lower lip carcinogenesis. Moreover, p53 and hMSH2 seem to be interrelated in early events of this process.

Histopathologic features in actinic cheilitis by the comparison of grading dysplasia systems.

PubMed

Pilati, Sfm; Bianco, B C; Vieira, Dsc; Modolo, F

2017-03-01

This study aimed to determine the histopathologic findings in actinic cheilitis (AC) and lip squamous cell carcinomas (LSCC) diagnosed at Federal University of Santa Catarina in order to attempt to predict the evolution from AC to LSCC based on the comparison of two dysplasia classification systems. Histopathologic features were evaluated according to the World Health Organization classification of dysplasia and binary system of classification. Also, in LSCC, pattern, stage of invasion, and degree of keratinization were evaluated. A total of 58 cases of AC and 70 cases of LSCC were studied, and data correlation was performed using statistical analysis. The presence of dyskeratosis and keratin pearls was found to be strongly associated with severe dysplasia and could represent higher proximity between the severe dysplasia in AC and LSCC. Also, changes related to the nuclei, such as hyperchromasia, nuclear pleomorphism, anisonucleosis, increase in the number and size of nucleoli, increased number of mitoses, and atypical mitoses, indicate progression in dysplasia spectrum. Knowledge of clinical and histological features of AC and LSCC leads to better understanding of factors possibly associated with malignant transformation of epithelial dysplasia. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Non-invasive imaging of actinic cheilitis and squamous cell carcinoma of the lip

PubMed Central

Lupu, Mihai; Caruntu, Ana; Caruntu, Constantin; Boda, Daniel; Moraru, Liliana; Voiculescu, Vlad; Bastian, Alexandra

2018-01-01

An early diagnosis is of overwhelming importance for the management and prognosis of mucocutaneous cancer. Actinic cheilitis (AC), defined by the clonal expansion of genomically unstable keratinocytes, is the most common potentially malignant lesion affecting the lips. Squamous cell carcinoma (SCC) is the most frequent oral malignancy, and there is strong evidence that the majority of the SCCs of the lip originate from AC. There is considerable difficulty in discerning between dysplasia and invasive carcinomas solely on a clinical basis. Although dermoscopy has become an essential tool for skin tumor evaluation, reflectance confocal microscopy (RCM) is a non-invasive imaging technology that has proved itself extremely useful in the diagnosis and monitoring of several skin diseases, including AC and SCC. The present study aimed to re-emphasize the usefulness of RCM in the early detection of malignant transformation, using AC and SCC of the lips as working examples. Due to the apparent innocuousness of AC for numerous patients, it is not possible to overstress the importance of a correct and early diagnosis, proper treatment and long-term patient follow-up as being essential for preventing the progression to lip SCC, or for its timely diagnosis. PMID:29725529

The ultrastructural features of the premalignant oral lesions.

PubMed

Olinici, Doiniţa; Cotrutz, Carmen Elena; Mihali, Ciprian Valentin; Grecu, Vasile Bogdan; Botez, Emanuela Ana; Stoica, Laura; Onofrei, Pavel; Condurache, Oana; Dimitriu, Daniela Cristina

2018-01-01

Premalignant oral lesions are among the most important risk factors for the development of oral squamocellular carcinoma. Recent population studies indicate a significant rise in the prevalence of leukoplakia, erythroplakia/erythroleukoplakia, actinic cheilitis, submucous fibrosis and erosive lichen planus. Since standard histopathological examination has numerous limitations regarding the accurate appreciation of potential malignant transformation, the present study aims to aid these evaluations using the transmission electron microscopy (TEM) technique, which emphasizes ultrastructural changes pertaining to this pathology. Oral mucosa fragments collected from 43 patients that were clinically and histopathologically diagnosed with leukoplakia, erosive actinic cheilitis and erosive lichen planus have been processed through the classic technique for the examination using TEM and were examined using a Philips CM100 transmission electron microscope. The electron microscopy study has confirmed the histopathological diagnosis of the tissue samples examined using photonic microscopy and has furthermore revealed a series of ultrastructural details that on the one hand indicate the tendency for malignant transformation, and on the other reveal characteristic features of tumor development. All the details furnished by TEM complete the overall picture of morphological changes, specific to these lesions, indicating the importance of using these techniques in establishing both a correct diagnosis and prognosis.

Widefield fluorescence imaging as an auxiliary tool to select the biopsy site for actinic cheilitis diagnosis

NASA Astrophysics Data System (ADS)

Kurachi, C.; Cosci, A.; Takahama, A.; Fontes, K. B. F. C.; Azevedo, R. S.

2014-03-01

Actinic cheilitis (AC) is considered a potentially malignant disorder that mainly affects the lower lip, and it is caused by prolonged sun exposure. Clinical diagnosis relies on visual inspection by a trained clinician, when suspected of dysplasia changes, a biopsy is required. The heteregenous characteristics of the AC, makes the choice of the biopsy site a difficult task. Fluorescence detection has been presented as a useful tool to to detect biochemical and morphological tissue features related to cancer diagnosis, but still its effectiveness to discriminate premalignant lesion is not completely defined. In this clinical study, 57 AC patients were investigated using widefield fluorescence imaging (WFI) to evaluate the efficacy of this technique as an auxiliary tool to biopsy site location. A handheld fluorescence system based on 400-450 nm LED illumination Distinct trained clinicians evaluate the patient either with the conventional examination or the WFI, and were blinded to the other evaluation. A biopsy site was chosen based on the clinical examination, and another site was chosen using the fluorescence visualization. A total of 114 punch biopsies were performed, and 93% of the tissue samples presented epithelial dysplasia. The majority of the sites that presented moderate or severe dysplasia were sites chosen by WFI, showing its efficiency to improve the diagnosis of AC.

Loss-of-Function Mutations in CAST Cause Peeling Skin, Leukonychia, Acral Punctate Keratoses, Cheilitis, and Knuckle Pads

PubMed Central

Lin, Zhimiao; Zhao, Jiahui; Nitoiu, Daniela; Scott, Claire A.; Plagnol, Vincent; Smith, Frances J.D.; Wilson, Neil J.; Cole, Christian; Schwartz, Mary E.; McLean, W.H. Irwin; Wang, Huijun; Feng, Cheng; Duo, Lina; Zhou, Eray Yihui; Ren, Yali; Dai, Lanlan; Chen, Yulan; Zhang, Jianguo; Xu, Xun; O’Toole, Edel A.; Kelsell, David P.; Yang, Yong

2015-01-01

Calpastatin is an endogenous specific inhibitor of calpain, a calcium-dependent cysteine protease. Here we show that loss-of-function mutations in calpastatin (CAST) are the genetic causes of an autosomal-recessive condition characterized by generalized peeling skin, leukonychia, acral punctate keratoses, cheilitis, and knuckle pads, which we propose to be given the acronym PLACK syndrome. In affected individuals with PLACK syndrome from three families of different ethnicities, we identified homozygous mutations (c.607dup, c.424A>T, and c.1750delG) in CAST, all of which were predicted to encode truncated proteins (p.Ile203Asnfs∗8, p.Lys142∗, and p.Val584Trpfs∗37). Immunohistochemistry shows that staining of calpastatin is reduced in skin from affected individuals. Transmission electron microscopy revealed widening of intercellular spaces with chromatin condensation and margination in the upper stratum spinosum in lesional skin, suggesting impaired intercellular adhesion as well as keratinocyte apoptosis. A significant increase of apoptotic keratinocytes was also observed in TUNEL assays. In vitro studies utilizing siRNA-mediated CAST knockdown revealed a role for calpastatin in keratinocyte adhesion. In summary, we describe PLACK syndrome, as a clinical entity of defective epidermal adhesion, caused by loss-of-function mutations in CAST. PMID:25683118

IDENTIFICATION OF NOVEL FIBROBLAST GROWTH FACTOR RECEPTOR 3 GENE MUTATIONS IN ACTINIC CHEILITIS

PubMed Central

Chou, Annie; Dekker, Nusi; Jordan, Richard C.K.

2009-01-01

Objective Activating mutations in the fibroblast growth factor receptor 3 (FGFR3) gene are responsible for several craniosynostosis and chondrodysplasia syndromes as well as some human cancers including bladder and cervical carcinoma. Despite a high frequency in some benign skin disorders, FGFR3 mutations have not been reported in cutaneous malignancies. Actinic cheilitis (AC) is a sun-induced premalignancy affecting the lower lip that frequently progresses to squamous cell carcinoma (SCC). The objective of this study was to determine if FGFR3 gene mutations are present in AC and SCC of the lip. Study Design DNA was extracted and purified from micro-dissected, formalin-fixed, paraffin-embedded tissue sections of 20 cases of AC and SCC arising in AC. Exons 7, 15, and 17 were PCR amplified and direct sequenced. Results Four novel somatic mutations in the FGFR3 gene were identified: exon 7 mutation 742C→T (amino acid change R248C), exon 15 mutations 1850A→G (D617G) and 1888G→A (V630M), and exon 17 mutation 2056G→A (E686K). Grade of dysplasia did not correlate with presence of mutations. Conclusion The frequency of FGFR3 receptor mutations suggests a functional role for the FGFR3 receptor in the development of epithelial disorders and perhaps a change may contribute to the pathogenesis of some AC and SCC. PMID:19327639

Prevalence and factors associated to actinic cheilitis in beach workers.

PubMed

de Souza Lucena, E E; Costa, D C B; da Silveira, E J D; Lima, K C

2012-09-01

Assess the prevalence and potential factors associated to actinic cheilitis (AC) in workers exposed to the sun. Workers assigned to urban beaches in a city in Northeastern Brazil completed a questionnaire containing personal and health data. Lips were examined to identify AC. A total of 362 workers, of which 15.5% exhibited AC, were examined. Among those with AC, there was a prevalence of males (86%), aged 37years or older (61.4%) and light-skinned (52.6%). They were undocumented (96.5%), exposed to the sun (84.2%), worked up to 6h daily (57.9%), five or more times per week (52.6%), and for more than 8years (54.4%). Photoprotection was used by 89.5%, including sunscreen (42.0%), lip protector (17.5%), and cap/hat (87.7%). Approximately 30% smoked and 29.8% consumed alcohol, 56.2% over two standard shots per day. Most (91.2%) ate healthy food five or more times per week. Being male, aged 37years or older, having up to 6years of schooling, being light-skinned, wearing a cap/hat, and using sunscreen were factors associated to AC. A high prevalence of actinic AC was observed. Special attention should be given to individuals chronically exposed to UV radiation, with the institution of educational, preventive, and curative measures. © 2012 John Wiley & Sons A/S.

Loss-of-function mutations in CAST cause peeling skin, leukonychia, acral punctate keratoses, cheilitis, and knuckle pads.

PubMed

Lin, Zhimiao; Zhao, Jiahui; Nitoiu, Daniela; Scott, Claire A; Plagnol, Vincent; Smith, Frances J D; Wilson, Neil J; Cole, Christian; Schwartz, Mary E; McLean, W H Irwin; Wang, Huijun; Feng, Cheng; Duo, Lina; Zhou, Eray Yihui; Ren, Yali; Dai, Lanlan; Chen, Yulan; Zhang, Jianguo; Xu, Xun; O'Toole, Edel A; Kelsell, David P; Yang, Yong

2015-03-05

Calpastatin is an endogenous specific inhibitor of calpain, a calcium-dependent cysteine protease. Here we show that loss-of-function mutations in calpastatin (CAST) are the genetic causes of an autosomal-recessive condition characterized by generalized peeling skin, leukonychia, acral punctate keratoses, cheilitis, and knuckle pads, which we propose to be given the acronym PLACK syndrome. In affected individuals with PLACK syndrome from three families of different ethnicities, we identified homozygous mutations (c.607dup, c.424A>T, and c.1750delG) in CAST, all of which were predicted to encode truncated proteins (p.Ile203Asnfs∗8, p.Lys142∗, and p.Val584Trpfs∗37). Immunohistochemistry shows that staining of calpastatin is reduced in skin from affected individuals. Transmission electron microscopy revealed widening of intercellular spaces with chromatin condensation and margination in the upper stratum spinosum in lesional skin, suggesting impaired intercellular adhesion as well as keratinocyte apoptosis. A significant increase of apoptotic keratinocytes was also observed in TUNEL assays. In vitro studies utilizing siRNA-mediated CAST knockdown revealed a role for calpastatin in keratinocyte adhesion. In summary, we describe PLACK syndrome, as a clinical entity of defective epidermal adhesion, caused by loss-of-function mutations in CAST. Copyright © 2015 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Malignant transformation of actinic cheilitis: A systematic review of observational studies.

PubMed

Dancyger, Alex; Heard, Victoria; Huang, Baikai; Suley, Cameron; Tang, Dorothy; Ariyawardana, Anura

2018-06-04

The aim of the present systematic review was to determine the malignant transformation rate of actinic cheilitis (AC). A comprehensive literature search was conducted using Medline/PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, OvidSP, and Google Scholar. The inclusion criteria comprised of observational human studies involving the malignant transformation of AC and publications in English. Studies included in this review were clinical follow-up, cohort, retrospective, or prospective investigations. The search yielded 1126 articles, and after exclusion, 34 full-text articles were eligible for full-text analysis. Only one article met the inclusion criteria. Based on the included article, it was determined that the malignant transformation rate of AC to squamous cell carcinoma (SCC) was 3.07%. Excluded articles focused on the clinicopathological characteristics and treatment efficacies of AC, and no malignant transformation rate was assessed. There is a need for more clinical studies on the malignant transformation of AC, as lip cancer is a public health concern. High-risk populations, including those living in tropical regions, have excessive exposure to UV radiation, and have older aged males, fair-skinned people, and smokers should be identified to prevent AC and its malignant change. Health practitioners should facilitate early intervention to prevent the progression of AC to SCC of the lip. © 2018 John Wiley & Sons Australia, Ltd.

Severe Skin Toxicity in Pediatric Oncology Patients Treated with Voriconazole and Concomitant Methotrexate

PubMed Central

van Eijkelenburg, Natasha K. A.; Huitema, Alwin D. R.; Schellens, Jan H. M.; Schouten-van Meeteren, Antoinette Y. N.

2013-01-01

We report the occurrence of skin toxicities in pediatric oncology patients on concomitant treatment with voriconazole and methotrexate (MTX). Of 23 patients who received this combination, 11 patients suffered from cheilitis and/or photosensitivity. In contrast, only in 1 of 9 patients who received voriconazole without MTX was photosensitivity observed. A mechanism of action was not able to be identified. We describe two cases with severe skin toxicities. Caution is warranted when using voriconazole and concomitant MTX. PMID:23571545

Sports-related dermatoses among road runners in Southern Brazil*

PubMed Central

Purim, Kátia Sheylla Malta; Leite, Neiva

2014-01-01

BACKGROUND Road running is a growing sport. OBJECTIVES: To determine the prevalence of sports-related dermatoses among road runners. METHODS Cross-sectional study of 76 road runners. Assessment was performed by means of a questionnaire, interview, and clinical examination. The chi-square and linear trend tests were used for analysis. RESULTS Most athletes were men (61%), aged 38±11 years, who ran mid- or long-distance courses (60.5%) for 45 to 60 minutes (79%), for a total of 25-64 km (42.1% ) or more than 65 km (18.4%) per week. The most prevalent injuries were blisters (50%), chafing (42.1%), calluses (34.2%), onychomadesis (31.5%), tinea pedis (18.4%), onychocryptosis (14.5%), and cheilitis simplex (14.5%). Among athletes running >64 km weekly, several conditions were significantly more frequent: calluses (p<0.04), jogger's nipple (p<0.004), cheilitis simplex (p<0.05), and tinea pedis (p<0.004). There was a significant association between the weekly running distance and the probability of skin lesions. Of the athletes in our sample, 57% trained before 10 a.m., 86% wore clothing and accessories for sun protection, 62% wore sunscreen, and 19.7% experienced sunburn. Traumatic and environmental dermatoses are common in practitioners of this outdoor sport, and are influenced by the weekly running distance. CONCLUSION In this group of athletes, rashes, blisters, sunburn, and nail disorders were recurrent complaints regardless of running distance. Calluses, athlete's foot, chapped lips, and jogger's nipple predominated in individuals who ran longer routes. PMID:25054745

Actinic cheilitis: epithelial expression of COX-2 and its association with mast cell tryptase and PAR-2.

PubMed

Rojas, I Gina; Martínez, Alejandra; Brethauer, Ursula; Grez, Patricia; Yefi, Roger; Luza, Sandra; Marchesani, Francisco J

2009-03-01

Cyclooxygenase-2 (COX-2) is overexpressed in various types of human malignancies, including oral cancers. Recent studies have shown that mast cell-derived protease tryptase can induce COX-2 expression by the cleavage of proteinase-activated receptor-2 (PAR-2). Actinic cheilitis (AC) is a premalignant form of lip cancer characterized by an increased density of tryptase-positive mast cells. To investigate the possible contribution of tryptase to COX-2 overexpression during early lip carcinogenesis, normal lip (n=24) and AC (n=45) biopsies were processed for COX-2, PAR-2 and tryptase detection, using RT-PCR and immunohistochemistry. Expression scores were obtained for each marker and tested for statistical significance using Mann-Whitney and Spearmann's correlation tests as well as multivariate logistic regression analysis. Increased epithelial co-expression of COX-2 and PAR-2, as well as, elevated subepithelial density of tryptase-positive mast cells were found in AC as compared to normal lip (P<0.001). COX-2 overexpression was found to be a significant predictor of AC (P<0.034, forward stepwise, Wald), and to be correlated with both tryptase-positive mast cells and PAR-2 expression (P<0.01). The results suggest that epithelial COX-2 overexpression is a key event in AC, which is associated with increased tryptase-positive mast cells and PAR-2. Therefore, tryptase may contribute to COX-2 up-regulation by epithelial PAR-2 activation during early lip carcinogenesis.

A comparative study using WHO and binary oral epithelial dysplasia grading systems in actinic cheilitis.

PubMed

Câmara, P R; Dutra, S N; Takahama Júnior, A; Fontes, Kbfc; Azevedo, R S

2016-09-01

To evaluate comparatively the influence of histopathological features on epithelial dysplasia (ED) and the effectiveness in usage of WHO and binary grading systems in actinic cheilitis (AC). Cytological and architectural alterations established by WHO for ED were evaluated in 107 cases of AC. Epithelial dysplasia was graded using WHO and binary systems. The comparisons were performed using kappa, chi-square, and phi coefficient tests (P < 0.05). Most cases were classified as mild ED (44.5%) in the WHO system and as low risk for malignant transformation (64.5%) in the binary system. There was a positive correlation between WHO and binary systems (k = 0.33; P < 0.0002). Loss of basal cell polarity (P < 0.001) was associated with severity of ED grade in the WHO system. Anisonucleosis (P < 0.0001), nuclear pleomorphism (P < 0.0001), anisocytosis (P = 0.03), cell pleomorphism (P = 0.002) increased nuclear/cytoplasm ratio (P < 0.0001), increased nuclear size (P < 0.0001), increased number of mitotic figures (P = 0.0006), and dyskeratosis (P = 0.008) were associated with severity of ED grade in the binary system. It seems that usage of binary ED grading system in AC may be more precise because there is correlation between many of cytological and some of architectural microscopic alterations with increased grade of ED. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Oral mucosal lesions and risk habits among men in an Italian study population.

PubMed

Campisi, G; Margiotta, V

2001-01-01

A randomly selected study population of 118 male subjects (> or = 40 years) living on the Mediterranean island of Pantelleria (southwest of Sicily, Italy) was examined for the presence of oral mucosal lesions, with particular emphasis on the early diagnosis of oral precancerous and cancerous lesions. The study population was interviewed for socioeconomic and behavioural information, and clinically examined using WHO criteria. The prevalence of oral mucosal lesions observed, and data obtained about oral hygiene, tobacco smoking, alcohol drinking and exposure to actinic radiation, were analysed. Alcohol drinking was the most common habit in the study population (73%), followed by tobacco smoking (58.5%, of whom 96% were cigarette smokers). Only 3% showed good oral hygiene and 25% were edentate. Oral lesions were observed in 81.3% of the study group, mainly coated tongue (51.4%), leukoplakia (13.8%), traumatic oral lesions (traumatic ulcers and frictional white lesions) in 9.2%, actinic cheilitis (4.6%), and squamous cell carcinoma in one case (0.9%). Statistically significant associations were found between the prevalence of coated tongue and tobacco smoking (P<0.0001), and between the prevalence of actinic cheilitis and tobacco smoking/alcohol drinking (P<0.05). Analysis of clinical and anamnestic data underlined the effective presence, in the population examined, of the behavioural risk factors for oral precancerous and cancerous lesions, and the lack of cultural motivation towards primary prevention activities, such as the elimination of risk habits.

Cheilitis glandularis: immunohistochemical expression of protein water channels (aquaporins) in minor labial salivary glands.

PubMed

Nico, M M S; Melo, J N; Lourenço, S V

2014-03-01

Cheilitis glandularis (CG) is a rare condition in which thick saliva is secreted from dilated ostia of swollen minor salivary glands from the lips. Aquaporins (AQPs) are membrane proteins that exhibit channel activity specific for water and small solutes. AQPs are essential for corporal homeostasis, and are widely expressed through human tissues. Most AQPs studies are based on renal and nervous pathophysiology; few involve salivary glands. Some previous investigators hypothesized that minor salivary gland structure and function is normal on CG. To study possible salivary synthesis alterations in CG, we compared the expression of AQPs present in minor salivary glands in specimens with CG and controls by using immunohistochemistry.   Seven cases of CG and three normal controls were studied. Intensity and patterns of expression of AQP 1, 2 and 8 differed in CG compared with controls. AQP 4 and 5 (the most important AQP in salivary function) showed identical patterns in CG and controls. Our findings suggest that the expression and arguably, function of some of the AQPs may be altered in CG; consequently, water flow mechanism abnormalities with possible alteration in salivary composition seem to occur. External factors (mainly UV rays) seem to play an important role in CG; nonetheless, our findings suggest that there might be some degree of alteration on water transportation. © 2013 The Authors. Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

The prevalence of actinic cheilitis in farmers in a semi-arid northeastern region of Brazil.

PubMed

Martins-Filho, Paulo Ricardo Saquete; Da Silva, Luiz Carlos Ferreira; Piva, Marta Rabello

2011-09-01

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to solar radiation. Despite being a relatively common lesion in tropical countries, the data related to AC prevalence in Brazil are sparse, particularly in regions with high levels of ultraviolet radiation. To estimate AC prevalence among farmers in a semiarid northeastern Brazil. Cross-sectional study was carried out involving a representative sample (n = 240) of the farm workers. Sociodemographic, clinical, and histopathological variables were analyzed. AC prevalence was 16.7% [95% confidence interval (CI): 12.0% to 21.4%]. The disease was more prevalent in males [prevalence ratio (PR) = 2.72; 95% CI: 1.52-4.90], fair-skinned farmers (PR = 2.07; 95% CI: 1.00-4.30), age over 50 years (PR = 2.91; 95% CI: 1.40-6.04), daily exposure time more than eight hours (PR = 1.84; 95% CI: 1.03-3.27), and among smokers/ex-smokers (PR = 2.17; 95% CI: 1.22-3.87). Mantel-Haenszel test showed a positive relationship between cumulative exposure time and development of AC (P < 0.001). Two cases were diagnosed as microinvasive squamous cell carcinoma. Our results suggest that farmers in this semiarid area have a high risk of lip cancer and indicate the need for health public programs in the early detection of AC and education to teach the population about precautions to be taken during sun exposure. © 2011 The International Society of Dermatology.

Optical diagnosis of actinic cheilitis by infrared spectroscopy.

PubMed

das Chagas E Silva de Carvalho, Luis Felipe; Pereira, Thiago Martini; Magrini, Taciana Depra; Cavalcante, Ana Sueli Rodrigues; da Silva Martinho, Herculano; Almeida, Janete Dias

2016-12-01

Actinic cheilitis (AC) is considered a potentially malignant disorder of the lip. Biomolecular markers study is important to understand malignant transformation into squamous cell carcinoma. Fourier transform infra red (FT-IR) spectroscopy was used to analyze AC in this study. The aim of the study was to evaluate if FT-IR spectral regions of nucleic acids and collagen can help in early diagnosis of malignant transformation. Tissues biopsies of 14 patients diagnosed with AC and 14 normal tissues were obtained. FT-IR spectra were measured at five different points resulting in 70 spectra of each. Analysis of Principal components analysis (PCA) and linear discrimination analysis (LDA) model were also used. In order to verify the statistical difference in the spectra, Mann-Whitney U test was performed in each variable (wavenumber) with p-value <0.05. After the Mann-Whitney U test the vibrational modes of CO (Collagen 1), PO2 (Nucleic Acids) and CO asymmetric (Triglycerides/Lipids) were observed as a possible spectral biomarker. These bands were chosen because they represent the vibrational modes related to collagen and DNA, which are supposed to be changed in AC samples. Based on the PCA-LDA results, the predictive model corresponding to the area under the curve was 0.91 for the fingerprint region and 0.83 for the high wavenumber region, showing the greater accuracy of the test. FT-IR changes in collagen and nucleic acids could be used as molecular biomarkers for malignant transformation. Copyright © 2016 Elsevier B.V. All rights reserved.

Actinic cheilitis: clinicopathologic profile and association with degree of dysplasia.

PubMed

de Santana Sarmento, Dmitry José; da Costa Miguel, Márcia Cristina; Queiroz, Lélia Maria Guedes; Godoy, Gustavo Pina; da Silveira, Ericka Janine Dantas

2014-04-01

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by exposure to solar radiation. This study was conducted to evaluate the clinicopathologic profile of cases of AC and to verify associations with the degree of dysplasia. This retrospective study analyzed data for 40 patients with AC. Demographic, clinical, and histopathologic data were evaluated. Sections measuring 5 μm in thickness were cut, deparaffinized, and stained with hematoxylin and eosin for histologic examination. The degree of epithelial dysplasia was graded using the criteria defined by the World Health Organization. Two calibrated oral pathologists analyzed the slides. Analysis of the AC patients sampled showed that 75.0% were male (P=0.002), 80.0% were aged≥40 years (P<0.001), 74.3% were Caucasian (P=0.004), and 68.6% had occupational exposure to sunlight (P=0.028). The most common clinical manifestation was white lesions (55.0%), and 40.0% of patients had no dysplasia. No significant associations emerged between the histologic grading of AC and gender (P=1.000), age (P=1.000), ethnicity (P=0.416), occupational exposure to sunlight (P=1.000), and clinical presentation (P=0.467). The degree of dysplasia in AC was not statistically associated with gender, age, ethnicity, occupational exposure to sunlight, or clinical appearance. This study provides some support for the hypothesis that clinicopathologic features are not related to the degree of dysplasia in AC. © 2013 The International Society of Dermatology.

Regulatory T cells in the actinic cheilitis.

PubMed

Gasparoto, Thaís Helena; de Souza Malaspina, Tatiana Salles; Damante, José Humberto; de Mello, Edgard Franco; Ikoma, Maura Rosane Valério; Garlet, Gustavo Pompermaier; Costa, Maria Renata Sales Nogueira; Cavassani, Karen Angélica; da Silva, João Santana; Campanelli, Ana Paula

2014-11-01

Actinic cheilitis (AC) is an oral potentially malignant lesion which is the counterpart of actinic keratosis of the skin and has potential to develop into squamous cell carcinoma. Regulatory T cells (Tregs) have a critical role in modulating the antitumor immune responses. The presence of regulatory T cells in potentially malignant lesions has not been described. We chose investigate the involvement of regulatory T cells in potentially malignant lesions. The frequency, phenotype, and activity of CD4+CD25+ T cells isolated from blood and lesion of AC patients were analyzed by flow cytometry. Cytokines were quantified by ELISA. Data were compared with samples from healthy subjects. The frequency and suppressor activity of circulating CD4+CD25+ T cells was similar in AC patients and control subjects. However, the frequencies of IL-10-positive Tregs were higher in AC patients, and these cells inhibited interferon-gamma (IFN-γ) and increased interleukin (IL)-10 productions in co-cultures. Furthermore, CD4+CD25+ T cells accumulate in AC lesions. Lesions-derived regulatory T cells suppressed lymphocyte proliferation and pro-inflammatory cytokine production. Moreover, high levels of IL-10 and transforming growth factor-β (TGF-β), and low IFN-γ were detected in the potentially malignant lesions. Therefore, our data show that Tregs accumulate in AC lesions, and these cells could be suppressing immune responses in a potentially malignant microenvironment. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Expression of laminin-5 and integrins in actinic cheilitis and superficially invasive squamous cell carcinomas of the lip.

PubMed

Peixoto da-Silva, Janaína; Lourenço, Silvia; Nico, Marcello; Silva, Filomena H; Martins, Marília Trierveiler; Costa-Neves, Adriana

2012-10-15

The progression of carcinogenesis entails the detachment of cells, invasion and migration of neoplastic cells. Alterations in epithelial adhesion and basement membrane proteins might mediate the early stages of carcinogenesis. This study investigated the expression of adhesion molecules and the basement membrane protein laminin-5 in actinic cheilitis (AC) and incipient squamous cell carcinoma of the lower lip to understand early photocarcinogenesis. Ln-5γ2 chain as well as α3, β1 subunits of α3β1 heterodimer and β4 subunit of integrin α6β4 were evaluated by immunohistochemistry in 16 cases of AC and 16 cases of superficially invasive squamous cell carcinoma (SISCC). Most AC cases showed reduced expression of β1, β4 and α3 integrins, and SISCCs lacked β1, β4 and α3 integrins in the invasive front. AC cases were negative for the Ln-5γ2 chain. Five cases of SISCC (31%) showed heterogeneous Ln-5γ2 chain expression in the invasive front of the tumor. Integrin β1, β4 and α3 expression is lost during the early stages of lip carcinogenesis. Expression of Ln-5γ2 in the invasive front in cases and its correlation with tumor progression suggest that it mediates the acquisition of the migrating and invading epithelial cell phenotype. Copyright © 2012 Elsevier GmbH. All rights reserved.

Cheilitis as a variation of Candida-associated lesions.

PubMed

Terai, H; Shimahara, M

2006-05-01

Occasionally, the clinical diagnosis of Candida-associated lesion is difficult because of a variety of its clinical manifestations. There have been a few reports on Candida-associated lip lesion except angular cheilitis. In this paper, we investigate the relation of Candida in persistent lesions of the lip. The present study includes consecutive nine patients with persistent erosive lip lesion. For each patient the age at presentation, gender, duration of the disease, other symptoms or signs, complete medical history and prior treatment or medications for the symptom were obtained. Then, mycological examination and the direct cytologic examination were performed. The reported average duration of the disease was 7 months. Six of nine patients had received prior treatments with topical steroids at the other clinic, which failed to resolve their symptoms. Six of nine patients had a predisposing factor for candidiasis. In the culture examination, Candida albicans were isolated in seven patients (77.8%). Five of nine patients received the direct cytologic examination, and four of them revealed pseudohyphae of fungi. The anti-fungal treatment was miconazol gel 25 mg four times per day, and average duration of the treatment was 2 weeks. The outcome was as follows: complete remission in five, remarkable response in two and no response in two. Our results suggested that one form of the varieties of Candida-associated lesions might be considered in the case of lip lesion with unknown origin that was persistent and ineffective to the topical steroids treatment.

Ulcerative cheilitis in a rhesus macaque.

PubMed

Bailey, C C; Miller, A D

2012-03-01

A 2-year-old, female, simian immunodeficiency virus E543-infected rhesus macaque (Macaca mulatta) was presented for necropsy following euthanasia due to a history of diarrhea, weight loss, and a small, round ulcer along the left labial commissure. Histopathologic examination of the ulcer revealed infiltration by large numbers of degenerate and nondegenerate neutrophils and macrophages admixed with syncytial epithelial cells. Rare epithelial cells contained herpetic inclusion bodies. These cells stained positive for Human herpesvirus 1 via immunohistochemistry, and DNA sequencing confirmed the presence of closely related Macacine herpesvirus 1 (B virus).

Ulcerative Cheilitis in a Rhesus Macaque

PubMed Central

Bailey, C. C.; Miller, A. D.

2011-01-01

A two-year-old, female, simian immunodeficiency virus E543-infected rhesus macaque (Macaca mulatta) was presented for necropsy following euthanasia due to a history of diarrhea, weight loss, and a small, round ulcer along the left labial commisure. Histopathologic examination of the ulcer revealed infiltration by large numbers of degenerate and non-degenerate neutrophils and macrophages admixed with syncytial epithelial cells. Rare epithelial cells contained herpetic inclusion bodies. These cells stained positive for Human herpesvirus 1 via immunohistochemistry and DNA sequencing confirmed the presence of closely related Macacine herpesvirus 1 (B virus). PMID:21383117

In vivo confocal microscopy for the oral cavity: Current state of the field and future potential.

PubMed

Maher, N G; Collgros, H; Uribe, P; Ch'ng, S; Rajadhyaksha, M; Guitera, P

2016-03-01

Confocal microscopy (CM) has been shown to correlate with oral mucosal histopathology in vivo. The purposes of this review are to summarize what we know so far about in vivo CM applications for oral mucosal pathologies, to highlight some current developments with CM devices relevant for oral applications, and to formulate where in vivo CM could hold further application for oral mucosal diagnosis and management. Ovid Medline® and/or Google® searches were performed using the terms 'microscopy, confocal', 'mouth neoplasms', 'mouth mucosa', 'leukoplakia, oral', 'oral lichen planus', 'gingiva', 'cheilitis', 'taste', 'inflammatory oral confocal', 'mucosal confocal' and 'confocal squamous cell oral'. In summary, inclusion criteria were in vivo use of any type of CM for the human oral mucosa and studies on normal or pathological oral mucosa. Experimental studies attempting to identify proteins of interest and microorganisms were excluded. In total 25 relevant articles were found, covering 8 main topics, including normal oral mucosal features (n=15), oral dysplasia or neoplasia (n=7), inflamed oral mucosa (n=3), taste impairment (n=3), oral autoimmune conditions (n=2), pigmented oral pathology/melanoma (n=1), delayed type hypersensitivity (n=1), and cheilitis glandularis (n=1). The evidence for using in vivo CM in these conditions is poor, as it is limited to mainly small descriptive studies. Current device developments for oral CM include improved probe design. The authors propose that future applications for in vivo oral CM may include burning mouth syndrome, intra-operative mapping for cancer surgery, and monitoring and targeted biopsies within field cancerization. Copyright © 2016 Elsevier Ltd. All rights reserved.

Actinic cheilitis among agricultural workers in Campinas, Brazil.

PubMed

Junqueira, J L R; Bönecker, M; Furuse, C; Morais, P de Camargo; Flório, F M; Cury, P R; Araújo, V C

2011-03-01

To assess the prevalence of Actinic Cheilitis (AC) among agricultural workers and analyze its risk factors. A cross sectional epidemiological study. A lip lesion was defined as an abnormal change on the lip mucosa surface, such as erythematous pigmented, ulcerative or swelling (Cataldo and Doku, 1981). Data were gathered according to age group, gender, ethnicity-time and frequency of occupational sunlight exposure, smoking habits, drinking habits and socio-economic status. Sugar-cane plantation farms in Brazil. Full-time workers of both genders employed at sugar-cane plantation farms for at least six months. Correlations between AC prevalence, demographic and socioeconomic risk factors. 202 people were examined and the prevalence of AC was 39.6%. Results revealed that being black (0.15-0.88- 95% CI; OR = 0.36; p = 0.025) or mulatto (0.21-0.82- 95% CI; OR = 0.42; p =0.011) decreased the risk for AC, while age and gender sex had no effect. In relation to socioeconomic variables, formal education and more than four years of education (0.07-0.68- 95% CI; OR = 0.22; p = 0.009) decreased the risk for AC. Moreover, drinking alcohol was a risk for AC (1.05-3.37- 95% CI; OR = 1.88; p = 0.034), while tobacco smoking was not (0.60-2.02- 95% CI; OR = 1.10; p = 0.763). The prevalence of AC is high in agricultural workers who were fairskinned, had low education and high alcohol intake. Prevention and early diagnosis are required for workers exposed to sunlight.

CD8+ and FoxP3+ T-cell infiltration in actinic cheilitis.

PubMed

Rojas, Isolde G; Spencer, Maria L; Zapata, Paulina A; Martínez, Alejandra; Alarcón, Rosario; Marchesani, Francisco J; Tezal, Mine

2017-01-01

Differences in immune profile between actinic cheilitis (AC), a precursor of lip squamous cell carcinoma, and normal lip vermillion (NL) have not been elucidated. To compare density, distribution, and ratios of CD8+ and FoxP3+ cells between AC and NL and assess their associations with clinicopathologic variables. Samples of AC and NL obtained between 2001 and 2013 at the College of Dentistry of the University of Concepcion, Chile, were retrospectively analyzed for immunohistochemical detection of CD8+ and FoxP3+ cells. Differences between groups were tested by Mann-Whitney U and Fisher's exact tests. Independent effects of cell densities and CD8/FoxP3 ratio with AC were assessed by multiple logistic regression analysis after adjustment for potential confounding. A total of 62 AC and 24 NL biopsies were included. Densities of CD8+ and FoxP3+ cells in AC were significantly higher than in NL. Conversely, the CD8+/FoxP3+ ratio was significantly lower in AC as compared to NL. After adjustment for sun exposure, age, gender, and smoking status, a stromal FoxP3+ cell density higher than 0.35 cells/field was significantly associated with increased odds of AC (odds ratio [OR] = 5.01, 95% confidence interval [CI]: 1.18-21.31), while a stromal CD8+/FoxP3+ ratio higher than 5.91 was associated with decreased odds of AC (OR = 0.29, 95% CI: 0.08-1.08). AC is characterized by increased FoxP3+ cell infiltration and a reduced CD8/FoxP3 ratio as compared to NL. Therefore, increased infiltration of FoxP3+ cells relative to CD8+ cells may contribute to the transition from normal to preneoplastic stages in lip carcinogenesis. © 2016 The International Society of Dermatology.

Immunohistochemical expression of matrix metalloproteinase-1, matrix metalloproteinase-2 and matrix metalloproteinase-9, myofibroblasts and Ki-67 in actinic cheilitis and lip squamous cell carcinoma.

PubMed

Bianco, Bianca C; Scotti, Fernanda M; Vieira, Daniella S C; Biz, Michelle T; Castro, Renata G; Modolo, Filipe

2015-10-01

Matrix metalloproteinases (MMPs), myofibroblasts (MFs) and epithelial proliferation have key roles in neoplastic progression. In this study immunoexpression of MMP-1, MMP-2 and MMP-9, presence of MFs and the epithelial proliferation index were investigated in actinic cheilitis (AC), lip squamous cell carcinoma (LSCC) and mucocele (MUC). Thirty cases of AC, thirty cases of LSCC and twenty cases of MUC were selected for immunohistochemical investigation of the proteins MMP-1, MMP-2, MMP-9, α-smooth muscle actin (α-SMA) and Ki-67. The MMP-1 expression in the epithelial component was higher in the AC than the MUC and LSCC. In the connective tissue, the expression was higher in the LSCC. MMP-2 showed lower epithelial and stromal immunostaining in the LSCC when compared to the AC and MUC. The epithelial staining for MMP-9 was higher in the AC when compared to the LSCC. However, in the connective tissue, the expression was lower in the AC compared to other lesions. The cell proliferation rate was increased in proportion to the severity of dysplasia in the AC, while in the LSCC it was higher in well-differentiated lesions compared to moderately differentiated. There were no statistically significant differences in number of MFs present in the lesions studied. The results suggest that MMPs could affect the biological behaviour of ACs and LSCCs inasmuch as they could participate in the development and progression from premalignant lesions to malignant lesions. © 2015 The Authors. International Journal of Experimental Pathology © 2015 International Journal of Experimental Pathology.

Increased fibroblast density in actinic cheilitis: association with tryptase-positive mast cells, actinic elastosis and epithelial p53 and COX-2 expression.

PubMed

Rojas, Isolde G; Boza, Yadira V; Spencer, Maria Loreto; Flores, Maritza; Martínez, Alejandra

2012-01-01

Actinic cheilitis (AC) is characterized by epithelial and connective tissue alterations caused by ultraviolet sunlight overexposure known as photodamage. Fibroblasts have been linked to photodamage and tumor progression during skin carcinogenesis; however, their role in early lip carcinogenesis remains unknown. The aim of this study was to assess the density of fibroblasts in AC and normal lip (NL) samples and determine their association with markers of lip photodamage. Fibroblasts, mast cells, p53, COX-2, and elastin were detected in NL (n = 20) and AC (n = 28) biopsies using immunohistochemistry/histochemistry. Mast cell and fibroblast density and epithelial p53 and COX-2 expression scores were then obtained. Elastosis was scored 1-4 according to elastin fiber density and tortuosity. Fibroblasts, mast cells, p53, COX-2, and elastosis were increased in AC as compared to NL (P < 0.001). Multivariate analysis showed an association between fibroblast and mast cell density at the papillary and reticular areas of AC and NL (P < 0.05). Papillary fibroblast density was also associated with epithelial p53 and COX-2 expression (P < 0.05). Increased fibroblast density, both papillary and reticular, was found in the high elastosis group (scores 3-4) as compared to the low elastosis group (scores 1-2) (P < 0.01). Increased reticular mast cell density was detected only in the high elastosis group (P < 0.01). Fibroblasts are increased in AC, and they are associated with mast cell density, epithelial p53 and COX-2 expression, and actinic elastosis. Therefore, fibroblasts may contribute to lip photodamage and could be considered useful markers of early lip carcinogenesis. © 2011 John Wiley & Sons A/S.

Efficacy of ablative fractional laser-assisted photodynamic therapy for the treatment of actinic cheilitis: 12-month follow-up results of a prospective, randomized, comparative trial.

PubMed

Choi, S H; Kim, K H; Song, K-H

2015-07-01

Early identification and treatment of actinic cheilitis (AC) is recommended. Although photodynamic therapy (PDT) is an attractive therapeutic option for AC, PDT for AC does not result in the same satisfactory outcomes as in actinic keratosis (AK). The aim of our study was to compare efficacy, recurrence rate, cosmetic outcome and safety between erbium:yttrium-aluminium-garnet ablative fractional laser-assisted methyl aminolaevulinate-PDT (Er:YAG AFL MAL-PDT) and standard MAL-PDT. Thirty-three patients with histologically confirmed AC randomly received either one session of Er:YAG AFL MAL-PDT or two sessions of MAL-PDT. In the MAL-PDT group, the second session of MAL-PDT was administered 7 days later. Patients were followed up at 1 week and 3 and 12 months, and biopsies were taken from all patients at 3 and 12 months after the last treatment session. At the final 12-month follow-up, cosmetic outcomes were assessed. Adverse events were assessed at week 1 of the treatment phase and every subsequent follow-up visit. In the per-protocol (PP) population, Er:YAG AFL MAL-PDT was significantly more effective (92% complete response rate) than MAL-PDT (59%; P = 0.040) at the 3-month follow-up, and differences in efficacy remained significant at the 12-month follow-up (85% in Er:YAG AFL MAL-PDT and 29% in MAL-PDT). The recurrence rate was significantly lower for Er:YAG AFL MAL-PDT (8%) than for MAL-PDT (50%) group at 12 months (P = 0.029). No significant difference in cosmetic outcome or safety was observed between Er:YAG AFL MAL-PDT and MAL-PDT. Ablative fractional laser pretreatment has significant benefit for the treatment of AC with PDT. © 2014 British Association of Dermatologists.

Oral mucosal conditions in preschool children of low socioeconomic status: prevalence and determinant factors.

PubMed

Vieira-Andrade, Raquel Gonçalves; Martins-Júnior, Paulo Antônio; Corrêa-Faria, Patrícia; Stella, Paulo Eduardo Melo; Marinho, Sandra Aparecida; Marques, Leandro Silva; Ramos-Jorge, Maria Letícia

2013-05-01

The aim of the present study was to determine the prevalence of oral mucosal conditions and associated factors among 541 preschoolers of low socioeconomic status. A cross-sectional study was carried out. Sociodemographic data and information on harmful oral habits were gathered with the use of a questionnaire. A clinical exam was performed for the determination of oral mucosal conditions, dental caries and level of oral hygiene. Data analysis involved statistical analysis, the Kruskal-Wallis test, Mann-Whitney test, chi-square test, Fisher's exact test and multivariate regression (p < 0.05, 95 % CI). The prevalence of oral mucosal conditions was 40.7 %. The most prevalent oral mucosal conditions were coated tongue (23.4 %), melanotic macules (14.4 %), oral ulcers (11.8 %), Fordyce's spots (8.1 %), angular cheilitis (3.0 %), geographic tongue (2.8 %), linea alba (1.5 %) and fistula (1.3 %). Children between 3 and 5 years of age had a greater chance of exhibiting coated tongue (OR, 2.55; 95 % CI, 1.6-4.1), melanotic macules (OR, 4.07; 95 % CI, 2.3-7.2) and Fordyce's spots (OR, 12.70; 95 % CI, 7.2-28.6). The female gender had a greater chance of exhibiting melanotic macules (OR, 2.23; 95 % CI, 1.3-1.8). Coated tongue was more prevalent among children from low-income families (OR, 2.35; 95 % CI, 1.3-4.3) and those with inadequate oral hygiene (OR, 4.65; 95 % CI, 2.9-7.4). Caries constituted a predictive factor for oral ulcers (OR, 2.15; 95 % CI, 1.2-3.9) and fistula (OR, 12.00; 95 % CI, 1.4-11.3). Bruxism (teeth clenching/grinding) was a predictive factor for angular cheilitis (OR, 5.55; 95 % CI, 1.9-16.3). The determinant factors for oral mucosal conditions were the female gender, age between 3 and 5 years, inadequate oral hygiene, low household income, residence in rural areas and presence of dental caries and bruxism.

Xeroderma pigmentosum: a case report and review of the literature.

PubMed

Feller, L; Wood, N H; Motswaledi, M H; Khammissa, R A G; Meyer, M; Lemmer, J

2010-06-01

Inherited molecular defects in nucleotide excision repair genes cause the autosomal recessive condition xeroderma pigmentosum. Xeroderma pigmentosum is characterized by photo-hypersensitivity of sun-exposed tissues, and by a several thousand-fold increase in the risk of developing malignant neoplasms of the skin and of the eyes. Mutations in xeroderma pigmentosum genes that regulate nucleotide excision repair, not only predispose persons with xeroderma pigmentosum to multiple malignancies, but also promote premature cutaneous and ocular ageing, and in some cases promote progressive neurodegenerative changes. This paper describes a case of xeroderma pigmentosum with advanced cutaneous squamous cell carcinoma, actinic cheilitis and ocular lesions in a 19-year-old black woman. The extensive ultraviolet radiation-induced skin and eye damage are evidence of neglect of sun-protection and lack of appropriate medical care from childhood.

[Application of photodynamic therapy in dentistry – literature review].

PubMed

Oruba, Zuzanna; Chomyszyn-Gajewska, Maria

Photodynamic therapy (PDT) is based on the principle that the target cells are destroyed by means of toxic reactive oxygen species generated upon the interaction of a photosensitizer, light and oxygen. This method is nowadays widely applied in various branches of medicine, mainly in oncology and dermatology. It is also applied in dentistry in the treatment of oral potentially malignant disorders (like lichen planus or leukoplakia) and infectious conditions (periodontitis, herpetic cheilitis, root canal disinfection). The application of the photodynamic therapy in the abovementioned indications is worth attention, as the method is noninvasive, painless, and the results of the published studies seem promising. The present article aims at presenting the principle of the photodynamic therapy and, based on the literature, the possibilities and results of its application in dentistry.

Lipstick dermatitis due to C18 aliphatic compounds.

PubMed

Hayakawa, R; Matsunaga, K; Suzuki, M; Arima, Y; Ohkido, Y

1987-04-01

An 18-year-old girl developed cheilitis. She had a past history of lip cream dermatitis, but the cause was not found. Patch tests with 2 lipsticks were strongly positive. Tests with the ingredients were positive to 2 aliphatic compounds, glyceryl diisostearate and diisostearyl malate. Impurities in the materials were suspected as the cause. Analysis by gas chromatography detected 3 chemicals in glyceryl diisostearate and 1 in diisostearyl malate as impurities. Patch testing with the impurities and glyceryl monoisostearate 0.01% pet in glyceryl diisostearate and isostearyl alcohol 0.25% pet in diisostearyl malate were strongly positive. The characteristics common to the 2 chemicals were liquidity at room temperature, branched C18 aliphatic compound and primary alcohol. Chemicals lacking any of the above 3 features did not react.

[The incidence of oral candidiasis in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome from Yunnan, China].

PubMed

Wen, Yan; Li, Chengwen; Pei, Junhaoxiang; Bai, Jinsong; Yang, Xianghong; Duan, Kaiwen

2014-08-01

To assess the incidence of oral candidiasis and its influencing factors in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). An oral examination was conducted in the 1 566 HIV/AIDS patients in the Third Hospital of Kunming from March 2008 to September 2012 (M/F: 1 062/504, age range: 0.2 to 84.0 years old). The HIV viral load (HIV- RNA) and peripheral blood CD4 count were respectively analyzed by Bayer Q340 fluorescence signal surveying instrument (bDNA method) and flow cytometry analysis. The information on usage of highly active anti-retroviral (HAART) drugs and transmission of HIV were obtained through questionnaires. The incidence of oral candidiasis in patients with different HIV-RNA levels and CD4 count and the use of HAART was analyzed and compared. The total incidence of oral candidosis was 31.0% (486/1 566) and there was no difference in sex. The oral lesions were presented by three types, psudomembranous candidosis (PC), erythematous candidosis (EC) and angular cheilitis (AC), and the morbidity was 13.9% (217/1 566), 17.0% (267/1 566) and 4.9% (77/1 566), respectively. The average level of CD4 count in psudomembranous candidosis, erythematous candidosis and angular cheilitis [81.0 (146.0), 74.0 (152.0) and 69.0 (121.5) cell/µl] showed no significant difference (P > 0.05). The incidence of oral candidiasis in non-HAART and HAART subjects were 36.3% (402/1 107) and 18.3% (84/459), respectively (P = 0.000). The CD4 count and absolute counts of HIV viral load in oral candidiasis patients and non-oral candidiasis patients had significant difference (Z = -10.261, P = 0.000 and Z = -4.762, P = 0.000). The morbidity of oral candidiasis in HIV/AIDS patients in Yunnan Province was high, including PC, EC and AC and hyperplastic candidosis was not detected. The incidence was related to the degree of immune suppression and HIV viral load.

Validation of World Health Organisation HIV/AIDS clinical staging in predicting initiation of antiretroviral therapy and clinical predictors of low CD4 cell count in Uganda.

PubMed

Baveewo, Steven; Ssali, Francis; Karamagi, Charles; Kalyango, Joan N; Hahn, Judith A; Ekoru, Kenneth; Mugyenyi, Peter; Katabira, Elly

2011-05-12

The WHO clinical guidelines for HIV/AIDS are widely used in resource limited settings to represent the gold standard of CD4 counts for antiviral therapy initiation. The utility of the WHO-defined stage 1 and 2 clinical factors used in WHO HIV/AIDS clinical staging in predicting low CD4 cell count has not been established in Uganda. Although the WHO staging has shown low sensitivity for predicting CD4<200 cells/mm(3), it has not been evaluated at for CD4 cut-offs of <250 cells/mm(3) or <350 cells/mm(3). To validate the World Health Organisation HIV/AIDS clinical staging in predicting initiation of antiretroviral therapy in a low-resource setting and to determine the clinical predictors of low CD4 cell count in Uganda. Data was collected on 395 participants from the Joint Clinical Research Centre, of whom 242 (61.3%) were classified as in stages 1 and 2 and 262 (68%) were females. Participants had a mean age of 36.8 years (SD 8.5). We found a significant inverse correlation between the CD4 lymphocyte count and WHO clinical stages. The sensitivity the WHO clinical staging at CD4 cell count of 250 cells/mm(3) and 350 cells/mm(3) was 53.5% and 49.1% respectively. Angular cheilitis, papular pruritic eruptions and recurrent upper respiratory tract infections were found to be significant predictors of low CD4 cell count among participants in WHO stage 1 and 2. The WHO HIV/AIDS clinical staging guidelines have a low sensitivity and about half of the participants in stages 1 and 2 would be eligible for ART initiation if they had been tested for CD4 count. Angular cheilitis and papular pruritic eruptions and recurrent upper respiratory tract infections may be used, in addition to the WHO staging, to improve sensitivity in the interim, as access to CD4 machines increases in Uganda.

Contact Allergy to (Ingredients of) Toothpastes.

PubMed

de Groot, Anton

The literature on contact allergy to (ingredients of) toothpastes is critically reviewed. We have found 47 case reports, small case series (n = 2-5) and citations published between 1900 and 2016 describing more than 60 patients allergic to toothpastes, and in addition 3 larger case series and many descriptions of toothpaste allergy among selected groups of patients. Allergic reactions usually manifest as cheilitis with or without dermatitis around the mouth, less frequently by oral symptoms. Formerly, many reactions were caused by cinnamon derivatives; more recently, reported allergens are diverse. A semiopen test or closed patch test with the toothpaste "as is" may be performed as an initial test, but a positive reaction should always be followed by confirmatory tests. The role of contact allergy to toothpastes in patients with oral symptoms (stomatitis, glossitis, gingivitis, buccal mucositis, burning, soreness, and possibly burning mouth syndrome and recurrent aphthous ulcers) is unclear and should be further investigated.

Relationship between the use of full dentures and mucosal alterations among elderly Brazilians.

PubMed

Freitas, J B; Gomez, R S; De Abreu, M H N G; Ferreira E Ferreira, E

2008-05-01

The objective of the present study was to evaluate the prevalence of oral mucosal lesions associated with the use of full dentures (FD) among non-institutionalized individuals of 60 or more years of age in a rural Brazilian population. The sample consisted of 344 individuals aged 60 or more from two rural communities of Brazil. Of this total, 146 were FD users and 198 FD, non-users. Angular cheilitis, denture stomatitis and inflammatory fibrous hyperplasia were statistically associated with prosthesis use. Hygiene and integrity of the prosthesis were related to the presence of oral lesions. While inflammatory fibrous hyperplasia was positively related to FD integrity, denture stomatitis was associated with time of use, hygiene status and integrity of FD. The results indicate the need for oral health care programmes for the elderly and show a relationship between time of use, quality and hygiene of oral prostheses with the presence of mucosal lesions.

Eating disorders in adolescents and their repercussions in oral health.

PubMed

Ximenes, Rosana; Couto, Geraldo; Sougey, Everton

2010-01-01

To examine the prevalence of oral alterations related to eating disorders and associated factors. A cross-sectional study including 650 adolescents aged from 12 to 16 was carried out through self-report questionnaires (EAT-26; BITE and self-rating hamilton depression questionnaire, SRHDQ) and dental examination. Significant associations were observed in mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions. The prevalence of adolescents at risk for eating disorders was of 33.1%, according to EAT-26 and 1.7% (high scores) and 36.5% (medium scores), in BITE, higher among 13-year-old females, with brothers, parents or responsible person who are illiterate, being the youngest child, living in a residence of at most two rooms and who showed depressive symptoms. All these factors showed significant relation to eating disorders. Presence of oral alterations is associated to symptoms of eating disorders, helping precocious detection of sub clinical cases.

Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: is it all in your mind?

PubMed

Shenefelt, Philip D

2003-01-01

Biofeedback can improve cutaneous problems that have an autonomic nervous system component. Examples include biofeedback of galvanic skin resistance (GSR) for hyperhidrosis and biofeedback of skin temperature for Raynaud's disease. Hypnosis may enhance the effects obtained by biofeedback. Cognitive-behavioral methods may resolve dysfunctional thought patterns (cognitive) or actions (behavioral) that damage the skin or interfere with dermatologic therapy. Responsive diseases include acne excoriée, atopic dermatitis, factitious cheilitis, hyperhidrosis, lichen simplex chronicus, needle phobia, neurodermatitis, onychotillomania, prurigo nodularis, trichotillomania, and urticaria. Hypnosis can facilitate aversive therapy and enhance desensitization and other cognitive-behavioral methods. Hypnosis may improve or resolve numerous dermatoses. Examples include acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Hypnosis can also reduce the anxiety and pain associated with dermatologic procedures.

Oral Manifestations in Pediatric Patients with Coeliac Disease - A Review Article.

PubMed

Macho, Viviana Marisa Pereira; Coelho, Ana Sofia; Veloso E Silva, Diana Maria; de Andrade, David José Casimiro

2017-01-01

Coeliac disease is a chronic enteropathy that remains a challenge for the clinician, due to its atypical manifestations and etiopathogenic complexity. This article intends to describe the oral characteristics of Coeliac Disease in children in order to facilitate their management in the dental office. A review of the literature was performed electronically in PubMed (PubMed Central, and MEDLINE) for articles published in English from 2000 to April of 2017. The article is also based on the authors' clinical experience with children with coeliac disease. The searched keywords were "coeliac disease ","oral manifestations ", "dental enamel defects", "recurrent aphthous stomatitis" and "oral aphthous ulcers". There are some oral manifestations which are strictly related to coeliac disease: dental enamel defects, recurrent aphthous stomatitis, delayed tooth eruption, multiple caries, angular cheilitis, atrophic glossitis, dry mouth and burning tongue. The complete knowledge of the oral manifestations of coeliac disease can trigger an effective change in the quality of life of the patients with this disease.

Prosthetic Oral Rehabilitation of a Child With S-ECC: A Case Report with Histopathologic Analysis.

PubMed

Tannure, P N; Moraes, G G; Borba, McU; Abrahão, A; Andrade, Mtrc; Fidalgo, Tks

2015-01-01

The aim of this case report is to describe the treatment planning of a young child with severe early childhood caries (S-ECC) as well as the prosthetic rehabilitation technique. A 3-year-old female child was referred to the pediatric dentistry clinic with the chief complaint of tooth pain, difficulty in eating and recurrent hospitalizations caused by dental infections. The mother reported intermittent episodes of fever and recurrent swelling of child's face. The girl presented angular cheilitis and was referred to a dietitian. The treatment plain consisted on a behavior changes in oral hygiene habits, exodontias of all primary teeth and oral rehabilitation with a prosthesis. The extracted teeth with periapical lesions were submitted to histopathologic analysis (hematoxilin and eosin staining) and revealed an inflammatory infiltrate. The aesthetic requirement of children with S-ECC has been a challenge to pediatric dentists. In the present case, the oral rehabilitation provided for the children better aesthetic, nutrition, phonation, and functional conditions.

Oral Health Status among Children with Cerebral Palsy in Dubai, United Arab Emirates

PubMed Central

Al Hashmi, Haifa; Kowash, Mawlood; Hassan, Amar; Al Halabi, Manal

2017-01-01

Objectives: The purpose of this study was to assess the oral health status of children with cerebral palsy (CP) in Dubai, United Arab Emirates (UAE). Materials and Methods: Eighty-four CP and 125 healthy children were recruited from special needs centers and private/public schools in Dubai. A dental examination for decayed-missing-filled teeth in primary dentition (dmft)/Decayed-Missing-Filled teeth in permanent dentition (DMFT) indices, simplified oral hygiene index, calculus index (CI), and oral debris index was conducted. In addition, assessments of occlusal, dentofacial, soft tissue anomalies and erosion were conducted. Statistical analysis was conducted using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: DMFT/dmft scores were comparable in both groups. CI was significantly higher among children with CP. CP patients had a significantly higher proportion of anterior open bite, anterior spacing, Class II molar Angle malocclusion, trauma, high-arched palate, tongue thrust, lymphadenopathy, angular cheilitis, macroglossia, drooling, and erosion as compared to controls. Conclusions: The study highlighted peculiar characteristics and needs for the CP patients in Dubai, UAE. PMID:29285470

Oral Manifestations in Pediatric Patients with Coeliac Disease – A Review Article

PubMed Central

Macho, Viviana Marisa Pereira; Coelho, Ana Sofia; Veloso e Silva, Diana Maria; de Andrade, David José Casimiro

2017-01-01

Background: Coeliac disease is a chronic enteropathy that remains a challenge for the clinician, due to its atypical manifestations and etiopathogenic complexity. Objective: This article intends to describe the oral characteristics of Coeliac Disease in children in order to facilitate their management in the dental office. Methods: A review of the literature was performed electronically in PubMed (PubMed Central, and MEDLINE) for articles published in English from 2000 to April of 2017. The article is also based on the authors' clinical experience with children with coeliac disease. The searched keywords were “coeliac disease “,”oral manifestations “, “dental enamel defects”, “recurrent aphthous stomatitis” and “oral aphthous ulcers”. Results: There are some oral manifestations which are strictly related to coeliac disease: dental enamel defects, recurrent aphthous stomatitis, delayed tooth eruption, multiple caries, angular cheilitis, atrophic glossitis, dry mouth and burning tongue. Conclusion: The complete knowledge of the oral manifestations of coeliac disease can trigger an effective change in the quality of life of the patients with this disease. PMID:29238414

Importance of Scar Prevention and Treatment-An Approach From Wound Care Principles.

PubMed

Marini, Leonardo; Odendaal, Derek; Smirnyi, Sergey

2017-01-01

The increased number of cosmetic surgical and nonsurgical procedures has led to a greater demand to achieve aesthetically acceptable scars. Silicone gel (SG) dressings were evaluated in these cases following the principles of wound care and also minimizing abnormal scar formation. A newly developed solution in wound care in the form of a SG has proven to be a highly effective treatment for a series of 4 clinically challenging cases presented in this article: postprocedure healing after a laser treatment, nonhealing scalp wounds, chronic relapsing xerotic eczematous cheilitis, and the treatment of scars caused by third degree burns. A standard SG was applied to improve the scar outcome of severe burns of a young child. Silicone gels offer excellent clinical results in these 4 cases. In terms of wound care and scar management, they provide a user friendly, convenient application form and increase patient comfort and compliance. To pursue these results, further studies need to be conducted but as of now, there is strong suggestive evidence that SGs indicate beneficial properties for wound care management and scar prevention.

Oral mucosal lesions in Anorexia Nervosa, Bulimia Nervosa and EDNOS.

PubMed

Panico, Rene; Piemonte, Eduardo; Lazos, Jerónimo; Gilligan, Gerardo; Zampini, Anibal; Lanfranchi, Héctor

2018-01-01

The aim of this study is to describe oral lesions in patients with eating disorders (ED), including Anorexia Nervosa (AN), Bulimia Nervosa (BN) and eating disorders not otherwise specified (EDNOS). A prospective case-control study was carried out from April 2003 to May 2004. Inclusion criteria for the study group were individuals with a diagnosis of ED; age and sex-matched individuals without ED were included as controls. Clinical data regarding ED, medical complications and oral examination were performed by previously calibrated professionals. Study group (n = 65) presented 46 cases of BN (71%), 13 of EDNOS (20%) and 6 of AN (9%); also, 94% (n = 61) showed oral lesions. The most common were: labial erythema, exfoliative cheilitis, orange-yellow palate, hemorrhagic lesions, lip-cheek biting and non-specific oral atrophies. Only two patients of the study group had dental erosions, and no case of major salivary gland swelling was found. ED display a wide array of oral mucosal lesions that can be regarded as their early manifestations. The dentist could be the first professional to detect symptoms of eating disorders, potentially improving early detection and treatment of ED. Copyright © 2017 Elsevier Ltd. All rights reserved.

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer.

PubMed

Leite, Ana Flávia Schueler de Assumpção; Bernardo, Vagner Gonçalves; Buexm, Luisa Aguirre; Fonseca, Eliene Carvalho da; Silva, Licínio Esmeraldo da; Barroso, Danielle Resende Camisasca; Lourenço, Simone de Queiroz Chaves

2016-01-01

This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Variant Carvajal syndrome with additional dental anomalies.

PubMed

Barber, Sophy; Day, Peter; Judge, Mary; Toole, Edell O'; Fayle, Stephen

2012-09-01

This paper aims to review the case of a girl who presented with a number of dental anomalies, in addition to unusual skin, nail and hair conditions. Tragically an undiagnosed cardiomyopathy caused unexpected sudden death. The case is discussed with reference to a number of dermatological and oral conditions which were considered as possible diagnoses. AW had been under long term dental care for prepubertal periodontitis, premature root resorption of primary teeth, soft tissue and dental anomalies, and angular cheilitis. Separately she had also been seen by several dermatologists with respect to palmar plantar keratosis, striae keratoderma, wiry hair and abnormal finger nails. Tragically the patient suffered a sudden unexpected death and the subsequent post mortem identified an undiagnosed dilated cardiomyopathy. The most likely diagnosis is that this case is a variant of Carvajal Syndrome with additional dental anomalies. To date we have been unable to identify mutations in the desoplakin gene. We aim to emphasise the importance of recognising these dental and dermatological signs when they present together as a potential risk factor for cardiac abnormalities. © 2012 The Authors. International Journal of Paediatric Dentistry © 2012 BSPD, IAPD and Blackwell Publishing Ltd.

Laser abrasion for cosmetic and medical treatment of facial actinic damage

DOE Office of Scientific and Technical Information (OSTI.GOV)

David, L.M.; Lask, G.P.; Glassberg, E.

1989-06-01

Previous studies have shown the carbon dioxide (CO/sub 2/) laser to be effective in the treatment of actinic cheilitis. After CO/sub 2/ laser abrasion, normal skin and marked cosmetic improvement of the lip were noted. In our study, twenty-three patients were treated with CO/sub 2/ laser abrasions for cosmetic improvement of facial lines and actinic changes. Pre- and postoperative histopathologic examinations were made on two patients. Preoperative examination of specimens from actinically damaged skin showed atypical keratinocytes in the basal layer of the epidermis, with overlying dense compact orthokeratosis and parakeratosis. Abundant solar elastosis was seen in the papillary dermis.more » Postoperative histologic specimens showed a normal-appearing epidermis with fibrosis in the papillary dermis and minimal solar elastosis (about four weeks after laser treatment). At present, various modalities are available for the regeneration of the aged skin, including chemical peels and dermabrasion. Significantly fewer complications were noted with CO/sub 2/ laser abrasion than with these methods. Thus, CO/sub 2/ laser abrasion can be useful in the cosmetic and medical treatment of the aged skin. Marked clinical and histologic improvement has been demonstrated.« less

Oral Thrombus: Report of 122 cases with clinically descriptive data.

PubMed

Tobouti, P-L; Pigatti, F-M; Martins-Mussi, M-C; Machado de Sousa, S-C-O

2017-05-01

The aim of the present study was to assess the frequency and characterize clinic-pathologic aspects of thrombus occurring as a single lesion or in association with other oral pathologies. 122 cases of thrombus from the oral cavity were retrieved. Information regarding site of the lesion, age, sex and clinical diagnosis or hypothesis and associated lesions were collected from the patients' records. The lesions occurred in a wide age range but the 5th decade was the most prevalent and female patients were more affected. The most frequent site for the lesion was the lip, followed by tongue, buccal mucosa, alveolar ridge, gingiva, floor of the mouth and vestibule. Thirty-five cases were associated with other vascular anomalies or actinic cheilitis. Microscopically, typical thrombus morphology was present. Organized thrombus presented neovascularization and fibroblasts, associated with hemorrhagic areas. Only 4 cases of oral thrombus have been described in the oral cavity. Given the limited number of cases reported, the importance of a thrombus in the oral cavity is not well established. This study contributes to establishing the profile of patients presenting oral thrombus, a lesion not rare but not well documented.

Orofacial manifestations in outpatients with anorexia nervosa and bulimia nervosa focusing on the vomiting behavior.

PubMed

Lourenço, Maria; Azevedo, Álvaro; Brandão, Isabel; Gomes, Pedro S

2018-06-01

This case-control study aims to evaluate the oral health status and orofacial problems in a group of outpatients with eating disorders (ED)-either anorexia nervosa (AN) or bulimia nervosa (BN)-further focusing on the influence of vomit. Fifty-five women outpatients with AN or BN diagnosis were invited to participate, of which 33 agreed. ED outpatients and matched controls were submitted to a questionnaire and clinical oral examination. Multivariate analysis identified a significantly higher incidence of teeth-related complications (i.e., tooth decay, dental erosion, and self-reported dentin hypersensitivity), periodontal disease, salivary alterations (i.e., hyposalivation and xerostomia), and oral mucosa-related complications in ED outpatients. Dental erosion, self-reported dentin hypersensitivity, hyposalivation, xerostomia, and angular cheilitis were found to be highly correlated with the vomiting behavior. ED outpatients were found to present a higher incidence of oral-related complications and an inferior oral health status, compared to gender- and age-matched controls. Alterations verified within outpatients were acknowledged to be quite similar to those previously reported within inpatients, in both of nature and severity, thus sustaining that the cranio-maxillofacial region is significantly affected by ED, even in the early/milder forms of the condition, as expectedly verified within outpatients.

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

PubMed Central

LEITE, Ana Flávia Schueler de Assumpção; BERNARDO, Vagner Gonçalves; BUEXM, Luisa Aguirre; da FONSECA, Eliene Carvalho; da SILVA, Licínio Esmeraldo; BARROSO, Danielle Resende Camisasca; LOURENÇO, Simone de Queiroz Chaves

2016-01-01

ABSTRACT Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors. PMID:27556207

Devriesea agamarum causes dermatitis in bearded dragons (Pogona vitticeps).

PubMed

Hellebuyck, Tom; Martel, An; Chiers, Koen; Haesebrouck, Freddy; Pasmans, Frank

2009-03-02

Devriesea agamarum is frequently isolated from dermatitis in lizards, notably from cheilitis in spiny tailed lizards (genus Uromastyx). It was the aim of the present study to assess the role of this bacterium as a causative agent of dermatitis by fulfilling Koch's postulates. First, its association with diseased lizards was demonstrated. The bacterium was isolated from several, mainly desert dwelling squamate species showing symptoms of dermatitis and/or septicaemia. The affected lizards mainly belonged to the family of the Agamidae (genera Pogona, Uromastyx, Agama) and in one case to the Iguanidae (genus Crotaphytus). Secondly, the occurrence of D. agamarum in 66 clinically healthy bearded dragons, 21 clinically healthy Uromastyx species and 40 squamate eggshells was studied. The bacterium was isolated from the oral cavity of 10 bearded dragons but from none of the healthy Uromastyx species. Hence D. agamarum was found to be part of the oral microbiota in Pogona vitticeps. Finally, bearded dragons (P. vitticeps) were experimentally inoculated with D. agamarum by direct application of a bacterial suspension on intact and abraded skin. At the scarified skin of all inoculated lizards, dermatitis was induced from which D. agamarum was re-isolated. In conclusion, D. agamarum is a facultative pathogenic bacterium, able to cause dermatitis in agamid lizards when the integrity of the skin is breached.

Actinic lesions in fishermen’s lower lip: clinical, cytopathological and histopathologic analysis

PubMed Central

Piñera-Marques, Karine; Lorenço, Silvia Vanessa; da Silva, Luiz Fernando Ferraz; Sotto, Mirian Nacagami; Carneiro, Paulo Campos

2010-01-01

INTRODUCTION Actinic cheilitis (AC) is considered to be a pre-malignant lesion or an incipient and superficial form of lip squamous cell carcinoma. It is commonly found in individuals whose occupational activities are related to chronic sun exposure and the definitive diagnosis is performed with biopsy. Althoug Exfoliative cytology has been used as a screening procedure to evaluate cancer of the oral cavity no studies have proposed the use of exfoliative cytologic analysis to evaluate and diagnose AC. OBJECTIVE The purpose of this study was to evaluate lower lip lesions on fishermen related to chronic solar exposure using clinical, cytologic and histopathologic analyses. PATIENTS AND METHODS Smears taken from the vermilion of the lower lips of 125 fishermen and 30 control individuals were subjected to cytologic analysis. RESULTS The harvested cells were sufficient for cytologic analysis in 83.2% of the samples. Sixteen fishermen exhibited prominent lower lip lesions that justified biopsy and histological studies. In total, 4 specimens were malignant (3.2%), and 12 displayed epithelial dysplasia, demonstrating that the prevalence of epithelial dysplasia and malignant lesions was high among the fishermen population. These conditions were strongly associated with infiltration and blurring of the vermilion margin of the lower lip. CONCLUSION The cytologic analysis was not useful for detecting epithelial dysplasia or malignant alterations. PMID:20454492

Oral mucosal lesions and immune status in HIV-infected Indian children.

PubMed

Subramaniam, Priya; Kumar, Krishna

2015-04-01

Pediatric HIV is growing at an alarming rate in developing countries. Due to their compromised immune status, children infected with HIV are prone to a number of opportunistic infections. Oral manifestations are the first signs of the disease in many of them. To assess the oral mucosal status of Indian children with HIV, based on their CD4 cell counts. Two hundred and twenty one HIV infected children aged 6-18 years from various HIV centers, were divided into three groups, based on their CD4 cell counts; Group 1: ≥500, Group 2: 201-499 and Group 3: ≤200 cells. The children in each group were further considered as 'prior to antiretroviral treatment (ART)' and 'on ART'. Oral mucosal examination was done based on presumptive criteria given by Ramos-Gomez for diagnosis of oro-facial lesions commonly associated with HIV infection in children. Data obtained was subjected to statistical analysis. Angular cheilitis and pseudomembranous candidiasis were the frequently seen oral lesions. Children with CD4 cell count ≥500 had significantly fewer oral lesions each. A high percentage of HIV-infected children were affected with oral mucosal lesions. There was a significant association between immune status and frequency of oral lesions. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

All-transretinoic acid (ATRA) treatment-related pancarditis and severe pulmonary edema in a child with acute promyelocytic leukemia.

PubMed

Işık, Pamir; Çetin, Ilker; Tavil, Betul; Azik, Fatih; Kara, Abdurrahman; Yarali, Nese; Tunc, Bahattin

2010-11-01

Use of all-transretinoic acid (ATRA) with other chemotherapeutic agents in the treatment of acute promyelocytic leukemia (APL) has been shown to cause the differentiation of abnormally granulated specific blast cells into mature granulocytes by acting on the t(15; 17) fusion gene product. The complete remission rate is increased and survival time is prolonged in APL patients who receive chemotherapy plus ATRA, whereas ATRA syndrome and other ATRA-related adverse effects including pseudo tumor cerebri, headache, severe bone pain, mucosal and skin dryness, hypercholesterolemia, and cheilitis may be observed especially during induction phase of the treatment. In this paper, we report a 9-year-old girl with APL who developed pancarditis while receiving the APL-93 treatment protocol. In our patient, endocarditis and myocarditis were initially determined after ATRA treatment during the induction part of the protocol. All findings disappeared after ATRA was discontinued. When ATRA was readministered in the maintenance part of the treatment protocol, she developed pancarditis and severe pulmonary edema. As her symptoms decreased dramatically with the discontinuation of ATRA and the initiation of steroid treatment, the clinical picture strongly suggested the ATRA treatment as the causative factor. To the best of our knowledge, this clinical picture of pancarditis secondary to ATRA treatment has not been reported earlier in the English literature.

DEVRIESEASIS IN A PLUMED BASILISK (BASILISCUS PLUMIFRONS) AND CHINESE WATER DRAGONS (PHYSIGNATHUS COCINCINUS) IN A ZOOLOGIC COLLECTION.

PubMed

Rossier, Christophe; Hoby, Stefan; Wenker, Christian; Brawand, Stefanie Gobeli; Thomann, Andreas; Brodard, Isabelle; Jermann, Thomas; Posthaus, Horst

2016-03-01

Devriesea agamarum is a Gram-positive bacterium that was first described in 2008 as a causative agent of disease in lizards. Until today, reports from several countries reported the presence of this bacterium in various lizard species, which suggests a wide distribution among lizard collections. Pathologic lesions ranged from proliferative dermatitis and cheilitis to abscesses in multiple organs and septicemia in single animals, as well as entire groups. Until now, disease caused by D. agamarum has been reported in several lizard species. Because the bacterium is only identified by 16S rRNA sequencing and no commercially available identification systems contain the agent in their database, it may be underdiagnosed. This report describes a series of fatal devrieseasis in plumed basilisks (Basiliscus plumifrons) and Chinese water dragons (Physignathus cocincinus) from a zoologic collection and extends the range of susceptible species. In 3 mo, five animals died with pyogranulomatous lesions in the subcutis, the coelomic cavity, or multiple organs. In all cases, diffuse swelling or focal skin elevations of different body parts were observed. Devriesea agamarum could be isolated from lesions in all animals. A subsequent clinical survey of the lizard collection including bacteriologic investigation of oral cavity swabs indicated that bearded dragons (Pogona vitticeps) were carriers of D. agamarum, which suggests that this species could be a source of infection with this pathogen.

Oral lesions and dental status of autistic children in Yemen: A case–control study

PubMed Central

Al-Maweri, Sadeq Ali; Halboub, Esam S.; Al-Soneidar, Walid Ahmed; Al-Sufyani, Ghadah A.

2014-01-01

Purpose: This study aimed to assess the prevalence of oral lesions among children with autism in Sana’a City, Yemen, and to evaluate their dental status. Patients and Methods: This case–control study included 42 children with autism, aged between 5 and 16 years, and 84 age- and gender-matched healthy children as controls. Oral lesions were assessed based on standardized criteria according to the World Health Organization (WHO) recommendations. Dental caries, gingival health, and oral hygiene status were assessed using dmft/DMFT index, Gingival Index (GI), and Plaque Index (PI), respectively. Chi-square test and Mann–Whitney's test were used to compare the groups. Results: Compared to controls, children with autism revealed higher proportion of fistulae (9.5% vs. 2.4%), ulcerative lesions (7.1% vs. 1.2%), gingival hyperplasia (4.8% vs. 0.0%), and cheilitis (4.8% vs. 2.4%); however, the differences were not statistically significant. The mean dmft score was significantly higher in children with autism than in controls (5.23 vs. 4.06; P < 0.001). Moreover, children with autism revealed poorer oral hygiene than controls, and the majority had gingivitis. Conclusions: Children with autism in Yemen have high prevalence of oral soft tissue lesions, caries, and gingivitis. Therefore, proper oral health education programs should be initiated and directed toward this special section of the society. PMID:25625079

The current role of in vivo reflectance confocal microscopy within the continuum of actinic keratosis and squamous cell carcinoma: a systematic review.

PubMed

Nguyen, Kim P; Peppelman, Malou; Hoogedoorn, Lisa; Van Erp, Piet E J; Gerritsen, Marie-Jeanne P

2016-12-01

Clinical differentiation between actinic keratosis (AK), squamous cell carcinoma (SCC) in situ, and invasive SCC and its variants may be difficult. Reflectance confocal microscopy (RCM) is a non-invasive technique for in vivo skin imaging. To explicate the diagnostic and monitoring use of RCM within the spectrum of AK and SCC, and evaluate the accuracy of RCM for these diagnoses relative to histopathology. A systematic literature search was performed in PubMed, EMBASE, the Cochrane Library, and Web of Science databases. The quality was assessed using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Twenty-five eligible studies were included. Different diagnostic RCM features have been described for AK, actinic cheilitis (AC), erythroplasia of Queyrat, Bowen disease, invasive SCC, and keratoacanthoma (KA). The overall range of sensitivity and specificity of RCM for the diagnosis of SCC, AK, SCC in situ, and KA was 79-100% and 78-100%, respectively. The current literature describes the use of RCM for diagnosing AK, AC, erythroplasia of Queyrat, Bowen disease, invasive SCC, and KA, as well as for monitoring treatments of AK, with good accuracy. Unfortunately, studies with high methodological quality are lacking. Pre-treatment of hyperkeratotic lesions and uniform definitions of RCM features are required to simplify the differentiation between AKs, SCC in situ, and SCC and its variants in clinical practice.

[Vemurafenib-induced toxic epidermal necrolysis].

PubMed

Wantz, M; Spanoudi-Kitrimi, I; Lasek, A; Lebas, D; Quinchon, J-F; Modiano, P

2014-03-01

Herein we report the first case of toxic epidermal necrolysis (TEN) occurring with use of vemurafenib. A 75-year-old female patient was being treated with vemurafenib for stage IV melanoma with BRAF V600E mutation. She suddenly presented fever, diffuse pruriginous maculopapular erythema, palpebral edema, palmar bulla, conjunctivitis, cheilitis and mucosal ulceration. The condition progressed towards detachment affecting 50% of the skin area. Cutaneous biopsy revealed lichenoid dermatosis, chiefly vesicular with numerous eosinophils. Direct immunofluorescence (IFD) was negative. Vemurafenib was the only drug to which the reaction was ascribable and we concluded on vemurafenib-induced TEN. To our knowledge, this is the first reported case of vemurafenib-induced TEN, but this adverse effect, although already described in the BRIM-3 study, appears rare in clinical practice. Other severe skin reactions have been described in the literature. These include a case of Stevens-Johnson syndrome in a female patient treated with vemurafenib and previously receiving ipilimumab. A more common occurrence is cutaneous reactions involving efflorescence of benign hyperkeratotic lesions, occasionally accompanied by authentic epidermal carcinoma or keratoacanthoma, and requiring regular dermatological monitoring of patients treated with vemurafenib. If maculopapular exanthema occurs under vemurafenib, continuation of this treatment should be reassessed since the risk of progression to a more serious condition such as TEN, as seen in the present case, cannot be ruled out. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Inmunohistochemical detection of mastocytes in tissue from patients with actinic prurigo

PubMed Central

Martínez-Luna, Eduwiges; Bologna-Molina, Ronell; Mosqueda-Taylor, Adalberto; Cuevas-González, Juan-Carlos; Rodríguez-Lobato, Erika; Martínez-Velasco, María-Abril

2015-01-01

Background Actinic prurigo (AP) is a type of photodermatosis, the pathophysiology of which has not been determined. AP has been suggested to be a hypersensitivity reaction to the presence of eosinophils and the local production of IgE. Material and Methods Descriptive study, using paraffin blocks of tissue that have been diagnosed with AP from the Dermopathology department, Hospital General Dr. Manuel Gea González. In 66 blocks from 63 patients, eosinophils were identified by hematoxylin and eosin staining, and mastocytes were labeled by immunohistochemistry. Three random microphotographs (40x) were used, and cell counts were calculated as the mean count in the 3 microphotographs. Results Forty cases (63.5%) were female, and 23 (36.5%) were male. The mean age was 26.49 ±14.09 years; regarding the evolution time of the disease, the average was 11.93 years ±11.39. In 38 of 63 cases (60%), the lip, skin, and conjunctiva were affected clinically. In 22 of 63 cases (34%), AP cheilitis was the sole manifestation, and in 4 of 63 cases (6%), there were lesions in the skin and conjunctiva. The mean eosinophil count was 9 per case, the average number of mastocytes/field was 28.48 (range 0 to 66) Kruskal-Wallis p=0.001. Conclusions There are elements in AP that mediate the reaction of hypersensitivity type IV b, necessitating the identification of triggering factors. Key words:Actinic prurigo, eosinophil, hypersensitivity IV b, IgE, mastocytes. PMID:26644844

The frequency of hematuria in acne vulgaris patients during isotretinoin treatment.

PubMed

Yesilkaya, Burcu; Alli, Nuran; Artuz, R Ferda; Ulu, Ezgi; Kartal, Demet; Cinar, S Levent

2017-03-01

Systemic isotretinoin (13-cis-retinoic acid) is effective in the treatment of acne vulgaris. The most common side effects are mucocutaneous ones. Hematuria seen secondary to isotretinoin treatment is thought to be due to mucosal dryness in the urinary system. This study aims to determine the frequency of hematuria in acne vulgaris patients during isotretinoin treatment. Eighty-eight subjects aged 16-32 years were included in the study group and 52 subjects were in the control group. The subjects were treated for 6 months and were monitored monthly by complete urine analyzes. They were also examined each month in terms of cheilitis, xerosis, epistaxis, rectal bleeding, fatigue, myalgia, weight loss, dry eye, conjunctivitis, headache, dysuria and pollakiuria. In the study group, 15 subjects (17%) had hematuria at least once during the study, and in the control group, four subjects (7.7%) had hematuria. The difference was not statistically significant (p = 0.118). Among the subjects who had hematuria, 11 of them (73.3%) were female and four of them (33.3%) were male in the study group while all the subjects with hematuria in the control group were female. Hematuria and gender did not show a statistically significant correlation. Hematuria was observed in 17% of the study group; this frequency rate was not different from that of the normal population. In subjects having isotretinoin treatment, if all the other reasons or disorders are excluded, one must keep in mind that hematuria may be due to isotretinoin use.

Hyposalivation and xerostomia among Parkinson's disease patients and its impact on quality of life.

PubMed

Barbe, A G; Heinzler, A; Derman, Shm; Hellmich, M; Timmermann, L; Noack, M J

2017-05-01

Parkinson's disease (PD) adversely affects oral health (OH). However, the informative value of xerostomia compared to objective parameters and its impact on quality of life (QoL) are still unclear. This study aimed to explore whether xerostomia correlates with hyposalivation and to define its impact on OH-related QoL. Whole stimulated saliva (WSS) was collected from 30 patients with PD and 30 matched healthy controls. Objective parameters (community periodontal index of treatment needs, plaque/gingivitis index, mucosa situation and cheilitis angularis) and questionnaires (German Oral Health Impact Profile [OHIPG]-14, visual analogue scale [VAS], xerostomia [yes/no] and the Unified Parkinson's Disease Rating Scale-II) were assessed. Eighty-seven per cent of patients with PD showed hyposalivation vs 50% of controls (P = 0.001); 50% of patients with PD reported xerostomia, and none of controls (P < 0.001). The OHIPG-14 was impaired in patients with PD compared to controls (P < 0.001), PD patients with xerostomia reported mean VAS values of 4.1 (s.d.: 2.2). WSS did not correlate with VAS values. Half of the patients with PD reported xerostomia and underestimated their xerostomic status, with higher probability than healthy controls. WSS did not reflect the grade of xerostomia. Patients with PD suffered from impaired OH-related QoL. Dental teams should not overlook these oral health risks. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Application of Theranostics in Oncology.

PubMed

Lymperopoulos, Georgios; Lymperopoulos, Panagiotis; Alikari, Victoria; Dafogianni, Chrisoula; Zyga, Sofia; Margari, Nikoletta

2017-01-01

In recent years, due to the development of nanotechnology new horizons in treatment and diagnosis of cancer open up. Development of nano-systems for simultaneous transfer of active substances and imaging of tumor regions gathers an important amount of scientific interest. This new category of nano-systems is called Theranostics. Theranostics methods can provide multiple benefits by inserting nanoparticles into the patient and using photodynamic therapy and pave the way for personalized medicine. The objective of this paper is to study the use and application of Theranostics in the diagnosis and treatment of cancer, in order to achieve personalized anticancer treatment. For this purpose, investigation of existing literature has been conducted using electronic databases, PubMed, Google Scholar and IEEE Xplore. In addition, there was a secondary research phase, using paper citations found during the first research phase. It has to be pointed out that nanoparticles are the basis of Theranostics, since, due to their properties, they provide the ability to display accurate imaging and provide diagnosis along with simultaneous treatment of diseases. Theranostics methods may be applied in treatment of esophageal cancer, prostate cancer, breast cancer, in treatment of actinic keratosis, actinic cheilitis and Bowen's disease and in treatment of basal cell epithelioma and macular degeneration. As a result, application of Theranostics can provide multiple benefits by inserting nanoparticles into the patient. This method is currently encountering many challenges, but continuation of research on the field is necessary not only for the improvement of the medical field and the healthcare techniques, but also for the creation of new treatment methods for patients with diseases that are incurable until now.

[Clinical analysis of cutaneous manifestations and related factors in patients with ulcerative colitis].

PubMed

Tian, Y; Li, J X; Wang, H H; Li, R Y; Liu, X G

2016-07-01

To investigate the cutaneous manifestations in patients with ulcerative colitis (UC) and related factors. Patients admitted to Department of Gastroenterology Peking University First Hospital from January 1994 to December 2014 and diagnosed as UC were retrospectively enrolled in this study. Skin disorders were confirmed by the dermatologists. Clinical data were collected and compared between patients with and without cutaneous manifestations. Among the total 373 UC patients, there were 34 cases (9.1%) with cutaneous manifestations, including 11 pyoderma gangrenosum, 8 erythema nodosum, 6 eczema, 3 psoriasis, 2 pemphigus, 1 granulomatous cheilitis, 1 ichthyosis, 1 acne rosacea, and 1 impetigo. The skin manifestations may occur after the diagnosis, simultaneously or even before the diagnosis of UC, which were 24, 7 and 3 patients respectively. The mean age in patients with skin lesions was (47.2±12.1) years, male to female ratio 0.79∶1. More patients with skin manifestations had severe activity of UC compared with non-skin group [50.0%(17/34) vs 25.1%(85/339), P=0.01]. In addition, the proportion of extensive colitis in skin lesion group was significantly higher than that in non-skin group [76.5%(26/34) vs 54.6%(185/339), P=0.04]. The cutaneous manifestations associated with UC are polymorphic, erythema nodosums and pyoderma gangrenosums are the most common skin lesions seen in UC patients. Skin lesions occur concurrently, pre or post the diagnosis of UC. Skin lesions in UC patients suggest more severe disease activity. Clinicians need to pay more attention to this group.

Oral pathology in inflammatory bowel disease

PubMed Central

Muhvić-Urek, Miranda; Tomac-Stojmenović, Marija; Mijandrušić-Sinčić, Brankica

2016-01-01

The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine. PMID:27433081

Investigation of contact allergy to dental materials by patch testing.

PubMed

Rai, Reena; Dinakar, Devina; Kurian, Swetha S; Bindoo, Y A

2014-07-01

Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials. This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials. Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG). Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities. The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials.

Surgical attitude in premalignant lesions and malignant tumors of the lower lip

PubMed Central

Calcaianu, N; Popescu, SA; Diveica, D; Lascar, I

2015-01-01

Introduction. Malignant tumors of the lower lip may have a variety of histopathology forms. The diagnosis and treatment of premalignant lesions are extremely important to avoid their malignant evolution. The lower lip tumor diagnosis is based on a series of correlations: anamnestic, clinical, laboratory and histopathological (the latter giving the certain diagnose). Material and methods. This study was carried out by selecting the cases with lower lip tumors operated between January 2012 and July 2014, in the Plastic Surgery and Reconstructive Microsurgery Clinic of Bucharest Clinical Emergency Hospital. The variables considered in the study were the following: age, gender, exposure to risk factors, diagnosis, and histopathology. Results. The histopathological examination revealed 63% squamous cell carcinoma, 30% basal cell carcinomas, 5% keratoacanthoma and 2% actinic keratosis. Men were the predominantly affected genre, with a percentage of 70%. In the group of patients studied, 66% were smokers. Discussions. The rate of the malignant transformation of premalignant lesion was 32.6% for keratoacanthoma, 16.9% for actinic cheilitis, 10% for actinic keratoses. Conclusions. There were no clinical or laboratory features to plead for the pre-malignant or malignant character of the of a lower lip tumor, consequently histopathological examination was used for the diagnosis of the lesion. Due to the high percentage of malignant transformation of precancerous lesions, particularly in the form of squamous cell carcinoma, the surgical attitude intending to eradicate a lower lip tumor from an oncological point of view was the excision with oncologic safety margins followed by a lip reconstruction. PMID:25914752

Association between oral mucosal lesions and crack and cocaine addiction in men: a cross-sectional study.

PubMed

Cury, Patricia Ramos; Araujo, Nara Santos; das Graças Alonso Oliveira, Maria; Dos Santos, Jean Nunes

2018-05-08

The aim of this cross-sectional study was to evaluate the prevalence of oral mucosal lesions (OMLs) and their association with crack/cocaine addiction in men. Clinical oral examination was performed in 161 adult male patients at the School of Dentistry of the Federal University of Bahia, Brazil. Crack/cocaine addiction was determined from the medical records, and all drug-addicted individuals used both crack and cocaine. All participants (40 crack/cocaine-addicted men and 121 non-addicted men) underwent a systematic evaluation of the lips, labial mucosa, commissures, buccal mucosa and sulcus, gingiva and alveolar ridge, tongue, floor of the mouth, and soft and hard palate by a single examiner. Bivariate and regression analyses were conducted to assess for the presence of OMLs and the association of OMLs with crack/cocaine addiction. OMLs were found in 22 participants with a significantly greater prevalence in the crack/cocaine-addicted group (25 vs. 9.9%; p = 0.01). The most prevalent types of lesions in the addicted group were traumatic ulcer and actinic cheilitis (7.5% for each) followed by fistulae associated with a retained dental root (5%). After adjusting for covariates, crack/cocaine addiction was significantly associated with OMLs (OR = 2.87; 95% CI = 1.08-7.67; p = 0.03). The prevalence of OMLs was higher in crack/cocaine-addicted individuals, and crack/cocaine addiction was significantly associated with OMLs. A public health program aimed at the early diagnosis and treatment of OMLs is vital to improving the oral health status of individuals addicted to crack/cocaine.

Investigation of contact allergy to dental materials by patch testing

PubMed Central

Rai, Reena; Dinakar, Devina; Kurian, Swetha S.; Bindoo, Y. A.

2014-01-01

Background: Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials. Aim: This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials. Materials and Methods: Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG). Results: Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities. Conclusion: The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials. PMID:25165644

Characterization of dendritic cells in lip and oral cavity squamous cell carcinoma.

PubMed

Costa, Nádia Lago; Gonçalves, Andréia Souza; Martins, Allisson Filipe Lopes; Arantes, Diego Antônio Costa; Silva, Tarcília Aparecida; Batista, Aline Carvalho

2016-07-01

There may be differences in the antitumor immunity induced by dendritic cells (DCs) during the development of squamous cell carcinoma (SCC) located in the lip rather than in the oral cavity. The aim of this study was to evaluate the number of immature and mature DCs in SCC and potentially malignant disorders of the oral cavity and lip. Immunohistochemistry was used to identify the number (cells/mm(2) ) of immature (CD1a(+) ) or mature (CD83(+) ) DCs in samples of oral cavity SCC (OCSCC) (n = 39), lip SCC (LSCC) (n = 23), leukoplakia (LK) (n = 21), actinic cheilitis (AC) (n = 13), and normal mucosa of the oral cavity (OC control, n = 12) and the lip (lip control, n = 11). The number of CD1a(+) cells tended to be higher in the OC control samples compared with the LK (P = 0.04) and OCSCC (P = 0.21). Unlike, this cell population was lower in the lip control than in AC or LSCC (P < 0.05). The number of CD83(+) cells was increased in the LSCC samples compared with the AC and lip control (P = 0.0001) and in OCSCC compared with both the LK (P = 0.001) and OC control (P = 0.0001) samples. LSCC showed an elevated number of CD1a(+) and CD83(+) cells compared with OCSCC (P = 0.03). The population of mature DCs was lower than the population of immature DCs in all of the tested groups (P < 0.05). There were a greater number of both mature and immature DC populations in the LSCC samples than in the OCSCC, which could contribute to establishing a more effective immune antitumor response for this neoplasm. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Peeling skin diseases: 21 cases from Turkey and a review of the literature.

PubMed

Köse, O; Safali, M; Koç, E; Arca, E; Açikgöz, G; Özmen, I; Yeniay, Y

2012-07-01

Peeling skin diseases (PSD) refer to a group of rare autosomal recessive dermatosis which are characterized by spontaneous, continual peeling of the skin. Three different clinical pictures can be distinguished: Inflammatory PSD also referred to as peeling skin syndrome (PSS) type B, non-inflammatory PSD also referred to as PSS type A, and localized forms i.e. acral type PSS. To characterize the clinical and histopathological features of PSD in Turkey. We retrospectively reviewed the medical records and clinical photographs of patients who were given diagnosis of PSD and conducted histopathological evaluation of skin biopsies to identify the site of cleavage. Also we evaluated the cases including age, gender, age onset, clinical and histological findings, family history, associated disorders and PSD type. Twenty-one patients with PSD were seen at Gulhane School of Medicine in Ankara between the years 1994 and 2010 in this retrospective study. All patients were men. Their ages were between 20 and 26 years (22.44±2.30, Mean age±SD). Of the patients, eight cases (40%) were type A, eight cases (40%) were type B, and five cases (20%) were acral type PSS. Eleven cases (52%) had parental consanguinity. Keratoderma, cheilitis, keratosis pilaris, melanonichia, clubbing, hyperhidrosis, onychodystrophy were observed in eight cases as an accompanying disorder. In this case series, PSD occurred rarely and also showed generally mild course of disease in Turkey and most likely related to consanguineous of marriages. Future investigations on PSD will contribute to our progressing alternative targets for pathogenesis-based therapy. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.

Candida infection in oral leukoplakia: an unperceived public health problem.

PubMed

Dilhari, Ayomi; Weerasekera, Manjula M; Siriwardhana, Anusha; Maheshika, Oshanthi; Gunasekara, Chinthika; Karunathilaka, Sunil; Nagahawatte, Ajith; Fernando, Neluka

2016-10-01

The study aimed to determine the proportion, known risk factors and etiology for Candida infection in leukoplakia lesions among patients with oral leukoplakia attending the Oral and Maxillofacial Clinic at a Tertiary Care Hospital in Sri Lanka. Eighty clinically suspected oral leukoplakia patients were included. Two oral swabs each, from leukoplakia patients: one swab from the lesion and the other one from the contralateral unaffected corresponding area (as a control) were collected. Direct microscopy and culture followed by colony count and phenotypic identification were performed to identify pathogenic Candida species. Candida infection was seen in 47% of patients with oral leukoplakia. Candida albicans (94.7%) was the most common Candida species followed by Candida tropicalis (5.3%). Majority of Candida-infected lesions were seen in the buccal mucosa region. Alteration of taste (p = 0.021), having other oral lesions (p = 0.008), angular cheilitis (p = 0.024) and periodontitis (p = 0.041) showed a significant association with Candida-associated leukoplakia. Increasing age showed a significant tendency for Candida infection (p = 0.020). Smoking (p = 0.026) and betel-quid chewing (p = 0.006) were also found to be significantly associated, although alcohol consumption alone did not show a significant association. Oral leukoplakia patients who had all three habits: alcohol consumption, smoking and betel-quid chewing had a significant association with Candida infection (p = 0.004). Patients who had a combination of risk factors: smoking, betel-quid chewing and alcohol consumption were seen to have a significant association with Candida infection. Further betel-quid chewing alone and smoking singly was also significantly associated with Candida infection in oral leukoplakia.

Orofacial Manifestations and Temporomandibular Disorders of Sjögren Syndrome: An Observational Study

PubMed Central

Crincoli, Vito; Di Comite, Mariasevera; Guerrieri, Mariateresa; Rotolo, Rossana Patricia; Limongelli, Luisa; Tempesta, Angela; Iannone, Florenzo; Rinaldi, Angela; Lapadula, Giovanni; Favia, Gianfranco

2018-01-01

AIMS: Sjӧgren Syndrome is a disorder involving oral tissues, with xerostomia, dysgeusia, dysphagia, tooth decay, gingivitis, angular cheilitis and glossitis. Temporomandibular disorders are a generic term referred to clinical conditions involving the jaw muscles and temporomandibular joint. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in Sjӧgren Syndrome (SS) patients compared with healthy people. METHODS: The study group included 72 SS patients (2 men, 70 women) diagnosed according to the American-European Consensus Group (AECG) Criteria. A randomly selected group of 72 patients, matched by sex and age, served as control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. RESULTS: SS patients complained more frequently (95.8%) of oral symptoms (xerostomia, dysgeusia, dysphagia) than controls (22.2%) (χ2= 80.66 p< 0.001). TMD symptoms (muscle pain on chewing, difficulty in mouth opening, arthralgia, headaches, tinnitus) were complained by 91.7% of SS patients and by 84.7% of controls (χ2= 1,667 p= 0,196). At the clinical examination, 91,7% of SS had at least one oral sign respect to 75 % of controls. The salivary flow measurements showed high statistical significance between the two groups (Unpaired test, p< 0,0001). Myofascial pain (caused by muscular contracture) was significantly higher in the study group than in the control one (p≤ 0,05). Furthermore 18,05% of SS patients showed deflection versus 5,5% of controls (χ2=5,402 p=0,020). CONCLUSIONS: Sjӧgren's Syndrome seems to play a role in temporomandibular joint disorders. PMID:29559836

Oral microflora and their relation to risk factors in HIV+ patients with oropharyngeal candidiasis.

PubMed

Sharifzadeh, A; Khosravi, A R; Shokri, H; Asadi Jamnani, F; Hajiabdolbaghi, M; Ashrafi Tamami, I

2013-06-01

The purpose of this study was to determine the prevalence of oral microflora and association of oral candidiasis and multiple risk factors in HIV(+) patients. The present study included 100 HIV-infected patients participated in Imam Khomeini Hospital, Tehran, Iran for Oropharyngeal candidiasis (OPC) and HIV. We assessed the presence or absence of OPC, and samples were obtained from the oral cavity and direct microscopic examination, gram staining and culture on standard microbiological media were performed in all patients. CD4(+) cell count/CD4(+) percentage were also calculated. The demographic characteristics showed that the patients had a mean age of 32.3 years old, 78% male and 22% female. Patients belonging to 'O(+)' blood group (27%) were more prone to develop OPC. A total of 460 bacterial colonies were obtained and Streptococcus mutans (15.4%) was the most frequently isolated species in the HIV(+) patients, followed by Staphylococcus epidermidis (12.8%) and Corynebacterium (8.7%). In addition, 254 yeasts (from four different genera) were isolated from the patient under study. Candida species (94.4%) were the most frequently obtained genera, followed by Saccharomyces (2.4%), Kluyveromyces and Cryptococcus (1.6% for both) species. Candida albicans (37.2%) was the most common species isolated from HIV(+) patients with OPC and its frequency was significantly higher than that of other Candida species (P<0.05). Candida glabrata, C. dubliniensis, C. tropicalis, C. parapsilosis, C. krusei, C. lusitaniae, C. guilliermondii and C. norvegensis were also identified. Forty percent of the patients had angular cheilitis as the most frequent clinical variant. The mean CD4(+) cell counts were 154.5 cells/μL, with a range of 8 to 611 cells/μL. Thirty percent patients had a CD4(+) cell count between 101 and 200 cells/μL (28.7% of total yeasts isolated). Yeast and bacteria counts did not differ statistically among HIV(+) patients' subgroups with different levels of CD4(+) cells counts. Our results showed that yeasts of the genus Candida were isolated at a comparable rate from the oral cavity of HIV(+) patients and there was no significant difference of the variables CD4(+) cell count and yeast counts. The findings of this study would be helpful in any further study, which, if done prospectively on a large cohort, can be confirmatory. Copyright © 2013. Published by Elsevier SAS.

Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing.

PubMed

Krupashankar, D S

2008-01-01

Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing. MACHINES: Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential. INDICATIONS FOR CO 2 LASER: Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos. AESTHETIC INDICATIONS: Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing. PHYSICIANS' QUALIFICATIONS: Any qualified dermatologist (DVD or MD) may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers. For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer's facility or at another centre using the machine is recommended. CO 2 lasers can be used in the dermatologist's minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory. Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be discussed with the patient. The patient should be provided brochures to study and also given adequate opportunity to seek information. Detailed consent forms need to be completed by the patients. Consent forms should include information on the machine used; possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. Choice of the machine and the parameters depends on the site, type of lesion, result needed, and the physician's experience. Localized lesions can be treated under eutectic mixture of local anesthesia (EMLA) cream anesthesia or local infiltration anesthesia. Full-face resurfacing can be performed under general anesthesia. Proper postoperative care is important to avoid complications.

Candidiasis and other oral mucosal lesions during and after interferon therapy for HCV-related chronic liver diseases.

PubMed

Nagao, Yumiko; Hashimoto, Kouji; Sata, Michio

2012-11-02

Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection. Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94). We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.