acyclovir and Stomatitis--Aphthous

Behçet's disease is a chronic inflammatory vasculitis that can affect multiple systems. Mucocutaneous involvement is common, as is the involvement of many other systems such as the central nervous system and skin. Behç̧et's disease can cause significant morbidity, such as loss of sight, and can be life threatening. The frequency of oral ulceration in Behçet's disease is thought to be 97% to 100%. The presence of mouth ulcers can cause difficulties in eating, drinking, and speaking leading to a reduction in quality of life. There is no cure for Behçet's disease and therefore treatment of the oral ulcers that are associated with Behçet's disease is palliative.. To determine the clinical effectiveness and safety of interventions on the pain, episode duration, and episode frequency of oral ulcers and on quality of life for patients with recurrent aphthous stomatitis (RAS)-type ulceration associated with Behçet's disease.. We undertook electronic searches of the Cochrane Oral Health Group Trials Register (to 4 October 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9); MEDLINE via Ovid (1946 to 4 October 2013); EMBASE via Ovid (1980 to 4 October 2013); CINAHL via EBSCO (1980 to 4 October 2013); and AMED via Ovid (1985 to 4 October 2013). We searched the US National Institutes of Health trials register (http://clinicaltrials.gov) and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language or date of publication in the searches of the electronic databases. We contacted authors when necessary to obtain additional information.. We included randomised controlled trials (RCTs) that looked at pre-specified oral outcome measures to assess the efficacy of interventions for mouth ulcers in Behçet's disease. The oral outcome measures included pain, episode duration, episode frequency, safety, and quality of life. Trials were not restricted by outcomes alone.. All studies meeting the inclusion criteria underwent data extraction and an assessment of risk of bias, independently by two review authors and using a pre-standardised data extraction form. We used standard methodological procedures expected by The Cochrane Collaboration.. A total of 15 trials (n = 888 randomised participants) were included, 13 were placebo controlled and three were head to head (two trials had more than two treatment arms). Eleven of the trials were conducted in Turkey, two in Japan, one in Iran and one in the UK. Most trials used the International Study Group criteria for Behçet's disease. Eleven different interventions were assessed. The interventions were grouped into two categories, topical and systemic. Only one study was assessed as being at low risk of bias. It was not possible to carry out a meta-analysis. The quality of the evidence ranged from moderate to very low and there was insufficient evidence to support or refute the use of any included intervention with regard to pain, episode duration, or episode frequency associated with oral ulcers, or safety of the interventions.. Due to the heterogeneity of trials including trial design, choice of intervention, choice and timing of outcome measures, it was not possible to carry out a meta-analysis. Several interventions show promise and future trials should be planned and reported according to the CONSORT guidelines. Whilst the primary aim of many trials for Behç̧et's disease is not necessarily reduction of oral ulceration, reporting of oral ulcers in these studies should be standardised and pre-specified in the methodology. The use of a core outcome set for oral ulcer trials would be beneficial.

Topics: Acyclovir; Adrenal Cortex Hormones; Alanine; Behcet Syndrome; Colchicine; Cyclosporine; Etanercept; Humans; Immunoglobulin G; Interferon-alpha; Oral Ulcer; Quinolones; Randomized Controlled Trials as Topic; Receptors, Tumor Necrosis Factor; Stomatitis, Aphthous; Sucralfate; Thalidomide

The myelodysplastic syndromes are a heterogenous group of hematologic disorders of myeloid progenitor cells. Oral manifestations may be among the first signs and often reflect degrees of neutropenia or neutrophil dysfunction. A patient with persistent herpes labialis and severe oral mucosal ulceration in myelodysplastic syndrome is reported. The features of myelodysplasia are reviewed and their oral manifestations and significance to dental management outlined.

Topics: Acyclovir; Aged; Aged, 80 and over; Candida; Dental Care for Disabled; Herpes Labialis; Humans; Male; Mouth Mucosa; Myelodysplastic Syndromes; Neutrophils; Staphylococcus aureus; Stomatitis, Aphthous

Topics: Acyclovir; Humans; Recurrence; Stomatitis, Aphthous

Aphthous stomatitis (canker sores) is a common cause of recurrent mouth ulceration. The effect of long-term oral acyclovir therapy on aphthous stomatitis recurrences was evaluated in 44 patients who were in a double-blind treatment trial for recurrent genital Herpes simplex infections. Twenty-five subjects received oral acyclovir daily for one year, while 19 received the drug only during outbreaks of herpes. The number of patients who experienced recurrences of aphthous stomatitis and the frequency and duration of attacks per patient were not significantly different between groups. Furthermore, no consistent change in attack rate was observed in members of either group compared to that reported before they had entered the trial. We conclude that oral acyclovir is not effective for prevention of recurrent aphthous stomatitis in most patients.

Topics: Acyclovir; Administration, Oral; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Genitalis; Humans; Male; Random Allocation; Stomatitis, Aphthous; Time Factors

Topics: Acyclovir; Antiviral Agents; Child; Child, Preschool; Folic Acid; Humans; Stomatitis, Aphthous; Stomatitis, Herpetic

Topics: Acyclovir; Biopsy; Cytomegalovirus Infections; Gentian Violet; Humans; Immunoenzyme Techniques; Male; Middle Aged; Stomatitis, Aphthous; Tongue Diseases

The authors present a patient with severe and persistent oral ulcerations despite acyclovir therapy. Because the patient initially had no skin lesions, the diagnosis of pemphigus was delayed. However, pemphigus commonly presents with oromucosal lesions before skin manifestations appear.

Topics: Acyclovir; Adult; Diagnosis, Differential; Female; Humans; Pemphigus; Stomatitis, Aphthous

Topics: Acyclovir; Administration, Topical; Anti-Inflammatory Agents; Diagnosis, Differential; Glucocorticoids; Herpesvirus 6, Human; Humans; Stomatitis, Aphthous; Stomatitis, Herpetic

Recurrent oral herpes simplex virus lesions are common in both immunocompetent and immunocompromised persons. In contrast, cytomegalovirus-associated intraoral lesions are rarely seen, even in the immunocompromised host. We report a case of concurrent oral herpes simplex virus and cytomegalovirus infection, appearing as an ulcerative lesion of the labial mucosa in a patient with acquired immunodeficiency syndrome. Herpes simplex virus type 1 was shown to be present in the lesion by culture tests, histopathologic examination, immunohistochemistry findings and a direct immunofluorescence assay, and cytomegalovirus by histopathologic examination and immunohistochemistry findings. We deduce that the lesion was due to concurrent herpes simplex virus-1 and cytomegalovirus infection. The patient responded well to 2 weeks of treatment with a high dose of acyclovir.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Cytomegalovirus; Cytomegalovirus Infections; Humans; Lip Diseases; Male; Mouth Diseases; Mouth Mucosa; Simplexvirus; Stomatitis, Aphthous; Stomatitis, Herpetic; Superinfection

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Topical; Adult; Anti-Inflammatory Agents; Humans; Hydrocortisone; Levamisole; Male; Middle Aged; Mouthwashes; Nystatin; Pentamidine; Stomatitis, Aphthous; Tetracycline; Triamcinolone; Zidovudine

Attempts were made to demonstrate herpes simplex virus (HSV) type 1 and type 2, varicella zoster virus (VZV) and cytomegalovirus (CMV) in specimens obtained from aphthous ulceration lesions by the immunofluorescent method using fluorescein-labeled monoclonal antibodies. HSV-1 and VZV were detected in 2 and 4 out of 30 patients, respectively. Although almost all viruses that can infect the oral cavity could occasionally cause stomatitis, neither HSV-2 nor CMV was not found in this study. VZV was detected in 1 out of 8 patients with recurrent aphthous ulceration. After treatment with acyclovir, the patient's symptoms has become less severe and recurrence rates of attacks reduced, however, the patient has not been totally free of the disease. There were no differences in clinical aspects of stomatitis between the patients with and without viral isolation. Further clinical investigation is encouraged to confirm the relationship between aphthous stomatitis and viral infection.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cytomegalovirus; Female; Fluorescent Antibody Technique; Herpesvirus 3, Human; Humans; Male; Middle Aged; Simplexvirus; Stomatitis, Aphthous

A case of aseptic meningoencephalitis with recurrent abnormal behavior, status epilepticus and aphthous stomatitis was described. A 39-year-old man, who had a history of low grade fever and abnormal behavior over 2 years without mucocutaneo-ocular symptoms, was admitted to Shinshu University Hospital because of status epilepticus. On admission, neurological examination revealed comatose state with neck stiffness, anisocoria (right greater than left), conjugate deviation to right and bilateral pyramidal tract signs. His cerebrospinal fluid examination revealed a total protein content of 206 mg/dl with 22 lymphocytes and 134 polymorphonuclear leukocytes/mm3. EEG recorded on the 3rd hospital day showed periodic sharp waves and polyspikes, occurring every 1 seconds, predominantly arise from the right hemisphere, which corresponds to periodic lateralized epileptiform discharges (PLEDs). Herpes simplex encephalitis was suspected and acyclovir was administered. Neck stiffness and cerebrospinal fluid findings were improved and PLEDs disappeared. But aphthous stomatitis appeared and meningoencephalitis was relapsed. Laboratory examination revealed erythrocyte sedimentation rate 40 mm/hr, positive C-reactive protein, elevated CH50 and sialic acid, enhanced migration of neutrophils and HLA-B 51. Neuro-Behçet's syndrome was strongly suspected with laboratory data but the clinical course was atypical. His clinical signs were markedly improved after administration of prednisolone. The present case suggests that neuro-Behçet's syndrome with only a part of major symptoms could be diagnosed as viral encephalitis and acyclovir may be effective for the treatment of neuro-Behçet's syndrome.

Topics: Acyclovir; Adult; Diagnosis, Differential; Electroencephalography; Humans; Male; Meningitis; Meningitis, Aseptic; Recurrence; Status Epilepticus; Stomatitis, Aphthous