clobetasol and Gingivitis

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Cross-Over Studies; Double-Blind Method; Female; Gingivitis; Humans; Lichen Planus, Oral; Male; Middle Aged; Pemphigus; Severity of Illness Index; Treatment Outcome

Desquamative gingivitis (DG) is a clinical condition characterized by red, painful, glazed, and friable gingiva, which might be a manifestation of some autoimmune mucocutaneous diseases. The time from the development of initial signs of DG to diagnosis can vary from months to years. Based on a literature search, no data concerning patients with DG without signs of autoimmune disease were available.. The aim of this trial was to compare the efficacy and tolerability of monotherapy with topical tacrolimus 0.1% in pectin ointment versus clobetasol propionate 0.5% ointment in adults affected by DG.. This randomized, double-blind clinical trial was conducted at the Dipartimento di Medicina Clinica e Sperimentale, Universita di Verona, Verona, Italy. Patients aged > or =18 years were selected using the department's electronic medical records based on a clinical diagnosis of moderate to severe DG. After a 2-week washout period, patients were randomly assigned to receive 2 mL of tacrolimus 0.1% in pectin (equivalent to 0.2 mg of tacrolimus) or 2 mL of clobetasol propionate 0.5% ointment (equivalent to 1 mg of clobetasol) QD for 4 weeks. Evaluations were performed before treatment (baseline), after the treatment period (week 4), and at 2 follow-up visits at weeks 6 and 8. The signs of DG (ie, erythema [atrophy] and desquamation [erosions/ulceration]) were quantified by a blinded investigator using a calculated score based on their surface extension, using a drawing in which the areas of various zones of the mouth were indicated as a percentage of the whole oral mucosa. Severity of erythema and desquamation was rated on a 4-point scale (0 = absent; 1 = involvement of <5% of surface [mild]; 2 = 5%-15% [moderate]; and 3 = >15% [severe]). The primary end point was the number of patients who achieved remission (severity score of 0) in either sign; the secondary end point was the proportions of patients achieving improvement (severity score of 0 or 1) in either sign. Before and after treatment, we measured the serum concentrations of tacrolimus and its metabolites with an immunoenzymatic assay kit. Tolerability was assessed using hematology, biochemistry, urinalysis, measurements of systolic/diastolic blood pressure and heart rate, patient interview, and spontaneous reporting.. A total of 24 patients (18 women, 6 men; all white of Italian origin; age range, 21-65 years; 12 patients per treatment group) were enrolled in the study. In the tacrolimus group, 11 (91.7%) patients achieved remission of erythema and/or desquamation at weeks 4 and 6; at week 8, these rates were 9 (75.0%) and 8 (66.7%), respectively; none of the patients in the clobetasol group achieved remission of either sign at any time point (all, P < 0.001). At weeks 4, 6, and 8, significantly greater proportions of patients treated with tacrolimus had improved erythema and desquamation compared with those treated with clobetasol (all, P < 0.001). At week 4, all patients had undetectable serum tacrolimus concentrations (<1.5 microg/L). Six (50.0%) patients in the tacrolimus group reported a mild oral burning sensation, and 6 (50.0%) patients in the clobetasol group reported mild mouth dryness. No other adverse events were reported.. The results of this small study suggest that topical tacrolimus 0.1 % in pectin was more effective compared with clobetasol propionate 0.5% ointment in the treatment of DG. Both treatments were generally well tolerated in the population studied.

Topics: Administration, Topical; Adult; Aged; Clobetasol; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Gingivitis; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Pectins; Severity of Illness Index; Tacrolimus; Treatment Outcome

Abstract.

Topics: Administration, Topical; Clobetasol; Gingivitis; Humans; Lichen Planus, Oral; Tacrolimus; Treatment Outcome

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-year-old patient with desquamative gingivitis. However, a negative Nikolsky's sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky's sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolsky's sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive, auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.

Topics: Administration, Topical; Autoantibodies; Clobetasol; Dystonin; Epithelium; Female; Fluorescent Antibody Technique, Indirect; Gingivitis; Glucocorticoids; Humans; Middle Aged; Mouth Mucosa; Pemphigoid, Benign Mucous Membrane; Tomography, Optical Coherence

Foreign body gingivitis (FBG) is a non-plaque induced chronic inflammatory process involving the marginal and/or attached gingiva. It results from the introduction of foreign particulate material, primarily dental prophylaxis paste and restorative dental materials, into the gingival tissues. Clinical presentation varies from an erythematous to vesiculoerosive-like process that may mimic a localized form of desquamative gingivitis or an erosive lichenoid process. Rarely, it may also present with a granular appearance. We describe the clinical presentation, differential diagnosis and clinical management of a 52-year-old Woman who presented with localized chronic inflammation of the maxillary anterior and left posterior gingiva secondary to the presence of foreign material.

Topics: Anti-Inflammatory Agents; Biopsy; Clobetasol; Diagnosis, Differential; Female; Foreign-Body Reaction; Gingival Diseases; Gingival Hyperplasia; Gingivitis; Glucocorticoids; Granuloma; Humans; Middle Aged

The purpose of this paper is to describe two cases of desquamative gingivitis (DG) that were treated with a topic gel containing clobetasol propionate and Calendula officinalis L in an acetate tray over two years.. Two patients with a diagnosis of lichen planus presenting as DG who had undergone previous treatments for this condition with no significant results, were treated by a handling gel containing clobetasol, nystatin, Calendula officinalis L and pectin in custom trays.. Both patients had remission of symptoms while using the trays and after they stopped the treatment, the symptomatic outbreaks were delayed and presented as less severe symptoms in the two years follow-up. The treatment is aimed primarily at reducing the length and severity of symptomatic outbreaks desquamative gingivitis.. This handling gel using a tray may be an efficacious treatment of desquamative gingivitis.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Calendula; Clobetasol; Drug Delivery Systems; Female; Gels; Gingivitis; Humans; Lichen Planus, Oral; Male; Phytotherapy; Remission Induction

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Dose-Response Relationship, Drug; Double-Blind Method; Gingivitis; Humans; Immunosuppressive Agents; Ointments; Patient Selection; Pectins; Randomized Controlled Trials as Topic; Reproducibility of Results; Research Design; Tacrolimus

Desquamative gingivitis is a condition characterized by intense erythema, ulceration, and desquamation of the free and attached gingiva. Approximately 50% of desquamative gingivitis cases occur on the gingival tissues though it is not uncommon at other intraoral and extraoral sites. Though topical corticosteroids are considered the mainstays in the treatment of desquamative gingivitis, the inability of these medicaments to be in contact with the affected sites for longer duration has been implicated as a factor in reducing the efficacy of this mode of treatment. The case presented here is of a 24-year old male with desquamative gingivitis of 3 years duration. Topical corticosteroid therapy using custom-made acrylic veneers was utilized in the patient with remarkable results. This paper highlights the use of acrylic labial veneers over the gingival tissue as a vehicle for delivering medication and as a way to improve aesthetics.

Topics: Acrylic Resins; Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Dental Veneers; Drug Delivery Systems; Gingivitis; Humans; Male; Pemphigoid, Benign Mucous Membrane

Desquamation of the gingiva is a sign that may be encountered in clinical practice. Various diseases can affect the gingival tissues. Mild desquamation that is localized may be associated with mechanical irritation or induced by trauma. Moderate to severe generalized desquamation associated with ulceration and erythema may be indicative of a more serious systemic condition. Although often overlooked, mucocutaneous diseases frequently present with gingival desquamation as an early presenting symptom. The most common mucocutaneous diseases that affect the oral cavity are lichen planus, pemphigus, and mucous membrane pemphigoid. This article reviews the etiology, signs and symptoms, and therapies for these disorders. Increased knowledge of mucocutaneous diseases can help the clinician recognize these disorders and enable the patient to receive appropriate therapy.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Autoimmune Diseases; Biopsy; Clobetasol; Dapsone; Diagnosis, Differential; Fluocinonide; Gingivitis; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Pemphigoid, Benign Mucous Membrane; Pemphigus; Prednisone

A case of plasma cell mucositis is described for its rarity. A probable aetiological correlation with periodontitis is discussed. The patient showed good response to intralesional and topical steroids.

Topics: Clobetasol; Drug Therapy, Combination; Follow-Up Studies; Gingivitis; Humans; Injections, Intralesional; Lip Diseases; Male; Middle Aged; Mouth Mucosa; Plasma Cells; Treatment Outcome; Triamcinolone