Hyaluronic acid versus dexamethasone for the treatment of recurrent aphthous stomatitis in children: efficacy and safety analysis

The objective of this study was to compare the safety and efficacy of 0.2% hyaluronic acid (HA) topical gel and dexamethasone topical ointment in the treatment of recurrent aphthous ulcers (RAU) in children. This retrospective observational study included 104 patients who had more than two episodes of oral aphthous ulcers per year and were treated with HA (n=52) or dexamethasone (n=52) from August 15, 2014 to September 3, 2018. Therapy efficacy was evaluated based on the ulcer size and pain score before versus 7 days after either therapy. The paired t-test, chi-squared test, and independent t-test were utilized for statistical analyses. There was no significant difference in ulcer size or pain score between the HA and dexamethasone groups, on day 1 or day 7. Both treatments were tolerated well and no side effects were reported. No significant differences in body temperature, respiration rate, pulse, or systolic/diastolic blood pressure were observed between the start (day 1) and end of treatment (day 7), for either treatment. HA and dexamethasone showed similar efficacy in reducing ulcer size and pain scores, and were tolerated equally well in children with RAU. Future high-quality studies with larger numbers of patients are needed to confirm our findings.

O papel dos anti-inflamatórios não hormonais no tratamento da dor musculoesquelética / The role of non-steroid anti-inflammatory in the treatment of musculoskeletal pain

Os anti-inflamatórios não esteroides (AINEs) estão entre os medicamentos mais comumente prescritos em todo o mundo e são responsáveis por cerca de um quarto de todas as notificações de reações adversas. Têm sido amplamente indicados em pacientes com doença reumática e outras doenças musculoesqueléticas - população de maior risco de graves complicações gastrintestinais (GI). Os AINEs tópicos são administrados para o tratamento de diversas condições: lesões musculoesqueléticas, dor pós-operatória, neuralgia pós-herpética, periodontite, úlceras aftosas e ceratoses actínicas. Dados mostram que metade dos AINEs é indicada para osteoartrite (OA). Sua administração tópica oferece como benefício menor incidência de efeitos adversos sistêmicos, como úlcera péptica e hemorragia GI, na metabolização do medicamento nos tecidos afetados...

Nonsteroidal anti-inflammatory are among the drugs more usually prescribed in all over the world which is responsible for about a fourth of all notifications of adverse reactions. It has been widely indicated in patients with rheumatic disease and others musculoskeletal disease - high risk population of severe gastrointestinal complications (GI). The topic AINEs are managed for the treatment of many conditions: musculoskeletal injury, postoperative pain, postherpetic neuralgy, periodontic, mouth ulcer and actinic keratosis. Data show that half of AINEs are indicated for osteoarthritis (OA). Its topic administration provides benefits like less incidence of systemic adverse effects like peptic ulcer and GI bleeding in drug-metabolizing in affected tissues...

Assessment of serum interleukin-8 as a sensitive serological marker in monitoring the therapeutic effect of levamisole in recurrent aphthous ulcers: A randomized control study.

Aim: The study was designed to evaluate the serum interleukin‑8 (IL‑8) levels in patients with recurrent aphthous ulcer (RAU) and monitor the immunomodulation and altered IL‑8 levels by levamisole before therapy and after levamisole therapy. Materials and Methods: This study was carried as a randomized case‑control study involving a study group of 30 patients diagnosed as RAUs and given levamisole (vermisole 150 mg, od for 1st 3 days of 3 weeks in a month and for 3 months with a gap of 1 week) and these patients were recalled after 3 months and were subjected for estimation of serum IL‑8 levels. Control group had 20 age and sex matched individuals with no systemic illness and were not given any levamisole. Good compliance was reported at the end of the study. Results: Mild gastric irritation was reported and when severe it was managed by H1 blocker. Patients were reviewed after 3 months. The follow‑up data at each visit with respect to each other and to base‑line values was calibrated using a Students t‑test. Highly significant comparisons were obtained in the serum IL‑8 between study and control groups before the onset of levamisole (t = 6.53, P ≤ 0.001). IL‑8 levels reduced by 72% after levamisole was instituted in RAU patients and comparison was highly significant for before and after levamisole onset (t = 5.54, P ≤ 0.001). Conclusion: This study points to the effectiveness of levamisole as an effective adjunct therapy in the routine management of RAU.

[ effect of purslane in the treatment of recurrent aphthous stomatitis]

Recurrent aphthous stomatitis [RAS] is a common disease with unknown etiology. There is no curative treatment. Purslane is considered as a rich source of antioxidants with anti-inflammatory effects. The purpose of this study is to evaluate the effect of Purslane in the treatment of RAS. A total of 50 patients were selected for this randomized triple-blind placebocontrolled clinical trial from School of Dentistry of Tehran University of Medical Sciences in 2011. All subjects were randomly divided into two groups. Groups A and B received placebo and Purslane, respectively, for three months. Pain intensity based on the visual analogue scale [VAS], the mean intervals of lesions occurrence, number of lesions and the mean duration of complete healing at baseline and at months 1, 2 and 3 were recorded. While no patient complained from increased severity of pain, decreased severity of pain for 4, 3, 2, and 1 grades were recorded in%16,%20, 20%, and 40%, respectively, which were much higher than 4%, 8%, 8%, and 28%, respectively, in the control group. A significant decrease in pain intensity in VAS scores were seen after treatment in group B [P<0.001]. The mean duration of complete healing showed significant differences [P<0.001] between groups A [-1.52 +/- 4.07 days] and group B [-6.56 +/- 4.50 days]. The mean intervals between lesions also showed significant differences [P<0.001] between group A [17.88 days] and group B [33.12 days]. No significant differences were found between group A and group B regarding to number of lesions. No serious side-effects occurred in either group. According to our study, Purslane is clinically effective in treatment of RAS and considering the lack of side-effects during the study period, this medicine may be a favorable alternative treatment for recurrent aphthous stomatitis.

Vitamin B12 for the treatment of recurrent aphthous stomatitis

The purpose of this study was to confirm the beneficial effects of Vitamin 12 in the treatment of Recurrent Aphthous Stomatitis. This study was conducted at the Department of Oral Medicine of Khyber College of Dentistry, Peshawar on 65 patients suffering from Recurrent Aphthous stomatitis. The patients were randomly divided in to two groups A sublingual dose of Vitamin B12 500 mcg and 1000 mcg was administered to the two groups for 6 months. There were 35 patients in Group-I who were given l000mcg Vitamin B 12 sublingually while in Group-II, 30 patients were given 500 mcg Vitamin B 12 sublingually for 6 months at bed time. The parameter has been recorded in each group on monthly basis for 6 months. The level, duration of pain, the number of outbreak and the size of ulcer was considerably reduced in patients who were treated with Vitamin B 12 l000mcg irrespective of blood Vitamin 12 level as compared to patients taking 500 mcg Vitamin B 12. There was no Recurrent Aphthous stomatitis in Group-I at the end of 6 months while in Group-II there was 30% relief. Thus Vitamin B 12 1 000 mcg sublingually in the treatment of Recurrent Aphthous ulceration is a safe, effective, inexpensive and low risk treatment regardless of serum Vitamin B 12 level in the blood

Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial

PURPOSE: This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS. METHODS: An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset. RESULTS: The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5 percent). Dapsone was prescribed for a total of nine patients, of whom eight (89 percent) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90 percent), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60 percent), of whom one patient showed complete remission. CONCLUSION: The therapeutic methods used in this trial provided significant symptom relief. Patients experienced relapses of the lesions; however, this occurred after withdrawal of their medication during the follow-up period.

Levamisol não previne lesões de estomatite aftosa recorrente: um ensaio clínico randomizado, duplo-cego e controlado por placebo / Levamisole does not prevent lesions of recurrent aphthous stomatitis: a double-blind placebo-controlled clinical trial

OBJETIVO: Avaliar a eficácia e a segurança do levamisol no tratamento profilático da afta recorrente, utilizando um protocolo de estudo duplo-cego. MÉTODOS: Quatorze pacientes receberam doses decrescentes de levamisol por via oral por seis meses (dose inicial de 150mg três vezes por semana). Dez pacientes receberam placebo. As avaliações foram mensais. RESULTADOS: Houve tendência à diminuição do número de crises nos dois grupos, mas sem diferenças entre ambos. O número de lesões diminuiu significantemente nos grupos levamisol e placebo, mas na comparação entre eles a diferença não foi significante. A duração das lesões diminuiu significantemente no grupo placebo, porém ao compará-lo com o grupo levamisol a diferença não foi significante durante todo o tratamento. A intensidade da dor foi significantemente menor nos dois grupos, mas ao compará-los a dor foi significantemente menor no grupo placebo. A avaliação global final mostrou melhora em 50 por cento dos pacientes do grupo levamisol e em 70 por cento do Placebo, sem diferença significante entre os dois tratamentos. Não foi observada diferença na frequência de efeitos colaterais entre os grupos. CONCLUSÃO: Levamisol, como usado nesse protocolo, é uma droga segura. Comparado ao placebo, levamisol não é efetivo no tratamento profilático da afta recorrente. O efeito placebo é importante em desordens nas quais fatores emocionais afetam a recorrência ou a expressão de sintomas.

OBJECTIVE: to utilize a double-blind protocol to provide clarification about the safety and effectiveness of levamisole in the treatment of recurrent aphthous stomatitis. METHODS: Fourteen patients took a decreasing dose of oral levamisole for six months (initial dose 150mg three times a week) and ten others were placebo control patients. All were evaluated monthly. RESULTS: The number of crises had a tendency to decrease in both groups, but without a difference between groups. The number of lesions diminished significantly in the two groups, but upon comparison the difference was not significant. Duration of the lesions diminished significantly in the placebo, however when compared to the levamisole group, difference was not significant during treatment. The intensity of pain was significantly lower in the two groups, but upon comparison, pain was significantly lower in the placebo group. The final global evaluation showed improvement in 50 percent of patients of the levamisole group and in 70 percent of the placebo, without a significant difference between treatments. No difference in the frequency of collateral effects was observed between groups. CONCLUSIONS: Levamisole, as used in this protocol, is a safe drug. When compared with the placebo, levamisole is not effective in the prophylactic treatment of recurrent aphthous stomatitis. The placebo effect is important in diseases where emotional factors affect recurrence or expression of symptoms.

Uso del Interferón Alfa en enfermedades virales por vía tópica / The usage of topic Alfa interferon in viral diseases

El Interferón es un conjunto de proteínas que se producen principalmente frente a un estímulo viral, también favorece y promueve otros mecanismos inmunológicos por lo cual es considerado una Citoquina, siendo el uso más frecuente, el terapéutico, en aquellas enfermedades donde se sospeche un origen principalmente viral. Desde su descubrimiento en el año 1957, el uso terapéutico es en afecciones las cuales se sospeche un origen viral y el cáncer, siendo más limitado su empleo como estimulador del Sistema Inmunológico. En el presente trabajo hemos tomado un grupo de estudio constituido por 362 pacientes al cual se le aplicó el Interferòn por vía tópica comparado con un Grupo control formado por 343 pacientes tratados con la terapéutica convencional durante 10 años de tratamiento. A ambos grupos se les habían diagnosticado diversas afecciones Virales de Piel y Mucosas y fueron tratados por un espacio de 10 años, tomándose una muestra inicial antes del tratamiento y posterior al mismo con intervalos de 1, 3, 6,12 meses y a los dos años de iniciado el tratamiento, comparándose algunos parámetros de la respuesta inmunológica, detectándose posteriormente en el grupo de estudio un aumento de la Inmunidad Humoral Sistémica, una remisión de los síntomas de más de 6 años y pocas reacciones colaterales.

The Interferon is a group of proteins, produced mainly against a viral stimulus; it also favors and promotes other immunologic mechanisms and that is why it is considered a cytokine, being its most frequent use, therapeutic, mainly in diseases of suspected viral origin. Since it was discovered in 1957, it has been therapeutically used in affections of suspected viral origins and cancer, being more limitedly used as a stimulator of the Immunological System. In our work we had a study group composed by 362 patients, who received Interferon by topical way, compared to a control group of 343 patients treated with conventional therapy during 10 years. Both groups were diagnosed with various viral affections of the skin and the mucous membrane. They were treated during 10 years, taking a sample before the treatment began and at the end of the 1 st , 3 rd , 6 th , 12 th months and the 2 nd year after the beginning of the treatment. Some parameters of the immunologic answer were compared, detecting in the study group an increase of the Systemic Humoral Immunity, a remission of the more-than-6-years symptoms and few side effects.

Comparison between the two mouth rinses [Persica and antiseptic Irsha] on recurrent aphthous stomatitis

Recurrent aphthous stomatitis [RAS] is one of the most common and the most pathologic status of oral soft mucosa. Frequencies of RAS is between%10 and%20 in population. Numerous agents have been evaluated in the treatment of RAS with mixed results. These agents include antihistamines, anesthetics, vitamins, Levamisole, antibiotics and corticosteroids. The aim of this study was to compare the efficacy of Irsha and Persica mouthrinses on RAS. Thirty - nine patients with recurrent aphthous stomatitis were selected for this double blind clinical trial trial [21 females and 18 males]. Twenty patients were assigned to use Irsha [group A] and nineteen to use Persica [group B] mouth rinse, twice a day for 30 seconds. This base population was identified by clinical examination of aphthous ulceration and based on specific criteria for clinical diagnosis, including appearance, location, size and number of lesions. The results were analyzed by Wilcoxon and Mann - whitney U tests. In three months treatment, the mean value was respectively 18.5 for Irsha and 21.25 for Persica. There was no significant difference between them. Both Irsha and Persica significantly reduced the duration and severity of RAS as compared with baseline in a protocol that included clinical diagnosis, individual patient baseline evaluation and pervision of each patient during the study. According to this study Persica and Irsha mouth rinses have similar effects on RAS. Both of them reduce pain, sore and duration of healing and can be used for treatment of RAS

Comparison of serum zinc level in recurrent aphthous patients and normal individuals

Recurrent oral aphthous is one of the most common ulcerative lesions of the oral cavity which no specific treatment has been introduced for it, sofar. Some studies suggest the zinc deficiency as one of the etiologic factors in aphthous ulcers and also in other experimental studies, zinc composition has been effective in aphthous treatment. The aim of this study was to determinate the serum zinc level in normal and aphthous individuals. This was a case-control study in which 88 individuals [44 normal and 44 aphthous patients] were studied. Both groups were equalized for age and sex. Sampling was convinence. The blood samples were taken and the zinc level of them were measured by Atomic Absortion Spectrometer and then the results were statistically analyzed with t-test. This study showed that the average serum zinc level in the case group was 70 +/- 9 microg/dlit [mean +/- SD] and in the control was 94 +/- 14 microg/dlit and there is a significant difference between two groups [P<0.001]. According to above results, serum zinc level is significantly lower in Recurrent Aphtous Stomatitis [RAS] patients, thus the determination of serum zinc level, and prescribing zinc if its serum level is low, are recommended in RAS patients

Hematologic abnormalities in recurrent oral ulceration.

The aim of this study was to analyse the hematologic status in patients with recurrent oral ulceration (ROU). Twenty-three patients with ROU and 19 control subjects were examined consecutively for hematological abnormalities including serum folate, red cell folate and vitamin B12 levels. Their complete blood counts, hemoglobin typing, serum and red cell folate and serum vitamin B12 levels were studied. Low red cell folate levels were found in 11 out of 23 patients (47.83%) with ROU. They were defined as having folate deficiency (n=5), folate deficient erythropoiesis (n=1), and folate depletion (n=5). The serum and red cell folate levels in the control group were within normal range. There was a statistically significant low red cell folate in the ROU compared to the control group (p=0.000). The serum vitamin B12 levels were within normal range in both ROU and control groups. Hemoglobin, hematocrit and mean corpuscular hemoglobin concentrations were in the normal range in both groups and none had anemia or macrocytosis.

Thalidomide: a re-look.

Thalidomide was synthesized in 1954 in erstwhile West Germany and marketed as a sedative in over 46 countries until the early 1960s. Owing to serious teratogenic effects, the drug was withdrawn from the market in 1961. A chance observation suggested the utility of thalidomide in erythema nodosum leprosum (ENL). After many controlled and uncontrolled trials were published, the World Health Organization recommended its use in ENL. The Food and Drug Administration, USA approved it for use in ENL in July 1998. Only established and well-defined studies conducted to substantiate the efficacy of thalidomide have been included in this review. Thalidomide is considered the drug of choice for the treatment of ENL, but for other conditions, it is recommended only when resistance to the currently available form of therapy is encountered. Once the anti-inflammatory, immuno-modulatory, anti-TNF-alpha and anti-angiogenic properties of thalidomide were discovered, it was also tried in AIDS and related wasting, apthous ulcers, microsporidiosis and Kaposi's sarcoma. Thalidomide has no clinical place as an immunosuppressant in solid organ transplantation. However, it has a therapeutic role in graft-verus-host-disease. Among the dermatological conditions, thalidomide has been found to be effective in systemic lupus erythematosus, discoid lupus erythematosus, actinic prurigo and prurigo nodularis. Used correctly, it is a safe and effective medicine (except for its teratogenic potential and delayed neuropathy) in a variety of disease conditions.

Aftas (ulceraçöes aftosas recorrentes): diagnóstico e tratamento / Aphtous (recurrent aphtous ulceration): diagnosis and treatment

Revisäo da literatura sobre as ulceraçöes aftosas recorrentes, com relaçäo à epidemiologia, etiologia, classificaçäo, localizaçäo, diagnóstico, estagios evolutivos e possíveis formas de tratamento.

Efectos del propoleos en los tratamiento quirurgicos y las ulceras bucales / Effects of propolis on surgical treatments and buccal ulcers

Se estudia la efectividad del propoleo para irrigar zonas intervenidas quirurgicamente en pacientes con distintas afecciones bucales. En las ulceras bucales, la disminucion del dolor y la cicatrizacion fue mas rapida que en el grupo donde se aplico el balsamo de Chostakovski. Se concluye que las propiedades antimicrobianas, hemostaticas y antiinflamatorias del propoleo favorecieron una recuperacion mas rapida y mejor de los tejidos en el posoperatorio de los pacientes intervenidos quirurgicamente, que en aquellos del grupo control. Asimismo, se obtuvo una regresion mas rapida de los sintomas dolorosos y una mejor curacion de las ulceras al comparar los resultados en ambos grupos