A set of thoughts on a series of patients with oral viral papillomas caused by the HPV 6 and 11 viruses: A brief review.

Introduction: Papillomas are associated with human papillomaviruses (HPV) and are commonly benign. Typically, the clinical presentation establishes the diagnosis, and treatment comprises excision and histological analysis. Objective: In light of our series of 39 patients with viral papillomas of the oral mucosa, we would like to express our concerns regarding the treatment of patients diagnosed with HPV 6 and 11-positive oral papillomas. Materials and Methods: The research is based on an analysis of 39 patients with oral papillomas who underwent conventional HPV viral testing. The analysis was conducted utilizing the in situ hybridization method. Patients tested positive for HPV subtypes 2, 4, 6, 11, 16, 18, 31, 33, and 51. More than fifty percent of individuals tested positive for HPV 6 and 11. Conclusion: HPV subtypes have been identified in lesions with comparable clinical presentation. Many of our patients carry the HPV subtypes 6 and 11, which have been associated to sexual transmission. However, more transmission routes are also possible. The ideal treatment for us would be a referral to a Venereologist for a thorough sexually transmitted illness examination.

Real world evidence: Patients with refractory pemphigus treated with Rituximab.

BACKGROUND: Pemphigus is a group of autoimmune blistering diseases, potentially life-threatening. Rituximab received FDA approval in June 2018 for the treatment of moderate to severe pemphigus vulgaris. OBJECTIVES: To evaluate the efficacy and safety of rituximab in patients with pemphigus, resistant to previous therapies or unable to receive classic immunosuppressive treatment due to serious adverse events or comorbidities. MATERIALS AND METHODS: Twenty-five patients (9 men, 16 women), mean age 49.4 ± 15.9 years (range 21-74 years), mean disease duration 4 ± 2.7 years (range 0.25-10 years) were included in the study: 19 patients with pemphigus vulgaris and 6 with pemphigus foliaceous. The efficacy of rituximab was evaluated according to the control of disease, retention of remission, disease severity, previous treatments and adverse reactions. During COVID-19 pandemic patients are monitored closely through tele-dermatology. RESULTS: Twenty-three out of 25 patients had great improvement, 2 out of 25 ceased therapy due to adverse events (arthralgias and dyspnea). Sixteen out of 23 received additional course after 8 months (range 5-60 months). More aged patients presented more frequently adverse events and underwent additional courses (p = 0.002). Rituximab was found superior to classic immunosuppressive treatment in terms of efficacy and safety, with larger periods of remission and lower doses of corticosteroids and immunosuppressants. No major adverse events were noticed. CONCLUSIONS: Rituximab is a very effective treatment of pemphigus and, remarkably, superior to classic immunosuppressive treatment.

Isolated lip dermatitis (atopic cheilitis), successfully treated with topical tacrolimus 0.03% / Dermatitis labial aislada (queilitis atópica), tratado con éxito con tacrolimus tópico al 0,03%

Background: Exfoliative and erosive cheilitis, may be a source of speech and chewing discomfort, but may alsobe an aesthetic issue for the patients affected. Such a clinical presentation may implicate a variety of inflamma-tory conditions, including atopic (eczematous) cheilitis. Topical and systemic agents, e.g. corticosteroids, havebeen used to treat inflammatory lip conditions. Topical tacrolimus has also been used in some inflammatory lipconditions.Material and Methods: We performed a retrospective clinical analysis of atopic cheilitis patients.Results: Between 2015 and 2020, we addressed 7 (seven) patients with atopic dermatitis affecting only lips andwere diagnosed as atopic-eczematous cheilitis. They were treated with 0.03 per cent topical tacrolimus ointmentand responded completely.Conclusions: These cases represent an underreported atopy / eczema event;-few cases of atopic cheilitis withoutconcomitant dermal lesions appear in the literature. We are also showing and discussing yet another applicationof tacrolimus in a local atopic form of inflammation affecting the lips.(AU)

Loss of Foveal Cone Structure Precedes Loss of Visual Acuity in Patients With Rod-Cone Degeneration.

Purpose: To assess the relationship between cone spacing and visual acuity in eyes with rod-cone degeneration (RCD) followed longitudinally. Methods: High-resolution images of the retina were obtained using adaptive optics scanning laser ophthalmoscopy from 13 eyes of nine RCD patients and 13 eyes of eight healthy subjects at two sessions separated by 10 or more months (mean 765 days, range 311-1935 days). Cone spacing Z-score measured as close as possible (average <0.25°) to the preferred retinal locus was compared with visual acuity (letters read on the Early Treatment of Diabetic Retinopathy Study [ETDRS] chart and logMAR) and foveal sensitivity. Results: Cone spacing was significantly correlated with ETDRS letters read (ρ = -0.47, 95%CI -0.67 to -0.24), logMAR (ρ = 0.46, 95%CI 0.24 to 0.66), and foveal sensitivity (ρ = -0.30, 95%CI -0.52 to -0.018). There was a small but significant increase in mean cone spacing Z-score during follow-up of +0.97 (95%CI 0.57 to 1.4) in RCD patients, but not in healthy eyes, and there was no significant change in any measure of visual acuity. Conclusions: Cone spacing was correlated with visual acuity and foveal sensitivity. In RCD patients, cone spacing increased during follow-up, while visual acuity did not change significantly. Cone spacing Z-score may be a more sensitive measure of cone loss at the fovea than visual acuity in patients with RCD.

A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging.

PURPOSE: High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. METHODS: The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. RESULTS: The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. CONCLUSIONS: Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. TRANSLATIONAL RELEVANCE: Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening.

Relationship Between Foveal Cone Structure and Visual Acuity Measured With Adaptive Optics Scanning Laser Ophthalmoscopy in Retinal Degeneration.

Purpose: To evaluate foveal function in patients with inherited retinal degenerations (IRD) by measuring visual acuity (VA) after correction of higher-order aberrations. Methods: Adaptive optics scanning laser ophthalmoscopy (AOSLO) was used to image cones in 4 healthy subjects and 15 patients with IRD. The 840-nm scanning laser delivered an "E" optotype to measure AOSLO-mediated VA (AOSLO-VA). Cone spacing was measured at the preferred retinal locus by two independent graders and the percentage of cones below the average density of 47 age-similar healthy subjects was computed. Cone spacing was correlated with best-corrected VA measured with the Early Treatment of Diabetic Retinopathy Study protocol (ETDRS-VA), AOSLO-VA, and foveal sensitivity. Results: ETDRS-VA significantly correlated with AOSLO-VA (ρ = 0.79, 95% confidence interval [CI] 0.5-0.9). Cone spacing correlated with AOSLO-VA (ρ = 0.54, 95% CI 0.02-0.7), and negatively correlated with ETDRS letters read (ρ = -0.64, 95% CI -0.8 to -0.2). AOSLO-VA remained ≥20/20 until cones decreased to 40.2% (CI 31.1-45.5) below normal. Similarly, ETDRS-VA remained ≥20/20 until cones were 42.0% (95% CI 36.5-46.1) below normal. Cone spacing z scores negatively correlated with foveal sensitivity (ρ = -0.79, 95% CI -0.9 to -0.4) and foveal sensitivity was ≥35 dB until cones were 43.1% (95% CI 39.3-46.6) below average. Conclusions: VA and foveal cone spacing were weakly correlated until cones were reduced by 40% to 43% below normal. The relationship suggests that VA is an insensitive measure of foveal cone survival; cone spacing may be a more sensitive measure of cone loss.

Chronic lip swelling as the sole presentation of Crohn's disease: three case reports.

Chronic lip swelling may be a clinical sign of a systemic disease, such as Crohn's. We report two cases of children in Greece where the chronic lip swelling was not only the initial, but the sole clinical symptom of Crohn's, and another case with only granulomatous cheilitis up to now. All lip biopsies revealed granulomatous cheilitis. The ileocolonoscopy revealed granulomatous ileitis, and the video capsule endoscopy aphthous lesions in the jejunum in the first two cases. The diagnosis of Crohn's was then established, and treatment was started. In the third case only granulomatous cheilitis was revealed. He was started on minocycline and corticosteroids and remains under frequent monitoring in case he should develop Crohn's. Clinicians should bear in mind that inflammatory bowel disease may present with atypical symptoms. This could thus be the case for any child with persistent lip swelling, and therefore further examinations should be performed to establish the diagnosis.

Biologic agents and oral diseases -- an update on clinical applications.

Biologic agents are targeted immune modulating agents that have been widely used in the treatment of inflammatory and neoplastic conditions with favorable results. The purpose of this review is to provide an update on the biologic agents that have been used in the treatment of diseases that affect the oral mucosa. Identification of relevant data, case reports and case series was performed using the PubMed-MEDLINE database and electronic databases of accredited organizations such as the European Medical Agency, US Food and Drug Administration, and clinicaltrials.gov (USA). According to the literature, the use of biologic agents in patients with oral diseases is limited mainly to patients suffering from refractory forms of immune-mediated diseases of the oral cavity. Biologic agents were used in all cases as off-label indications. Patient's response varied, but in general biologic agents could be considered as a therapeutic option in patients with no other alternative. A point requiring extra precaution is their safety profile because severe life threatening infections are among their side effects. Another aspect that limits their broader use is their high economic cost. We aimed to provide a practical update for the clinicians who deal with oral diseases, covering as many aspects as possible of the applications of biologic agents in oral diseases reported to date.