ABSTRACT
A 56-year-old women suddenly had a swelling on her right cheek and on the right side of her upper lip, for which she decided to first visit her family physician and subsequently her family dentist. During the past two years, she was treated for an ovarian carcinoma by an oncologist. Recently, she was using the antihypertensive ACE inhibitor enalapril, prescribed by her family physician. Consultation between her family dentist, family physician and oncologist led to the diagnosis angioedema as an adverse effect of enalapril. The family physician replaced enalapril by the angiotensin II receptor blocker losartan. Subsequently, the swelling disappeared within two days. This angioedema type occurs most frequently in the head and neck area. Oropharyngeal, tongue and laryngeal oedema are very dangerous because they may cause airway obstruction. Today, a live-threatening or fatal condition is mostly prevented as a result of better vigilance of dentists and physicians. Nevertheless, such a condition will still occur occasionally.
Subject(s)
Angioedema , Tongue Diseases , Angioedema/chemically induced , Angioedema/diagnosis , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Face , Female , Humans , Middle AgedABSTRACT
The medicament afamelanotide is an analogue of endogenous ?-melanocyte-stimulating hormone. It promotes cutaneous pigmentation, providing protection from sunlight. In dermatology, afamelanotide seems to establish therapeutic results for polymorphic light eruption, solar urticaria, erythropoietic protoporphyria, Hailey-Hailey disease, vitiligo and acne vulgaris. Afamelanotide is available for non-medical use to realise quick and easy skin tanning. Adverse effects of afamelanotide mentioned in the scientific literature are development and aggravation of melanocytic naevi, degeneration of melanocytic naevi to melanomas, melanonychia, systemic toxicity, rhabdomyolysis, posterior reversible encephalopathy syndrome, priapism and hyperpigmentation of oral soft tissues. Furthermore, numerous adverse effects of afamelanotide have been reported to the Netherlands pharmacovigilance centre LAREB as well as numerous adverse effects due to overdosage of afamelanotide to the National Poisons Information Centre. Dentists should be alert to hyperpigmentation of oral soft tissues due to afamelanotide.
Subject(s)
Hyperpigmentation , Posterior Leukoencephalopathy Syndrome , Humans , Male , Netherlands , alpha-MSH/analogs & derivativesABSTRACT
Scleroderma is a rare connective tissue disease of unknown origin. It is characterized by increased collagen deposition leading to fibrosis and degeneration of the skin and sometimes of internal organs. There are two main groups of scleroderma: circumscribed scleroderma and systemic sclerosis. Circumscribed scleroderma is limited to the skin and systemic sclerosis has involvement of internal organs. The main oral manifestation of scleroderma is microstoma, which is a limiting factor in oral selfcare and professional oral health care. A case report is presented of the treatment of a 15-year-old female scleroderma patient with microstoma.
