Amlexanox for the treatment of recurrent aphthous ulcers

Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease in humans, estimated to affect between 5% and 50% of the general population. The minor manifestation of the condition is the most common and is characterised by small, shallow, round or oval lesions that are surrounded by a raised erythematous halo and are covered by a grey-white pseudomembrane. Appropriate management of patients with this condition is largely symptomatic and should focus on reducing ulcer duration, relieving pain and reducing or preventing ulcer recurrence. Amlexanox is a novel anti-inflammatory and anti-allergic agent that has been evaluated for the treatment of RAU in a series of robust clinical trials. After a 100mg dose of 5% amlexanox topical paste, applied directly to the lesion, the maximum serum concentration of the drug was 120 ng/mL, which was achieved 2.4 hours after application. Steady-state concentrations were achieved within 1 week of starting four times daily dosing and there was no evidence of accumulation. In terms of efficacy, application of 5% amlexanox topical paste was shown to consistently and significantly accelerate complete ulcer healing and the time to resolution of pain across four large efficacy studies. Significantly more patients had completely healed ulcers from day 3 (compared with no treatment) and day 4 (compared with vehicle). Healing was mirrored by an improvement in pain: significantly more patients had complete resolution of pain from day 2 (compared with no treatment) and day 3 (compared with vehicle). Overall, amlexanox was well tolerated, with a low frequency of adverse effects. In the oral application studies, adverse effects that were considered by investigators to be potentially related to the study treatment occurred in 2.4% and 2.1% of 5% amlexanox and vehicle recipients, respectively. These effects were mainly local and were all classed as mild to moderate in severity, with the exception of one case of severe stinging in the vehicle treatment group. Furthermore, the incidence of dermal irritation and sensitisation was very low with amlexanox. These findings suggest that 5% amlexanox topical paste is a useful and well tolerated therapeutic option for the treatment of RAU.     

儿童口腔溃疡治疗及分析

目的对比局部治疗儿童口腔溃疡和综合治疗儿童口腔溃疡的疗效,分析找出最适合治疗儿童口腔溃疡的治疗方法。方法将104例各种儿童口腔溃疡患者分为局部治疗组和综合治疗组。每组52例。局部治疗组按局部治疗方法进行治疗。综合治疗组按综合治疗方法进行治疗。结果综合治疗组总有效率明显高于局部治疗组。综合治疗组口腔溃疡愈合的天数明显少于局部治疗组。结论综合治疗方法可快速治愈儿童口腔溃疡患者,提高儿童机体机能,加强抗病能力,有效防止复发。从而提高儿童口腔溃疡临床疗效。     

Maintenance therapy for prevention of recurrent peptic ulcers

Peptic ulcer disease is a chronic, relapsing disease. Successful healing of duodenal and gastric ulcers with antacids, cimetidine, ranitidine, famotidine, or sucralfate is frequently followed by ulcer recurrence. The need for long-term, low-dose maintenance therapy is based on disease severity, ulcer history, complications, therapeutic intervention, response to treatment, and potential risk factors. Comparison of ulcer maintenance trials requires consideration of important factors such as frequency of endoscopy, duration of follow-up period, and the method used to calculate ulcer recurrence rates. Clinical trials indicate that chronic treatment with low-dose cimetidine, ranitidine, famotidine, and probably sucralfate decreases the frequency of duodenal ulcer recurrence and that ranitidine may be superior to cimetidine. Preliminary studies indicate that higher doses of these same medications may be required to prevent gastric ulcer recurrence. Long-term maintenance therapy with these agents must be continuous in order to prevent relapses, but treatment should be limited to one year because of unknown consequences beyond this period.     

胸腺蛋白口服液治疗复发性口腔溃疡的临床研究

目的：观察胸腺蛋白口服溶液治疗复发性口腔溃疡的疗效。方法选择复发性口腔溃疡患者210例随机分成2组：对照组用维生素加蒙脱石散常规治疗;治疗组在常规治疗的基础上加用胸腺蛋白口服液,观察平均溃疡期与疼痛指数及疗效。结果对照组有效率为72．4％,治疗组有效率为89．5％,2组治疗有效率差异有统计学意义（P＜0．05）。结论胸腺蛋白口服液降低了患者的溃疡时间和疼痛程度,促进复发性口腔溃疡的愈合,提高了愈合质量,并降低复发率,减轻了患者痛苦程度,是适合普通患者的一种有效治疗方法。     

葡萄糖酸锌口服液联合锡类散治疗复发性口腔溃疡

目的 观察锌制剂联用锡类散治疗复发性口腔溃疡的疗效.方法 锡类散局部涂敷,qid;葡萄糖酸锌口服液bid,每次1支.结果 1年内未复发,显效82%,半年内未复发,有效10%,总有效率92%.结论 两药合用,不但促进溃疡愈合,且锌制可能增强机体免疫功能,有效阻止溃疡复发.     

Management of autoimmune skin disorders in the elderly

Senescence of the skin immunological system may explain why the elderly population has an increased susceptibility to certain autoimmune skin disorders. These disorders are characterised by the production of either antibodies that react with host tissue or immune effector T cells that are autoreactive. Bullous pemphigoid is the most common autoimmune blistering disease in the elderly. Although oral corticosteroids are the best established therapy, high-potency topical corticosteroids are very useful as initial treatment and, in the elderly, should be used instead of oral prednisolone wherever possible. Pemphigus is a chronic blistering disease of which there are two main subtypes: vulgaris and foliaceous. Paraneoplastic pemphigus is a unique clinical, histological and immunologically distinct autoimmune mucocutaneous disease which tends to be relentlessly progressive. Lichen sclerosus presents specific complications and a small but definite increased risk of squamous cell carcinoma in elderly patients. It is important to be aware of practical issues such as the difficulty in applying topical corticosteroids, the mainstay treatment of this condition. Dermatomyositis is an autoimmune systemic disorder where the skin and muscles are the most commonly affected organs. Tumour-associated disease occurs more commonly in elderly patients and has a poorer prognosis. Management of the disease includes sunscreens, topical or systemic corticosteroids, antimalarials, oral immunosuppressants or intravenous immunoglobulins. It is important to bear in mind that old age modifies the management of skin diseases because of physical and social circumstances as well as the unwanted adverse effects of medications. Polypharmacy results in an increased risk of drug interactions and, therefore, drug regimens need to be kept as simple as possible. Drug-induced autoimmune skin eruptions are common amongst the elderly and usually resolve when the offending drug is discontinued.     

巨和粒口腔含漱治疗化疗性口腔溃疡的疗效观察

目的探讨恶性肿瘤患者化疗后口腔溃疡治疗及护理的有效措施。方法将化疗后发生口腔溃疡患者随机分为护理组及对照组,每组各25例。护理组于溃疡发生时予巨和粒（rhIL-11）稀释液口腔含漱及氧气雾化局部喷雾;对照组常规予本院特制的薄酚苏打液漱口,持续应用,直到口腔疼痛缓解,溃疡愈合。结果护理组口腔溃疡疼痛持续时间明显缩短,溃疡面愈合时间提前,与对照组比较,差异有显著性（P〈0．05）。结论巨和粒稀释液口腔含漱及氧气雾化局部喷雾能在短时间内缓解口腔溃疡疼痛。促进溃疡面愈合,缩短口腔溃疡病程,有利于化疗按期进行,值得推广应用。     

Prophylaxis and treatment of NSAID-induced gastroduodenal disorders.

A significant percentage of patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) experience some type of adverse gastrointestinal symptoms, lesions of the gastroduodenal tract being clinically the most relevant. NSAIDs cause gastrointestinal damage by 2 independent mechanisms: a topical effect, which is pH and pKa related, and a systemic effect mediated by cyclooxygenase (COX) inhibition with a reduction in prostaglandin synthesis. Using endoscopy, gastroduodenal lesions identified include subepithelial haemorrhages, erosions and ulcers. The prevalence of ulceration in NSAID users has been reported as being between 14 and 31% with a 2-fold higher frequency of gastric ulcers compared with duodenal ulcers. Among the strategies used to decrease the risk of ulcer development are: (i) the use of analgesics other than NSAIDs; (ii) use of the lowest possible dosage of NSAID; (iii) the use of a COX-2 selective NSAID; (iv) the use of low doses of corticosteroids instead of NSAIDs; (v) avoidance of concomitant use of NSAIDs and corticosteroids; and (vi) use of preventive therapy. In an attempt to reduce the incidence of NSAID-induced gastrointestinal lesions, the following approaches have been proposed: (i) use of the prostaglandin analogue misoprostol, which is an antiulcer drug which has been proven to be as effective in the prevention of NSAID-induced gastric and duodenal ulcers as in the reduction of serious upper gastrointestinal complications; (ii) histamine H2 receptor antagonists (H2 antagonists), e.g. ranitidine, cimetidine and famotidine, which are useful in the prevention of NSAID-induced duodenal ulcers during long term treatment, but not in the prevention of NSAID-induced gastric ulcers; (iii) proton pump inhibitors, e.g omeprazole, and pantoprazole, whose efficacy in preventing NSAID-associated ulcers has been recently demonstrated; and (iv) barrier agents, e.g. sucralfate, which cannot be recommended as prophylactic agents to prevent NSAID-induced gastropathy. The first step in the treatment of NSAID-associated ulcers lies in a reduction in the dosage of the NSAID or discontinuation of the drug. If NSAID treatment cannot be withdrawn, a proton pump inhibitor appears to be the most effective treatment in healing ulcers, accelerating the slow healing observed with H2 antagonists.     

白血病患者化疗后实施口腔护理的临床意义

口腔溃疡及炎症是大多数白血病患者化疗期间极易发生的并发症,不仅增加了患者的痛苦,而且加大了致死性感染的几率。因此对化疗患者实施有针对性的口腔护理能有效地预防和治疗口腔溃疡及感染,明显提高口腔及全身抗感染的能力。因此,血液患者化疗后进行口腔护理对于预防和治疗口腔溃疡有着十分重要的意义。     

氨来呫诺糊剂治疗复发性口腔溃疡临床研究

目的研究氨来呫诺糊剂的临床疗效和安全性。方法采用随机、双盲、安慰剂平行对照临床试验法,选择复发性口腔溃疡患者222例,随机分为试验组及对照组,分别给予5g：250mg的氨来呫诺糊剂或氨来呫诺糊剂基质4次／d,连续3d溃疡面涂布治疗。以用药前后患者口腔溃疡的平均溃疡期及疼痛指数作为疗效指标评价药物的疗效。结果试验组平均溃疡期为（5．91±1．64）d,对照组为（8．89±1．71）d（P〈0．05）;试验组临床有效率为85．0％,优于对照组35．2％（P〈0．05）。试验组不良反应发生率为2．78％,对照组为5．66％（P〉0．05）,均为灼热、皮肤丘疹、口干等轻微不良反应。结论氨来呫诺糊剂能有效减轻复发性口腔溃疡的疼痛症状,明显缩短溃疡愈合期。     

Oral lichen planus: an update

Oral lichen planus (OLP) is a chronic autoimmune disease of unknown etiology that affects the skin and mucosae, including the oral cavity. The disease is characterized by lacy, thin white lines on a violaceous background on the oral mucosa, usually on the inside of the cheeks. The disease is also characterized by chronic inflammation and is often associated with severe pain and a burning sensation in the mouth. The etiopathogenesis of lichen planus is complex, with the involvement of T lymphocytes, mast cells, intercellular adhesion molecule-1 (ICAM-1) and major histocompatibility complex class II antigens. The immunologic process results in vacuolar degeneration, lysis of basal cells and, ultimately, liquefaction of the basal cells. The precipitating factors of OLP can be: stress, particular foods, dental plaque, systemic illness and poor oral hygiene. Often no medication is necessary for benign disease. In the case of severe pain and the burning sensation, high potency topical corticosteroids remain the most reliably effective treatment. Other available treatments are topical cyclosporine, tacrolimus, retinoids and other immunosuppressive agents. Systemic corticosteroids may be indicated in patients whose condition is unresponsive to topical corticosteroids. However, OLP remains a challenging disease to treat, in spite of the numerous treatments tried in the patient population.     

Psoriasis

Psoriasis is an inflammatory disorder of the skin that involves complex interactions between the dermis and epidermis. There are several forms of psoriasis, the most common being plaque type psoriasis. Other forms include guttate, pustular and erythrodermic psoriasis. Both the skin and joints are affected in this disease. Psoriasis ranges in severity from a few small plaques to involvement of the entire cutaneous surface. Therapy of psoriasis depends on the location, type and severity of the disease. Treatments include a wide array of topical medications including tars, anthralin, topical corticosteroids, vitamin D(3) analogs, retinoids and over-the-counter preparations. Phototherapy with ultraviolet B and PUVA are used for more widespread involvement. Common systemic therapies include methotrexate, retinoids and cyclosporin. This article will review the pathogenesis and clinical features of psoriasis, as well as current and future therapies.     

Eosinophilic oesophagitis: epidemiology, pathogenesis and management

Eosinophilic oesophagitis (EE) is a clinico-pathological entity recognized with increased frequency in children and adults. It is an atopic disease involving ingested and inhaled allergens. A pathological eosinophilic infiltrate is diagnosed by finding ≥ 15 eosinophils per high-powered field on oesophageal mucosal biopsies. This infiltrate may result in a narrowed oesophageal lumen. It does not involve the stomach or duodenum. Children commonly present with abdominal pain, vomiting and dysphagia. Presentation in adults is with dysphagia, heartburn, chest pain or impaction of a food bolus in the oesophagus. There is often a history of allergy (asthma, hay fever, eczema). A male predominance (70% in adults) is unexplained. Distinctive endoscopic features are linear furrows, mucosal rings and white papules, and the narrowed lumen may be appreciated. Although EE and gastro-oesophageal reflux disease are separate entities, there is a significant overlap of the conditions. Treatment options include nonpharmacological approaches including an elimination or elemental diet, and/ or medications, chiefly with corticosteroids. The topical administration of fluticasone propionate has been demonstrated to improve symptoms and mobilize the pathological infiltrate of eosinophils. There has been a variable effect with the leukotriene receptor antagonist montelukast and promising early results with mepolizumab, a monoclonal antibody against interleukin-5. The long-term efficacy of topical corticosteroids has not been well studied and most patients experience recurrent symptoms when treatment is completed. Currently, repeated short courses of topical corticosteroids are utilized. Acid suppression by a proton pump inhibitor may be considered in view of the overlap between EE and gastro-oesophageal reflux disease.     

Pharmacological management of recurrent oral mucosal ulceration

A number of diseases can cause recurrent intraoral ulceration. This review focuses principally on drug management of intraoral ulceration associated with local and systemic conditions most likely to be observed on an outpatient basis by the general practitioner. These consist of recurrent aphthous stomatitis, erosive lichen planus, benign mucous membrane pemphigoid (BMMP), erythema multiforme. Beh?et's disease, allergic stomatitis and infection. Information is provided on a spectrum of medication found useful in ulcer management, including topical antimicrobial and antifungal agents, topical and systemic corticosteroids, topical and systemic analgesics, and systemic immunosuppressive and anxiolytic drugs, plus details of dosage, important adverse reactions and interactions. A treatment guide for management of recurrent aphthae is presented. The reader is presumed to be familiar with differential diagnosis and the importance of establishing an accurate impression before starting drug therapy.     

Management of pressure ulcers.

PURPOSE: Wound healing, the epidemiology and staging of pressure ulcers, and pressure ulcer prevention and treatment are discussed. SUMMARY: The principal event leading to the formation of pressure ulcers appears to be a consistent interruption in blood supply to the skin. Several known risk factors exist and can be attributed to patient-specific variables and wound-specific conditions. Initial management should include removal of the source of pressure, a comprehensive assessment of the patient, and proper staging of the ulcer. Preparation of the wound for treatment is essential and can have a significant impact on healing. While the patient's nutritional status is thought to affect wound healing, only an increased protein content in the diet has been demonstrated to have a benefit. Specialized wound dressings are available for pressure ulcers of all stages and drainage characteristics. With wide variation in cost and in application regimens, a direct cost-effectiveness comparison of commercially available dressing products is difficult. Many of the growth factors commonly present in healing wounds have been synthesized and evaluated as treatments. Although topical platelet-derived growth factor has demonstrated benefit in some studies, its use remains controversial. To date, no topical growth factors carry FDA-approved labeling for use in the treatment of pressure ulcers. Human skin equivalents mark the latest advancement in therapy. Certain species of bacteria have been associated with poorly healing ulcers and may warrant intervention with either local or systemic antibiotic therapy. CONCLUSION: No pharmacologic intervention has been conclusively shown to be effective for pressure ulcers. The cornerstones of therapy remain elimination of the source of pressure or friction and appropriate wound care. usa.     

Review article: cellular and molecular mechanisms of NSAID-induced peptic ulcers

Background  Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most prescribed drugs worldwide and have now probably overtaken Helicobacter pylori as the most common cause of gastrointestinal injury in Western countries. Further understanding of the pathogenesis of NSAID-induced ulcers is important to enable the development of novel and effective preventive strategies.
Aims  To provide an update on recent advances in our understanding of the cellular and molecular mechanisms involved in the development of NSAID-induced ulcers.
Methods  A Medline search was performed to identify relevant literature using search terms including 'nonsteroidal anti-inflammatory drugs, aspirin, gastric ulcer, duodenal ulcer, pathogenesis, pharmacogenetics'.
Results  The mechanisms of NSAID-induced ulcers can be divided into topical and systemic effects and the latter may be prostaglandin-dependent (through COX inhibition) or prostaglandin-independent. Genetic factors may play an important role in determining individual predisposition.
Conclusions  The pathogenesis of NSAID-induced peptic ulcers is complex and multifactorial. Recent advances in cellular and molecular biology have highlighted the importance of various prostaglandin-independent mechanisms. Pharmacogenetic studies may provide further insights into the pathogenetic mechanisms of NSAID-induced ulcers and help identify patients at increased risk.     

Review article: oral ulcers and its relevance to systemic disorders

Oral ulceration is a common problem, and is sometimes a marker of gastroenterological disease. Patients with signs or symptoms of oral ulcers are sometimes referred to gastroenterology clinics, however, in most instances the ulcers does not reflect gastrointestinal disease. Indeed, a spectrum of disorders other than those of the gut can give rise to oral mucosal ulcers ranging from minor local trauma to significant local disease such as malignancy or systemic illness. This present article reviews aspects of the aetiology, diagnosis and management of common ulcerative disorders of the oral mucosa.     

Review article: the long-term management of ulcerative colitis

After the induction of remission, the second priority of therapy for ulcerative colitis is sustained clinical remission, defined as the absence of inflammatory symptoms (diarrhoea, bleeding, rectal urgency) and the maintenance of an intact mucosa, with the absence of ulcers, friability or significant granularity at endoscopy. The 'optimal' maintenance strategy will depend on the therapy needed to induce remission. Thus, the transition from induction to maintenance therapy will be determined by the intensity of acute therapy necessary to induce remission and the duration of therapy required to complete the resolution of clinical symptoms. There are few controlled clinical trials pertaining to maintenance after each induction regimen. However, experience dictates that aminosalicylates are efficacious after aminosalicylate-induced remissions, that steroids should be tapered according to the time required to induce remission, that patients requiring ciclosporin will benefit from the addition of long-term immunomodulation with azathioprine or mercaptopurine, and that many patients with distal colitis who require topical mesalazine (mesalamine) will continue to need topical therapy to maintain remission, albeit at reduced frequency. The expectations for maintenance therapy require patient adherence to the prescribed treatment regimen. Patients require education with regard to the long-term goals of maintenance therapy (e.g. prevention of relapse, reduction of long-term complications of disease activity or risks of acute therapy with steroids), and should be warned against the use of nonsteroidal anti-inflammatory drugs and cautioned about the cessation of smoking, when applicable, due to potential risks of relapse or chronic activity.     

Topical steroid allergy and dependence

(1) When a topical corticosteroid fails to control a skin condition, the first explanations are usually a wrong diagnosis or inadequate drug potency; however, allergy or dependence should also be considered. (2) Contact dermatitis due to a topical corticosteroid is difficult to diagnose as the symptoms are often mixed with those of the underlying skin disease. Allergy to topical corticosteroids can mimic acute eczema or localised acute swelling. The most commonly affected areas are the legs, hands and face. (3) Risk factors include long term, frequent application of topical steroids by patients with leg ulcers, stasis dermatitis, atopic dermatitis or contact dermatitis (especially on the hands). The diagnostic performance of skin tests is controversial. (4) Several studies and other lines of evidence point to rare allergic cross-reactions to topical corticosteroids, undermining the usefulness of switching to a second topical corticosteroid. (5) Sometimes, especially when skin tests are negative, the problem seems to be dependence to the topical corticosteroid rather than allergy. (6) In practice, stopping the steroid treatment completely is sometimes the best solution, although this may prove difficult.