Diclofenac in hyaluronic acid gel: an alternative treatment for actinic cheilitis

Objective

Actinic cheilitis (AC) is a precancerous lesion of the lip vermillion caused by prolonged exposure to ultraviolet light. The aim of this study was to evaluate the effect of 3% diclofenac in 2.5% hyaluronic acid gel in the treatment of AC.

Methods

Thirty-four patients with chronic AC were treated twice a day with topical diclofenac during a period of 30 to 180 days. The individuals were followed up every 15 days by means of clinical examination and digital photographic documentation.

Results

Of the 27 patients that completed the study, 12 (44%) showed complete remission of the whitish plaques and exfoliative areas, and 15 (56%) had partial remission of the clinical picture of cheilitis. The latter group was submitted to excision of the leukoplakic areas which diagnosis varied from mild to moderate epithelial dysplasia.

Conclusion

The results suggest a promising role for diclofenac in hyaluronic acid gel in the treatment of AC. This treatment has the advantages of not being invasive and showing few side effects.     

慢性唇炎中医治疗现状及研究进展

慢性唇炎是一种常见的口腔黏膜病,病因较复杂,没有特效药物或疗法。单纯用西药治疗,常不能治愈。采用中西医结合治疗此病,不仅可以提高疗效,还可以减轻西药的副作用。查阅1979年至今国内发表的有关中西医结合治疗慢性唇炎的文献,总结中医治疗的方法及药物,以期为以后的临床及研究提供一定的参考。     

Cheilitis Granulomatosa: A Review

Cheilitis granulomatosa (CG) is a cosmetically disturbing and persistent idiopathic lip swelling. It is one manifestation of orofacial granulomatosis (OFG), which is a clinical entity describing facial and oral swelling in the setting of non-caseating granulomatous inflammation and in the absence of systemic disease such as Crohn’s disease and sarcoidosis. CG can occur by itself or as part of the Melkersson–Rosenthal syndrome, which includes facial palsy and a plicated tongue. Other proposed causes of OFG include dietary allergens such as cinnamon and benzoates. Similar orofacial swelling may be an early manifestation of Crohn’s disease or sarcoidosis, and so clinical history is important in diagnosis. The cause of CG has not been wholly elucidated, but a current hypothesis holds that a random influx of inflammatory cells is responsible. Other granulomatous and edematous causes of lip swelling must be investigated prior to diagnosis. Options for treatment include dietary modifications, antibiotics, systemic or intralesional corticosteroids, and surgery, although treatment is not always necessary. CG should be considered in the differential of persistent lip swelling.     

Association between orofacial granulomatosis and Crohn’s disease in children: Systematic review

AIM: To review pediatric cases of orofacial granulomatosis (OFG), report disease characteristics, and explore the association between OFG and Crohn’s disease.METHODS: We conducted a systematic review according to the PRISMA guidelines. We searched Medline, LILACS, Virtual Health Library, and Web of Knowledge in September 2013 for cases of OFG in the pediatric age range (< 18 years), with no language limitations. All relevant articles were accessed in full text. The manual search included references of retrieved articles. We extracted data on patients’ characteristics, disease characteristics, association with other diseases, and treatment. We analyzed the data and reported the results in tables and text.RESULTS: We retrieved 173 reports of OFG in children. Mean age at onset was 11.1 ± 3.8 years (range: 2.0-18 years). Prevalence in males was significant higher than in females (P < 0.001), with a male:female ratio of 2:1. Gastrointestinal signs or symptoms were present in 26.0% of children at the time of OFG diagnosis. Overall, 70/173 (40.4%) children received a concomitant diagnosis of Crohn’s disease. In about half (51.4%) of the cases the onset of OFG anticipated the diagnosis of Crohn’s disease, with a mean time between the two diagnoses of 13.1 ± 11.6 mo (range: 3-36 mo). Overall, 21/173 (12.1%) of the children with OFG had perianal disease, while 11/173 (6.4%) had a family history of Crohn’s disease. Both perianal disease and a family history of Crohn’s disease were significantly associated with a higher risk of Crohn’s disease diagnosis in children with OFG [relative risk (RR) = 3.10, 95% confidence interval (CI): 2.46-3.90; RR = 2.74, 95%CI: 2.24-3.36, P < 0.0001 for both). Treatment of OFG included steroids (70.8% of children) and other immunosuppressive drugs (42.7%), such as azathioprine, thalidomide and infliximab.CONCLUSION: High prevalence of Crohn’s disease in children with OFG suggests that OFG may be a subtype of Crohn’s disease.     

平阳霉素治疗肉芽肿性唇炎的效果观察

目的探讨平阳霉素治疗肉芽肿性唇炎的疗效.方法将22例肉芽肿性唇炎患者随机均分为试验组和对照组,分别用平阳霉素和得保松注射病变部位,每2周1次,共注射2次.结果平阳霉素治疗肉芽肿性唇炎治愈率82%,得保松治愈率27%;平阳霉素疗效优于得保松,差异有统计学意义（P＜0.01）.结论平阳霉素是一种治疗肉芽肿性唇炎理想的新方法.     

0.1%他克莫司软膏治疗唇炎的临床效果观察

目的：探讨0.1%他克莫司软膏治疗唇炎的临床效果。方法选择2013年4月~2014年3月本院就诊的36例唇炎患者作为观察对象,外涂0.1%他克莫司软膏,早晚各1次,7 d为1个疗程,连续使用2个疗程。另设30例作对照,外涂丁酸氢化可的松软膏,早晚各1次,7d为1个疗程,连续使用2个疗程。结果他克莫司组的总有效率为94.4%,明显高于丁酸氢化可的松组(80.0%),差异有统计学意义(P<0.05);治疗结束后进行了3个月的随访发现,他克莫司组中4例患者复发,复发率为11.1%,丁酸氢化可的松组中有8例患者复发,复发率为26.7%,他克莫司组的复发率显著低于丁酸氢化可的松组,差异有统计学意义(P<0.05)。结论0.1%他克莫司软膏治疗唇炎的效果显著,复发率低,值得临床推广应用。     

浆细胞性唇炎１例

报告１例浆细胞性唇炎。患者男,５２岁,下唇这办清楚的暗红色斑块,有少量解唇屑回皮。组织病理示真皮层呈现弥漫密集的浆细胞和少量淋巴细胞浸润。     

Melkersson–Rosenthal Syndrome: Reduction Cheiloplasty Utilizing a Transmodiolar Labial Suspension Suture

Melkersson–Rosenthal syndrome is a rare condition which consists of progressive and recurrent orofacial edema, intermittent facial palsy, and lingua plicata. Labial swelling is the most common feature of this syndrome complex. The lips may enlarge up to three times their normal size, resulting in aesthetic deformity and functional disability. Traditional medical interventions are only marginally successful in treating this syndrome. We present a case of Melkersson–Rosenthal syndrome with massive lower lip enlargement, which was successfully treated by combining a fleur-de-lis resection with a transmodiolar labial suspension suture. Five-year follow-up photographs are presented.     

前列腺不同疾病在移行区的超声表现

目的了解前列腺移行区在前列腺不同疾病中的形态特征.方法采用经直肠超声断层法观测了280例不同年龄、不同前列腺疾病的移行区形态特征及大小变化.结果①正常前列腺的移行区最易辨认,位于腺体中央偏前方,呈椭圆形稍低回声暗区,比周边区回声弱.前列腺炎和前列腺癌的移行区变化不大.前列腺增生症表现为移行区扩大,回声增强,边缘模糊,与周边区不易分清.单纯前列腺结石的移行区不扩大,合并前列腺增生症时,移行区扩大.②各年龄段前列腺移行区面积随年龄增大而增大.结论移行区增生、扩大是前列腺增生的主要形式.