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Oral Roflumilast Shows Promise In Treating Recurrent Aphthous Stomatitis: Multicenter Study Highlights Efficacy And Safety
Spain: A multicenter observational study has highlighted the potential of oral roflumilast, a phosphodiesterase-4 (PDE4) inhibitor, as an effective treatment for recurrent aphthous stomatitis (RAS).
The study, published in the International Journal of Dermatology, indicates that roflumilast may be an effective treatment for RAS, helping to reduce the frequency and duration of flare-ups and ulcers, and alleviating associated symptoms.
"Additionally, roflumilast is well tolerated at low doses, has a favorable safety profile, and does not necessitate frequent monitoring. Combined with its cost-effectiveness, these benefits position roflumilast as a promising therapeutic option for managing RAS," the researchers wrote.
Recurrent aphthous stomatitis is a condition characterized by painful ulcers in the oral cavity, that often disrupts patients' quality of life due to frequent flare-ups, prolonged healing times, and significant discomfort. RAS poses a therapeutic challenge due to its significant impact on a patient's quality of life. Moreover, there are currently no approved systemic treatments for the condition. Roflumilast, a phosphodiesterase-4 inhibitor, has demonstrated potential in treating other inflammatory dermatological disorders, showing promise for use in RAS.
Against the above background, Rodrigo Peñuelas Leal, Dermatology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain, and colleagues aimed to evaluate the characteristics, effectiveness, and safety of roflumilast in the treatment of RAS within routine clinical practice.
For this purpose, the researchers conducted a single-cohort ambispective observational study across five Spanish centers involving 22 RAS patients with RAS who were treated with roflumilast. The study collected data on demographic, clinical, and outcome variables. Statistical analysis was performed to compare the outcomes of 12 weeks of roflumilast treatment with a comparable 12-week period before treatment.
The study revealed the following findings:
The researchers note that the study's small sample size, unblinded design, lack of a placebo, and potential recall bias may affect the results.
"While further research, including long-term and randomized trials with larger patient groups and varying dosages, is needed, these factors suggest that roflumilast could become a safe, effective, and cost-efficient treatment for RAS, benefiting a broader patient population," the researchers concluded.
Reference:
Leal, R. P., Bagan, L., Echevarría, A. G., Peñuelas Ruiz, J. A., Ninet, V. Z., Sánchez Carazo, J. L., Pastor, G. P., Hoyos, C. L., Finello, M., Fernández, S. M., Imbernon, D. B., García, Á. G., Zafrilla, E. P., Cabrera, M. M., & Bagan, J. Treatment of recurrent aphthous stomatitis with oral roflumilast, a multicenter observational study. International Journal of Dermatology. Https://doi.Org/10.1111/ijd.17478
Tonsillectomy And Colchicine Reduce Attack Frequency In Disease Management
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The following is a summary of "Assessment of Attack Frequency in PFAPA Patients Based on Therapeutic Modalities," published in the December 2024 issue of Pediatrics by Kalayci et al.
Children are affected by Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) syndrome. This is a recurrent autoinflammatory condition and can significantly impact their QoL.
Researchers conducted a retrospective study to compare the effects of various treatments on attack frequency in children diagnosed with PFAPA syndrome.
They included 195 children (aged 6 months to 18 years) diagnosed with PFAPA syndrome who were followed for at least 12 months. Participants were divided into 4 groups, untreated (n = 58), corticosteroid treatment (n = 43), colchicine prophylaxis (n = 62), and tonsillectomy (n = 32). Demographic data, clinical characteristics, laboratory findings, and attack patterns were collected and analyzed.
The results showed that tonsillectomy reduced the frequency of attacks from 12 to 3 episodes (P<0.001), while colchicine prophylaxis reduced attacks from 12 to 1 episode (P<0.001). Children who received corticosteroids for 3 or more attacks experienced an increased frequency of attacks compared to their pre-treatment period (P<0.0001). Tonsillectomy resulted in a significantly more significant reduction in attack frequency compared to colchicine prophylaxis (P<0.001).
They concluded that tonsillectomy significantly reduced attack frequency in children with PFAPA syndrome, colchicine prophylaxis effectively reduces attacks, and repeated corticosteroid use increases attack frequency.
Source: onlinelibrary.Wiley.Com/doi/abs/10.1111/jpc.16756
Everyday Foods And Drinks Linked To Allergic Contact Cheilitis: Case Study Implies Role Of Sulfites And Cinnamon
Belgium: Allergic contact cheilitis and stomatitis (ACD) are conditions that can be triggered by everyday products such as beverages and food, yet they remain underreported and often misdiagnosed. These reactions can present as persistent symptoms such as swelling, erythema, and burning sensations around the lips and oral mucosa. A recent case study published in Contact Dermatitis highlights the role of non-occupational allergens, particularly sulfites and cinnamon, in causing allergic contact cheilitis and stomatitis.
One patient, an 81-year-old woman, sought medical help after experiencing recurrent swelling and erythema on her lower lip, accompanied by a burning sensation in her oral mucosa. These symptoms persisted for six months, disappearing intermittently without any clear cause. Despite consulting multiple specialists and undergoing various tests, including biopsies and serological examinations, no autoimmune condition was diagnosed. However, a patch test revealed a positive reaction to sodium metabisulphite, a preservative commonly found in sparkling wines. The patient's daily consumption of wine, containing about 170 ppm of sulphite, was identified as the trigger. Upon discontinuing the wine, her symptoms improved, confirming the diagnosis of allergic contact cheilitis due to sulphites in beverages.
This case underscores the significance of considering beverages, particularly alcoholic drinks containing sulphites, as potential allergens. Sulphites, both naturally occurring and as additives in wine, have been increasingly recognized as a cause of allergic reactions. Despite being included in baseline patch testing, sulphites may be misclassified as irritants rather than allergens. It is essential for clinicians to thoroughly investigate potential sources of allergens in non-occupational settings, such as daily food and drink habits.
Another case involved a 50-year-old woman referred for suspected autoimmune disease due to persistent aphthous ulcers on her lower lip and swelling around her eyelids. Initial investigations ruled out conditions like lupus and dermatomyositis. Patch testing, however, revealed positive reactions to several allergens, including cinnamic alcohol, a compound found in cinnamon. A detailed history revealed her daily consumption of apples with cinnamon, which she was advised to stop. Within weeks, her symptoms completely disappeared, confirming the diagnosis of allergic contact stomatitis caused by cinnamon.
Both cases highlight the critical role of patch testing in diagnosing allergic contact cheilitis and stomatitis. These conditions often result from allergens in everyday foods and beverages, such as sulphites and cinnamon. Clinicians should consider ACD in cases of persistent or unexplained oral symptoms and take a comprehensive history to identify potential triggers. Avoidance of the offending agent remains the primary treatment, offering relief and preventing recurrence.
The increasing recognition of food and beverage-related ACD calls for greater awareness among healthcare providers to better diagnose and manage this often underreported condition.
"Comprehensive patient history and patch testing are crucial for pinpointing contact allergens responsible for treatment-resistant oral ulcers," the researchers concluded.
Reference:
Kerre, S., & Goossens, A. Allergic contact cheilitis/stomatitis due to beverages and food, an underreported diagnosis. Contact Dermatitis. Https://doi.Org/10.1111/cod.14725
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