Francina Lozada

Oral manifestations of tumor and opportunistic infections in the acquired immunodeficiency syndrome (AIDS): Findings in 53 homosexual men with Kaposi's sarcoma

Fifty-three homosexual men with Kaposis sarcoma (KS) were studied. Twenty-seven had biopsy-proved oral KS, the palate being the most common site. Past or present infections with cytomegalovirus, hepatitis, venereal diseases, and gastrointestinal microorganisms occurred in more than 70%. Oral candidiasis was confirmed in 57%. Heavy marijuana smoking was the most common habit. Transmission of AIDS is thought to be by a viral agent. Precautions involving the use of gloves, eyeglasses, and masks, similar to those recommended for the management of patients with hepatitis B, are urged.

Prednisone and azathioprine in the treatment of patients with vesiculoerosive oral diseases

Systemic corticosteroids offer the most effective means of treating patients with symptomatic oral vesiculoerosive diseases. However, underlying systemic diseases and adverse side effects limit their use at clinically therapeutic dosages. The purpose of this open clinical trial was to assess the synergistic effect of azathioprine with prednisone, comparing clinical benefits with side effects. Twelve patients were studied. The minimum effective dose of prednisone when azathioprine was never more than 25 mg. daily and ranged as low as 5 mg. daily. This study indicated that azathioprine effectively enhanced corticosteroid activity, allowing lower doses of prednisone with satisfactory clinical efficacy and a marked reduction in side effects.

Erythema multiforme. Clinical characteristics and natural history in fifty patients.

Erythema multiforme is a chronic mucocutaneous inflammatory disease with a variable recurrent pattern. Thirty female and twenty male patients, ranging in age from 11 to 75 years, were studied. Twelve patients had oral lesions only, nineteen had oral and lip changes, and nineteen had oral, lip, and skin involvements. Most of the patients had a noncyclical pattern of attacks which required systemic corticosteroid therapy. When the disease attacks electively were not treated, healing would vary between 2 and 24 weeks. This study confirmed the idiopathic nature and extremely variable features of erythema multiforme. Frequency, location, duration, and severity of attacks did not shed any clues as to trigger mechanisms (etiology), persons who might be predisposed to such attacks, treatment responses, or prognosis.

An epilogue to plasma-cell gingivostomatitis (allergic gingivostomatitis)

Sixteen cases of plasma-cell gingivostomatitis were studied at the University of California San Francisco between 1966 and 1971. Twelve women and four men made up the group, with ages ranging from 15 to 70 years. Prior to treatment, the duration of the disease ranged from 5 to 60 months. Each of the sisteen patients manifested a homogeneous, diffuse, erythematous gingivitis associated with a cheilitis, and fifteen also had a marked glossitis. Each subject was symptomatic, and nine also complained of bleeding. Every biopsy specimen demonstrated a characteristically diffuse and dense plasma-cell infiltrate. There were no spontaneous remissions. Six patients completely responded to systemic corticoids alone, two to discontinuation of gum chewing or the use of their dentifrice, one to antifungal therapy, and the other seven to a combination of the preceding modalities. After completion of therapy, fifteen patients were followed for 2 to 55 months without any evidence of recurrence. Of interest, 69 per cent were gum chewers. The therapeutic benefit of discontinuing gum chewing by itself was not clear. It is assumed that the now nonexistent plasma-cell gingivostomatitis syndrome was a hypersensitivity response to an unidentifiable antigen used in various substances.

Histiocytosis X: occurrence and oral involvement in six adolescent and adult patients.

Six cases of adolescent- and adult-onset histiocytosis X with oral involvement and their evaluation are described. Clinical findings can be mistaken for dental infection. Management involved a combination of low-dose radiation and chemotherapeutic drugs. The extreme variability of clinical signs and symptoms and the extent and progression of the disease suggest that the classic classification of histiocytosis X is inappropriate.

Histopathologic spectrum of oral erythema multiforme

The histopathologic tissue patterns found in twenty-five patients with oral erythema multiforme were as variable as the clinical appearances. The biopsies served an important role in ruling out malignancy, dysplasia, and other classified diseases. While all of the specimens were designated as showing nonspecific inflammatory reactions, in many biopsy specimens there were sufficient characteristic connective tissue and epithelial changes to suggest a tissue diagnosis consistent with the clinical diagnosis of erythema multiforme.

Levamisole in the treatment of erythema multiforme: a double-blind trial in fourteen patients.

Abstract Fourteen patients with oral erythema multiforme participated in a double-blind study using levamisole. Patient response to treatment was determined by pain severity, duration of attacks, and frequency of attacks. All patients on levamisole experienced a decrease in signs and symptoms, while only two patients reported some degree of pain relief from placebo. Five of the patients experienced side effects from levamisole, the most common being dysguesia, skin rash, and headache.

Results of Immunologic Testing in Patients With Erythema Multiforme

Thirteen patients with oral erythema multiforme were assessed immunologically by skin testing and in vitro tests (lymphocyte transformation and rosettes). The results suggested a possible defect in cell-mediated immunity for most patients in this group.

Pemphigus vulgaris: A study of six cases treated with levamisole and prednisone

Six patients with pemphigus vulgaris (PV) who had been treated unsuccessfully with other modalities and who were maintained on prednisone for disease control were started on levamisole in addition to their minimum effective dose of prednisone (40 to 80 mg. daily). All patients responded within 2 to 8 weeks. The minimum effective dose range of prednisone when used with levamisole was reduced to 5 to 35 mg. daily. A temporary minor side effect occurred in only one patient. This corticosteroid-sparing, combination-drug approach for patients with PV has resulted in acceptable clinical control and diminution of the side effects that often interfere with high-dosage, long-term treatment.

Clinical and immunologic responses to levamisole in 13 patients with erythema multiforme

Abstract Thirteen patients with severe oral erythema multiforme (EM) were treated with levamisole. Apparent clinical benefit consisting of a marked decrease in the severity and frequency of attacks was observed in 8 of these patients. Immunologic parameters, including skin test reactivity, lymphocyte stimulation by antigen and PHA, and rosette forming cells did not change in any consistent fashion following therapy. The immunologic responses did not correlate with clinical results. From this open trial with levamisole we concluded: levamisole may offer substantial clinical benefit to some patients with EM; levamisole may be associated with less serious side effects than prednisone; and further studies of the efficacy of levamisole in this disease are warranted.