Marília Heffer Cantisano

Prevalence of oral manifestations in 203 patients with psoriasis

ous treatment. Female patients with failure of isotretinoin treatment had been included only in two studies. Furthermore, this was the first study to our knowledge which assessed the response to spironolactone of the acne located in the back. In literature, some of the studies specify that the patients included have a facial acne; only one of them describes that 32 patients out of 47 included in the study have acne located on the trunk; but the therapeutic response for this zone is not assessed. As reported in the literature, the rates of effectiveness of spironolactone in the treatment of acne vary a lot in different studies and probably depend on the main endpoint chosen. In our study, patients with isotretinoin treatment failure respond to the treatment noticeably with an improvement of facial acne in 50% of the cases and of the acne of the back in 37.5% of the cases. In conclusion, spironolactone is a therapeutic alternative in case of treatment failure with isotretinoin in adult women with acne. The efficacy in the case of back lesions is one of the novel aspects of our study.

Extraneural Soft Tissue Perineurioma of the Oral Mucosa

A58-year-oldCaucasianfemalepresentedwithapainless,fibroelastic,well-definedmobilesubmucosalnoduleinthelowerbuccalfoldadjacenttotheleftfirstmolar,measuring0.5 cm in diameter. The duration of the lesion was un-knownandthepatientwasotherwisehealthy.Panoramicradiographyshowednobonealterations,buttheassociatedleftfirstmolarwasendodonticallytreated.Withthemainclinicalhypothesisofareactivelymphadenopathy,anexci-sional biopsy was performed under local anesthesia. Thelesionwasayellowishwell-definednodulethatwaseasilydetachedfromtheadjacenttissue(Fig1).Microscopically,itwascomposedofamoderatelycircumscribedbutnonen-capsulated spindle cell proliferation (Fig 2A). The tumorwashypercellularandcomposedofangulatedspindlecellsdisposed in a storiform pattern with some perivascularwhorls (Fig 2B). The cells were thin with scarce eosino-philic cytoplasm, indistinct cell borders, and elongatedwavy-shaped nuclei. Tissue cracking artifact could be ob-servedandtherewerenopleomorphism,mitosis,andne-crosis(Fig2C).Aprovisionaldiagnosisofabenignspindlecellneoplasmofneuraloriginwasestablished,andimmu-nohistochemicalreactionswerecarriedoutusingtheavi-

Regression of major recurrent aphthous ulcerations using a combination of intralesional corticosteroids and levamisole: a case report.

Recurrent aphthous ulcerations (RAU) are common oral lesions that affect approximately 10% to 20% of the population. The disease is characterized by recurrent and painful ulcerations of the oral non-keratinized mucosa, which measure from 3 to 10 mm in diameter and heal without scarring in 7 to 14 days.1 The etiology of RAU remains unknown, but there is increasing evidence that its development has an immunogenic basis. The search for its cause should concentrate on disorders associated with immunoderegulation, decreased mucosal barriers, or conditions that elevate the antigenic stimulus. Major RAU have irregular margins, frequently exceed 10 mm in size, and typically leave scars.2 There have been many attempts over the years to find an effective treatment for RAU. Because the etiology of RAU remains unknown, its treatment consists of therapeutic measures to suppress its symptoms rather than bringing about a definitive cure. The therapeutic choice depends on the severity of the disease, which is measured by the frequency of ulcer recurrence, the number of ulcers, their location and duration, and the level of associated orofacial pain.3,4 Cases of major RAU that are characterized by pain, fever, and dysphagia and that are recurrent usually require systemic therapy. Several systemic drugs have been used to treat major RAU, including systemic corticosteroids, dapsone, colchicine, thalidomide, pentoxifylline, low-dose interferon-α, and levamisole.2,5 The use of systemic corticosteroids and immuno-modulating agents has been the mainstay of treatment for major RAU. Intralesional steroid injections, which contain betamethasone dipropionate and betamethasone disodium phosphate, combined with levamisole therapy may successfully treat the large ulcers associated with major RAU.6 This paper presents a case report of major RAU where we tested the therapeutic efficacy of a treatment combining an intralesional corticosteroid and a drug used to modulate immune responses.