Marinka Mravak Stipetić

The Effect of Low-Level Laser Therapy on Salivary Glands in Patients with Xerostomia

OBJECTIVE The aim of this study was to investigate the effect of low-level laser irradiation on the secretory function of salivary glands in 34 patients with xerostomia (dry mouth). BACKGROUND DATA Xerostomia, a common complaint of oral dryness within the elderly population, is caused by a reduction in normal salivary secretion due to different causes. Treatment is aimed at increasing salivary flow, although in most cases it remains palliative. MATERIALS AND METHODS In this study, laser light from a pulsed Ga-As laser operating at 904 nm was applied bilaterally on each salivary gland area: extraorally on the parotid and submandibular gland areas and intraorally on the sublingual gland area. The operational probe distance from the irradiated area was 0.5 cm resulting in an irradiance of 246 mW/cm(2). The exposure time was 120 sec per daily treatment during 10 consecutive days. The average energy density per exposure was 29.5 J/cm(2). The control group consisted of 16 patients who were treated with 15 mL of a 2% citric acid solution applied as a mouth rinse for 30 sec. RESULTS The average difference in the amount of salivation (dQ-sal, mL/min) before and after laser therapy increased linearly from dQ-sal = 0.05 mL/min on the first day, up to dQ-sal = 0.13 mL/min on the last (10th) day of therapy. In the control group, the average dQ-sal initially demonstrated a gradual increase, with a reversal of the trend toward the end of the therapy period and eventually yielding no correlation between the duration of therapy and dQ-sal. CONCLUSION The results of our study indicate that the effects of low-level laser therapy on salivary glands are not only stimulating, but also regenerative to a degree since the glandular response to the same amount of applied laser energy increased linearly over time.

High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease.

Aim To determine the frequency and the characteristics of cutaneous manifestations, especially vitiligo and alopecia areata, in patients with chronic graft-vs-host disease (cGVHD). Methods 50 patients with cGVHD were prospectively enrolled in the observational study protocol and evaluated by an experienced dermatologist. The evaluation was focused on the clinical spectrum of skin and adnexal involvement, and the cutaneous GVHD score was determined according to National Institutes of Health (NIH) Consensus criteria. The presence of vitiligo, alopecia, xerosis, nail changes, and dyspigmentation was also assessed. Results Out of 50 cGVHD patients, 28 (56%) had skin involvement, and 27 of them (96%) had hypo and/or hyperpigmentations. 11 patients (39%) had a mild cutaneous NIH cGVHD score, 22% moderate, and 39% severe. 15 (30%) patients had nail changes and 10 (20%) had vitiligo or alopecia areata. Univariate analysis showed that patients with vitiligo/alopecia areata received more lines of prior systemic immunosuppressive therapy (P = 0.043), had lower Karnofsky performance status (P = 0.028), and had a higher B-cell number (P = 0.005), platelet count (P = 0.022), and total protein (P = 0.024). Vitiligo and alopecia areata were associated with higher NIH skin score (P = 0.001), higher intensity of immunosuppressive treatment (P = 0.020), and total body irradiation conditioning (P = 0.040). Multivariate regression model showed that patients with higher NIH skin scoring were 3.67 times more likely to have alopecia and/or vitiligo (odds ratio 3.67; 95% confidence interval 1.26-10.73), controlled for all other factors in the model (age at study entry, number of B-cells, platelet count, and global NIH score). Conclusion These data indicate that vitiligo and alopecia areata occur more frequently in cGVHD than previously reported.

High prevalence of small- and large-fiber neuropathy in a prospective cohort of patients with moderate to severe chronic GvHD

High prevalence of small- and large-fiber neuropathy in a prospective cohort of patients with moderate to severe chronic GvHD