Recurrent aphthous stomatitis. Clinical, therapeutic, histopathologic, and hypersensitivity aspects

Oral cavity consists of a small vestibule and a larger oral cavity proper. A wide number of dermatological conditions can affect the oral cavity. The clinical characteristics of the same were studied in patients attending departments of Dermatology/ENT Himalayan Institute of Medical Sciences, Dehradun. To delineate and identify the various patterns of oral dermatological conditions in this part of the country. One hundred and fifty patients were included in the study having oral lesions irrespective of age, sex and duration. Clinical examination including cutaneous examination and simple investigations like routine blood, urine, stool, blood sugar, KOH mount and scraping, Tzanck test, and on certain cases biopsy were carried out. Out of 11,840 patients attending Dermatology/ENT OPD, HIMS, Dehradun from April 2008 to March 2009, 150 patients were having various disorders with oral manifestations. The incidence of oral cavity dermatoses in this study was 1.26%, male to female ratio was 2:3. (Out of 150 patients, 60 were males and 90 were females). Aphthous ulcer (28.57%) and pemphigus vulgaris (26.60%) formed the major bulk of patients followed by SLE (17.02%), oral candidiasis (16.07%), DLE (13.83%), lichen planus (12.77%) and others.

show abstract

“…Commonest sites of occurrence of RAS are labial and buccal mucosa [5]. Most common type was minor type in this study.…”

Section: Discussionsupporting

confidence: 45%

Oral Dermatological Conditions: A Clinical Study

Roy

Varshney

2012

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…Streptococcus sanguis has been implicated in the pathogenesis of RAS [3,9,29]. Indeed, there is a molecular basis for the earlier findings that S. sanguis and autoimmune or microbial cross-reactive responses [2,6,8,9,29] are involved in the pathogenesis of RAS.…”

Section: Discussionmentioning

confidence: 99%

“…The onset of RAS usually presents during adolescence, and the course of the disease is characterized by recurrences followed by remissions. The disease may persist for many years and varies from minor ulcers, which may cause transient discomfort, to major ulcers which are associated with pain, inability to eat and loss of weight [2].The aetiology of RAS has not been determined, but Streptococcus sanguis or its L-form [3,4] has been implicated, as has autoimmunity to the oral mucosal homogenate [5][6][7]. A common or cross-reactive antigen between streptococci and oral epithelium has been suggested [6][7][8][9] and demonstrated between the streptococcal 60-65 kD heat shock protein (HSP) and oral mucosal tissue [10].…”

mentioning

confidence: 99%

“…The aetiology of RAS has not been determined, but Streptococcus sanguis or its L-form [3,4] has been implicated, as has autoimmunity to the oral mucosal homogenate [5][6][7]. A common or cross-reactive antigen between streptococci and oral epithelium has been suggested [6][7][8][9] and demonstrated between the streptococcal 60-65 kD heat shock protein (HSP) and oral mucosal tissue [10].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Defining a T-cell epitope within HSP 65 in recurrent aphthous stomatitis

Hasan¹,

Shinnick

Mizushima

et al. 2002

Clinical and Experimental Immunology

View full text Add to dashboard Cite

Recurrent aphthous stomatitis (RAS) is the most common disease of the oral mucosa, affecting at least 10% of the general population [1]. The onset of RAS usually presents during adolescence, and the course of the disease is characterized by recurrences followed by remissions. The disease may persist for many years and varies from minor ulcers, which may cause transient discomfort, to major ulcers which are associated with pain, inability to eat and loss of weight [2].The aetiology of RAS has not been determined, but Streptococcus sanguis or its L-form [3,4] has been implicated, as has autoimmunity to the oral mucosal homogenate [5][6][7]. A common or cross-reactive antigen between streptococci and oral epithelium has been suggested [6][7][8][9] and demonstrated between the streptococcal 60-65 kD heat shock protein (HSP) and oral mucosal tissue [10]. Significant increase in serum antibodies to HSP has been detected in patients with RAS [10].Heat shock proteins (HSP) are a group of highly conserved proteins found in eukaryotic and prokaryotic cells, including Gram-positive and Gram-negative micro-organisms [11,12]. Viruses can enhance the production of host HSP. The high degree of homology between microbial and human HSP 60 [13] has led to the concept that molecular mimicry between the microbial and self HSP may be involved in the pathogenesis of autoimmune diseases [14]. A comprehensive investigation of T-cell epitopes within the 65 kD mycobacterial-and 60 kD human HSP-derived peptides has identified four T-cell epitopes specific for Behcet's disease, in which oral ulceration is the most consistent manifestation [15]. All but one of the four peptides (amino acids 219-233) showed significantly greater stimulation of lymphocytes from patients with Behcet's disease than those from RAS. However, the investigation raised the possibility that another peptide (amino acids 91-105) might specifically stimulate lymphocytes from RAS and not Behcet's disease. Indeed, specific lymphoproliferative responses are stimulated with peptide 91-105 in RAS [16]. A comparative investigation with the homologous human 60 kD HSP peptide 116-130 also revealed significantly greater lymphoproliferative responses in RAS than in controls.The objectives of this investigation in patients with RAS were to define the critical residues within the T-cell epitope 91-105, and to investigate the role of HLA class I and II restriction elements in the lymphoproliferative response. The possibility that g d T cells may be involved was also explored. 318 Defining a T-cell epitope within HSP 65 in recurrent aphthous stomatitis SUMMARYThe 65 kD heat shock protein (HSP) has been implicated in the aetiology of recurrent aphthous stomatitis (RAS). We have previously demonstrated that peptide 91-105 derived from the sequence of mycobacterial 65 kD HSP stimulates specifically lymphocytes from patients with RAS. In this investigation, we show that both CD4 + and CD8 + T cells were significantly stimulated with mycobacterial peptide 91-105. In contrast, the human h...

show abstract

“…16 -18 A lymphocytic infiltrate is observed early in the histopathologic progression of recurrent aphthous ulcers as well. 19 Therefore, both PFAPA and recurrent aphthous stomatitis may result from dysregulated inflammation in mucosal lymphoid tissue in the oropharynx. Interestingly, >50% of patients with PFAPA reported having fewer infections than other children, raising the possibility that PFAPA confers immunologic protection against other infectious ailments.…”

Section: Figure 1 Continuedmentioning

confidence: 99%

Family History in Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA) Syndrome

et al. 2016

View full text Add to dashboard Cite

OBJECTIVE: The goal of this study was to describe family history and inheritance patterns in patients with periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis (PFAPA) syndrome. METHODS: We performed a case–control study to compare the family histories of patients with PFAPA recruited from Vanderbilt University Medical Center and matched healthy control subjects from a pediatric primary care practice in Nashville, Tennessee, by using a structured questionnaire. Characteristics of paired case subjects, control subjects, and their family members were compared by using McNemar’s test and Wilcoxon signed-rank tests. RESULTS: Eighty PFAPA index case subjects and 80 control subjects were recruited. Eighteen PFAPA case subjects (23%) had ≥1 family member with PFAPA. Parents of PFAPA index case subjects were more likely to have recurrent pharyngitis (36% vs 16%; P < .001) and recurrent aphthous stomatitis (46% vs 28%; P = .002) compared with parents of control subjects. Siblings of case subjects had a higher prevalence of PFAPA (10% vs 2%; P = .04), recurrent pharyngitis (24% vs 10%; P = .03), and recurrent aphthous stomatitis (27% vs 7%; P = .003) compared with siblings of control subjects. CONCLUSIONS: A portion of PFAPA case subjects seems to be familial, implying an inherited genetic predisposition to the disorder and/or shared environmental exposures. First-degree relatives (parents and siblings) of patients with PFAPA have a higher prevalence of recurrent pharyngitis and aphthous stomatitis than relatives of control subjects, which suggests that these disorders represent reduced penetrance phenotypes of PFAPA. Further characterization of the genetics and inflammatory profiles of these patients and their relatives is warranted.

show abstract

Recurrent aphthous stomatitis. Clinical, therapeutic, histopathologic, and hypersensitivity aspects

Cited by 110 publications

References 4 publications

Oral Dermatological Conditions: A Clinical Study

Oral Dermatological Conditions: A Clinical Study

Defining a T-cell epitope within HSP 65 in recurrent aphthous stomatitis

Family History in Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA) Syndrome

Contact Info

Product

Resources

About