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Cinnamon contact hypersensitivity in the oral cavity. Clinical manifestations and diagnosis in 40 patients
1982
325
Cinnamon contact hypersensitivity in the oral cavity. Clinical manifestations and diagnosis in 40 patients Eleni Gagari, DMD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Dimitra Zafeiratou, MD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Sevasti Afantenou, MD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Ioanna Panoutsopoulou, MD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Ioannis Koutlas, DMD, University of Minnesota School of Dentistry, Minneapolis, MN, United States
Does severe chronic hand eczema (sCHE) have differential impact on quality of life in men and women? Bruno Halioua, PhD, Institut Alfred Fournier, Paris, France; Celine Aubin, DPharm, GSK, Marly-le-Roi France, France; Gilles Rostain, PhD, Fondation Lenval, Nice, France; Cristina Mura, PhD, GSK, Marly-le-Roi, France; Olivier Chosidow, MD, PhD, H^ opital Henri Mondor, Creteil, France
Contact hypersensitivity reactions in the oral cavity are common but frequently hard to diagnose as they require identification of the causative agent. Cinnamon flavoring in chewing gum has been known to cause a hypersensitivity reaction known as ‘‘cinnamon contact stomatitis’’ (CCS). Cinnamon flavoring agent is up to 100 times more concentrated in gum, candy, toothpaste or breath fresheners than in the natural spice. We present a case series of 40 patients with contact hypersensitivity to cinnamon chewing gum. Thirty-four patients were female and six male, with ages ranging from 21 to 71 years old. Diagnosis relies on careful clinical evaluation and recognition of a specific hypersensitivity pattern that reflects the pattern of mastication. Specifically: red, erosive areas often covered with pseudomembranes were noted in a band-like pattern on the buccal mucosa at the occlusal line. The band-like lesions of the occlusal buccal line usually correspond with white and red lesions of the lateral border of the tongue that is juxtaposed to the area. The severity of the lesions ranged according to the frequency of the habit, from redness to painful erosions and small ulcerations. In addition, similarly affected areas in the oral cavity may be found according to the chewing habits of the individual. The lesional pattern is characteristic and reproducible in all patients and in and of itself suggests the habit of cinnamon chewing gum. After clinical evaluation, all patients were asked if they were engaged in the habit and all responded positively. In all patients, lesions resolved completely 2-3 weeks after discontinuation of the habit. Two opted for short-term treatment with corticosteroids in order to speed up healing of the lesions. Differential diagnosis includes oral vesiculobullous diseases, lichen planus, lichenoid mucositis, leukoplakia, and hypersensitivity reactions to other agents. In summary, we present a comprehensive case series of a particular contact hypersensitivity pattern in the oral cavity is that is highly recognizable. Accurate diagnosis leads to lesion resolution without further treatment. Commercial support: None identified.
Introduction: Severe chronic hand eczema (CHE) is a skin condition that can cause physical morbidity and impair quality of life (QoL). This impact has never been assessed if it is different between men and women. Aim: To compare quality of life in men and women suffering from severe chronic hand eczema (sCHE). Materials and methods: Multicenter, prospective, observational study conducted at the request of French the health care agencies (HAS) to evaluate the efficacy of alitretinoin and survey its usage in patients with CHE (Study N8117235, funded by GSK). Patients’ social, demographic and occupational characteristics were collected. The severity of sCHE was assessed using the Physician Global Assessment (PGA, which scores a series of signs and symptoms) and the modified Total Lesion Symptom Score (mTLSS which yields a global score for seven symptoms of CHE). QoL was evaluated according to Skindex and using digital scales (from 1 10) measuring the impact of sCHE on patients’ social, professional and family lives. This abstract presents a post hoc analysis focusing on the differences between men and women at baseline. Groups were compared by the Fisher test, ANOVA, the Kruskal-Wallis test, depending on the variable concerned and its distribution. Results: Over 400 patients (403) were included by 109 dermatologists between November 2010 and December 2012. Baseline data were analyzed for 388 patients, 212 men and 176 women. The mean age was 44.9 6 14.4 with no gender-related difference. The men and women were also comparable in terms of time since onset of the disease, duration of the ongoing episode, phenotypes and severity (PGA and mTLSS scores). In women, mean scores were significantly higher for impact on social life (5.9 6 2.9 vs 5.0 6 2.9, P \.001) and family life (5.2 6 3.2 vs 4.2 6 3.1, P \ .001). Impairment of QoL as measured by Skindex was also greater in the women, with a higher mean score (51.8 6 18.2% vs 45.6 6 17.7%, P ¼.02) as well as higher scores for all its component dimensions (emotions, physical and symptoms physiques and function). Discussion: The greater impact of sCHE on QoL in women could be accounted for by more women feeling ‘‘stigmatized’’ and rejected or like an object of mockery because of the visible lesions. Conclusion: The fact that a woman’s QoL may be more profoundly affected should be taken into account when deciding how to treat CHE. Study Sponsored by GSK.
355 Clinical characteristics and impact of severe chronic hand eczema (sCHE) in France: Study of 388 cases Bruno Halioua, PhD, Institut Alfred Fournier, Paris, France; Philippe Berbis, PhD, H^ opital Nord, Marseille, France; Frederic Cambazard, PhD, H^ opital Nord, SaintEtienne, France; Marie-Sylvie Doutre, PhD, H^ opital Haut-Lev^eque, Pessac, France; Pascal Joly, PhD, H^ opital Charles Nicolle, Rouen, France; Marie-Aleth Richard, PhD, H^ opital Sainte Marguerite, Marseille, France; Carle Paul, PhD, Hopital Larrey, Toulouse, France; Celine Aubin, PharmD, GSK, Marly-le-Roi, France; Cristina Murat, PhD, GSK, Marly-le-Roi, France; Olivier Chosidow, PhD, Hopital Henri Mondor, Cr eteil, France Introduction: Severe chronic hand eczema (CHE) is an inflammatory skin condition that can entail physical, psychological and social problems, and impair quality of life. Alitretinoin (AL) is indicated in eczema resistant to topic steroids. Aim: Description of clinical characteristics and impact of severe chronic hand eczema (sCHE) in a French cohort of patients treated by AL. Materials and methods: Multicenter, prospective, observational study conducted at the request of the French health care agencies to evaluate the efficacy of AL and survey its usage in patients with sCHE (study number 117235, funded by GSK). Inclusion criteria were adult with chronic hand eczema (CHE) for whom the dermatologist considered it appropriate and necessary to initiate treatment with AL in accordance with the terms of the marketing authorization. The following baseline data are reported: patients’ social, demographic and occupational characteristics; clinical characteristics of CHE and its severity using the Physician Global Assessment (PGA, scoring signs and symptoms) and the modified Total Lesion Symptom Score (mTLSS, up to 21 points). The patients in this study are still being monitored. Results: 403 patients were included by 109 dermatologists between November 2010 and December 2012. Baseline data could be analyzed for 388 patients (54.6% men), median age 45.5, 75.3% in employment status. An occupational cause was identified in 21.8% of the patients, entailing a change of job in 9.0%. In the six months prior to inclusion, their CHE had necessitated time off for 20.1% of the working patients (median 18 days off work [3-252]). 65.5% had a hyperkeratotic form, combined or not with another clinical manifestation; 16.4% had simple pompholyx. The median disease history was 4.0 years and the median duration of the ongoing episode was 6.0 months. The mean mTLSS score was 11.1 6 3.0. According to the PGA, the condition was severe in 48.3% of cases and moderately severe in 45.5%. 93.3% of the patients had been treated with topical corticosteroids, and 81.5% of them had stopped treatment because of loss of efficacy. 16.0% of the patients had been given a systemic treatment and 4.1% had received PUVA therapy. Discussion/conclusion: This study shows sCHE has major impact on professional life, as evidenced by the high numbers of patients reporting taking time off work and changing job. Study Sponsored by GSK.
AB78
J AM ACAD DERMATOL
1680 Management of chronic spontaneous urticaria in accordance with the guidelines EAACI/GA2LEN/EDF/WAO Irene Marin-Cabanas, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Angelica Bouret-Lebron, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Francisco De Leon, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Laura Berbegal, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Juan Francisco Silvestre, MD, Dermatology Department Hospital General Alicante, Alicante, Spain Background: Chronic spontaneous urticaria (CSU), which accounts for about 70% of all chronic urticaria, has a substantial impact on the patient’s quality of life due to the challenging therapeutic handling of the illness. The objective of this study is to describe the therapeutic response of our patients with CSU following the recommendations of the guidelines EAACI/GA2LEN/EDF/WAO. Methods: This is a cross-sectional study on the care for patients with CSU seen in the Dermatology department of a tertiary hospital in Spain, during the period July 2011 to January 2014. The following data concerning the therapeutic management were collected: use of oral corticosteroid (number of times), antihistamine medication (dose and compound), cyclosporine, leukotriene antagonist and omalizumab. Results: A total of 57 patients with CSU were included in the study, 21 men (36.8%) and 36 women (63.2%). The mean duration of the disease course was 23.19 6 14.13 months. One-third of all cases (36.8%) had concurrent angioedema. One-third of all cases (36.8%) associated an inducible form of urticaria. Most patients (40.4%) were taking NAIDs at the time of diagnosis. Treatment response: Systemic corticosteroid treatment was required in 47.4% of cases. All patients were treated as first-line therapy with nonsedating H1-antihistamines (nsAHs). 11 cases (19.3%) responded to regular doses of nsAHs. However, the 79.8% required higher doses (up to two, three or four-fold) to control the symptoms. 12 cases (21%) did not respond to nsAHs and required alternative treatment options. Montelukast (leukotriene antagonist) was added to 28% of cases in combination to the antihistamine treatment. This was successful in one of every four patients treated. 8 (14%) patients were treated with cyclosporine (3.5-5 mg/kg per day) as fourth-line treatment, proving to be effective in 75% of cases. 4 (7%) patients were treated with omalizumab. Omalizumab was successful in all the patients treated. No serious adverse effects were reported. Conclusion: To control most of the CSU patients, higher dosage of nsAHs is necessary. Cyclosporine and omalizumab seem to be effective and safe treatments in refractory cases of CSU. The avoidance of NSAIDs is not a common practice in patients with CSU. Commercial support: None identified.
MAY 2015
325
Cinnamon contact hypersensitivity in the oral cavity. Clinical manifestations and diagnosis in 40 patients Eleni Gagari, DMD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Dimitra Zafeiratou, MD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Sevasti Afantenou, MD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Ioanna Panoutsopoulou, MD, Department of Dermatology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece; Ioannis Koutlas, DMD, University of Minnesota School of Dentistry, Minneapolis, MN, United States
Does severe chronic hand eczema (sCHE) have differential impact on quality of life in men and women? Bruno Halioua, PhD, Institut Alfred Fournier, Paris, France; Celine Aubin, DPharm, GSK, Marly-le-Roi France, France; Gilles Rostain, PhD, Fondation Lenval, Nice, France; Cristina Mura, PhD, GSK, Marly-le-Roi, France; Olivier Chosidow, MD, PhD, H^ opital Henri Mondor, Creteil, France
Contact hypersensitivity reactions in the oral cavity are common but frequently hard to diagnose as they require identification of the causative agent. Cinnamon flavoring in chewing gum has been known to cause a hypersensitivity reaction known as ‘‘cinnamon contact stomatitis’’ (CCS). Cinnamon flavoring agent is up to 100 times more concentrated in gum, candy, toothpaste or breath fresheners than in the natural spice. We present a case series of 40 patients with contact hypersensitivity to cinnamon chewing gum. Thirty-four patients were female and six male, with ages ranging from 21 to 71 years old. Diagnosis relies on careful clinical evaluation and recognition of a specific hypersensitivity pattern that reflects the pattern of mastication. Specifically: red, erosive areas often covered with pseudomembranes were noted in a band-like pattern on the buccal mucosa at the occlusal line. The band-like lesions of the occlusal buccal line usually correspond with white and red lesions of the lateral border of the tongue that is juxtaposed to the area. The severity of the lesions ranged according to the frequency of the habit, from redness to painful erosions and small ulcerations. In addition, similarly affected areas in the oral cavity may be found according to the chewing habits of the individual. The lesional pattern is characteristic and reproducible in all patients and in and of itself suggests the habit of cinnamon chewing gum. After clinical evaluation, all patients were asked if they were engaged in the habit and all responded positively. In all patients, lesions resolved completely 2-3 weeks after discontinuation of the habit. Two opted for short-term treatment with corticosteroids in order to speed up healing of the lesions. Differential diagnosis includes oral vesiculobullous diseases, lichen planus, lichenoid mucositis, leukoplakia, and hypersensitivity reactions to other agents. In summary, we present a comprehensive case series of a particular contact hypersensitivity pattern in the oral cavity is that is highly recognizable. Accurate diagnosis leads to lesion resolution without further treatment. Commercial support: None identified.
Introduction: Severe chronic hand eczema (CHE) is a skin condition that can cause physical morbidity and impair quality of life (QoL). This impact has never been assessed if it is different between men and women. Aim: To compare quality of life in men and women suffering from severe chronic hand eczema (sCHE). Materials and methods: Multicenter, prospective, observational study conducted at the request of French the health care agencies (HAS) to evaluate the efficacy of alitretinoin and survey its usage in patients with CHE (Study N8117235, funded by GSK). Patients’ social, demographic and occupational characteristics were collected. The severity of sCHE was assessed using the Physician Global Assessment (PGA, which scores a series of signs and symptoms) and the modified Total Lesion Symptom Score (mTLSS which yields a global score for seven symptoms of CHE). QoL was evaluated according to Skindex and using digital scales (from 1 10) measuring the impact of sCHE on patients’ social, professional and family lives. This abstract presents a post hoc analysis focusing on the differences between men and women at baseline. Groups were compared by the Fisher test, ANOVA, the Kruskal-Wallis test, depending on the variable concerned and its distribution. Results: Over 400 patients (403) were included by 109 dermatologists between November 2010 and December 2012. Baseline data were analyzed for 388 patients, 212 men and 176 women. The mean age was 44.9 6 14.4 with no gender-related difference. The men and women were also comparable in terms of time since onset of the disease, duration of the ongoing episode, phenotypes and severity (PGA and mTLSS scores). In women, mean scores were significantly higher for impact on social life (5.9 6 2.9 vs 5.0 6 2.9, P \.001) and family life (5.2 6 3.2 vs 4.2 6 3.1, P \ .001). Impairment of QoL as measured by Skindex was also greater in the women, with a higher mean score (51.8 6 18.2% vs 45.6 6 17.7%, P ¼.02) as well as higher scores for all its component dimensions (emotions, physical and symptoms physiques and function). Discussion: The greater impact of sCHE on QoL in women could be accounted for by more women feeling ‘‘stigmatized’’ and rejected or like an object of mockery because of the visible lesions. Conclusion: The fact that a woman’s QoL may be more profoundly affected should be taken into account when deciding how to treat CHE. Study Sponsored by GSK.
355 Clinical characteristics and impact of severe chronic hand eczema (sCHE) in France: Study of 388 cases Bruno Halioua, PhD, Institut Alfred Fournier, Paris, France; Philippe Berbis, PhD, H^ opital Nord, Marseille, France; Frederic Cambazard, PhD, H^ opital Nord, SaintEtienne, France; Marie-Sylvie Doutre, PhD, H^ opital Haut-Lev^eque, Pessac, France; Pascal Joly, PhD, H^ opital Charles Nicolle, Rouen, France; Marie-Aleth Richard, PhD, H^ opital Sainte Marguerite, Marseille, France; Carle Paul, PhD, Hopital Larrey, Toulouse, France; Celine Aubin, PharmD, GSK, Marly-le-Roi, France; Cristina Murat, PhD, GSK, Marly-le-Roi, France; Olivier Chosidow, PhD, Hopital Henri Mondor, Cr eteil, France Introduction: Severe chronic hand eczema (CHE) is an inflammatory skin condition that can entail physical, psychological and social problems, and impair quality of life. Alitretinoin (AL) is indicated in eczema resistant to topic steroids. Aim: Description of clinical characteristics and impact of severe chronic hand eczema (sCHE) in a French cohort of patients treated by AL. Materials and methods: Multicenter, prospective, observational study conducted at the request of the French health care agencies to evaluate the efficacy of AL and survey its usage in patients with sCHE (study number 117235, funded by GSK). Inclusion criteria were adult with chronic hand eczema (CHE) for whom the dermatologist considered it appropriate and necessary to initiate treatment with AL in accordance with the terms of the marketing authorization. The following baseline data are reported: patients’ social, demographic and occupational characteristics; clinical characteristics of CHE and its severity using the Physician Global Assessment (PGA, scoring signs and symptoms) and the modified Total Lesion Symptom Score (mTLSS, up to 21 points). The patients in this study are still being monitored. Results: 403 patients were included by 109 dermatologists between November 2010 and December 2012. Baseline data could be analyzed for 388 patients (54.6% men), median age 45.5, 75.3% in employment status. An occupational cause was identified in 21.8% of the patients, entailing a change of job in 9.0%. In the six months prior to inclusion, their CHE had necessitated time off for 20.1% of the working patients (median 18 days off work [3-252]). 65.5% had a hyperkeratotic form, combined or not with another clinical manifestation; 16.4% had simple pompholyx. The median disease history was 4.0 years and the median duration of the ongoing episode was 6.0 months. The mean mTLSS score was 11.1 6 3.0. According to the PGA, the condition was severe in 48.3% of cases and moderately severe in 45.5%. 93.3% of the patients had been treated with topical corticosteroids, and 81.5% of them had stopped treatment because of loss of efficacy. 16.0% of the patients had been given a systemic treatment and 4.1% had received PUVA therapy. Discussion/conclusion: This study shows sCHE has major impact on professional life, as evidenced by the high numbers of patients reporting taking time off work and changing job. Study Sponsored by GSK.
AB78
J AM ACAD DERMATOL
1680 Management of chronic spontaneous urticaria in accordance with the guidelines EAACI/GA2LEN/EDF/WAO Irene Marin-Cabanas, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Angelica Bouret-Lebron, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Francisco De Leon, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Laura Berbegal, MD, Dermatology Department Hospital General Alicante, Alicante, Spain; Juan Francisco Silvestre, MD, Dermatology Department Hospital General Alicante, Alicante, Spain Background: Chronic spontaneous urticaria (CSU), which accounts for about 70% of all chronic urticaria, has a substantial impact on the patient’s quality of life due to the challenging therapeutic handling of the illness. The objective of this study is to describe the therapeutic response of our patients with CSU following the recommendations of the guidelines EAACI/GA2LEN/EDF/WAO. Methods: This is a cross-sectional study on the care for patients with CSU seen in the Dermatology department of a tertiary hospital in Spain, during the period July 2011 to January 2014. The following data concerning the therapeutic management were collected: use of oral corticosteroid (number of times), antihistamine medication (dose and compound), cyclosporine, leukotriene antagonist and omalizumab. Results: A total of 57 patients with CSU were included in the study, 21 men (36.8%) and 36 women (63.2%). The mean duration of the disease course was 23.19 6 14.13 months. One-third of all cases (36.8%) had concurrent angioedema. One-third of all cases (36.8%) associated an inducible form of urticaria. Most patients (40.4%) were taking NAIDs at the time of diagnosis. Treatment response: Systemic corticosteroid treatment was required in 47.4% of cases. All patients were treated as first-line therapy with nonsedating H1-antihistamines (nsAHs). 11 cases (19.3%) responded to regular doses of nsAHs. However, the 79.8% required higher doses (up to two, three or four-fold) to control the symptoms. 12 cases (21%) did not respond to nsAHs and required alternative treatment options. Montelukast (leukotriene antagonist) was added to 28% of cases in combination to the antihistamine treatment. This was successful in one of every four patients treated. 8 (14%) patients were treated with cyclosporine (3.5-5 mg/kg per day) as fourth-line treatment, proving to be effective in 75% of cases. 4 (7%) patients were treated with omalizumab. Omalizumab was successful in all the patients treated. No serious adverse effects were reported. Conclusion: To control most of the CSU patients, higher dosage of nsAHs is necessary. Cyclosporine and omalizumab seem to be effective and safe treatments in refractory cases of CSU. The avoidance of NSAIDs is not a common practice in patients with CSU. Commercial support: None identified.
MAY 2015