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Effects of oral acyclovir on prevention of recurrent aphthous stomatitis
Letters
Treatment laser
to the Editor
of melasma with the Q-switched ruby
To the Editor: In their article on classification and treatment of melasma [l], Katsambas and Antoniou present a complex spectrum of treatment modalities for the handling of this cosmetically disturbing condition. They also discuss laser irradiation as a possible source for the management of melasma. Their paragraph on lasers concludes that the role of lasers has yet to be established in this concern. Accordingly, based on a previous report by Taylor [2] and on our own experiences [3], we suggest that the Q-switched ruby laser should be listed among “non-recommended therapies” for the treatment of melasma because of refractoriness or worsening of the hyperpigmentation after Q-switched ruby laser irradiation.
Reply: Treatment ruby laser
Daisy Kopera ‘, Ulrich Hohenleutner b a Department of Dermatology, platz 8, A-8036 Graz, Austria b Department of Dermatology, Josef StrauJ Allee 11, D-93024
Uniuersity
of Graz,
Auenhrugger-
University of Regensburg, Regensburg, Germany
Franz
References 111 Katsambas A, Antoniou Ch. Melasma. Classification and treatment. J Eur Acad Dermatol Venereol 1995;4:217-223. [2] Taylor CR, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation. J Dermato1 Surg Oncol 1994;20:592-597. [3] Kopera D, Hohenleutner U. Melasma: keine Indikation Wr den Rubinlaser. Z Ham Geschl 1995;70:414-416.
PII SO926-9959(96)00016-5
of melasma with the Q-switched
To the Editor: We totally agreewith the comment with regard to the role of Q-switched laser in the treatment of melasma.We firmly believe that for the time being, lasersand in particular Q-switched laser, have no role in the treatment of melasma.The reason why we did not categorize lasersunder the non-re-
Effects of oral acyclovir on prevention rent aphthous stomatitis ’
of recur-
To the Editor: Recurrent aphthous stomatitis @AS) is characterized by recurrent, painful, single ’ This paper was presented in a joint meeting tional Society of Dermatology and the Dermatology ogy Society, 6-9 June 1995, Istanbul, Turkey.
of the Intemaand Venereol-
commendedtherapies, is that we believe that in the future there are possibilities for a positive contribution of lasersin the treatment of melasma. Andreas Katsambas Department of Dermatology, Athens, Greece
Uniuersity
of Athens,
10673
SSDI 0926-9959(96)00017-7
or multiple ulcerations of the oral mucosa without signsof systemic disease[l]. The causeof RAS has nit been determined [2,3]. Various etiological factors, such as hypersensitivity, endocrine disturbances, trauma, avitaminosis, environmental stress, emotional problems, foods, gastrointestinal disease, and a number of systemic diseasesof uncertain origin, such as Behget’s syndrome and infectious agents(bacteria and viruses) have been thought to be
Letters
to the Editor
associated with RAS [ 1,4]. Links to certain viral pathogens, such as herpes simplex, adenovirus, and Coxsackie virus, have been suggested but not established [4]. In addition to the above viruses, reactivation of locally latent varicella zoster virus (VZV) may be a cause of aphthous ulcerations [5]. Acyclovir is a specific antiviral agent that is highly active against several herpes viruses, including herpes simplex 1 and 2, VZV, and Epstein-Barr virus [6-91. We carried out this study in order to evaluate the preventive effect of oral acyclovir, an effective drug against VZV, on RAS. Thirty patients suffering from RAS were included in the study. Patients were given acyclovir (Zovirax) tablets for 3 months (1000 mg/day in 5 separate administrations of 200 mg each) and were controlled monthly. Patients’ ages ranged between 22 and 52 years and the mean age was 35.23 + 1.68. Duration of RAS ranged between 1 and 20 years, and the mean duration was 5.76 k 0.81 years. The mean frequency of recurrences before and after therapy was 4.43 * 0.22 and 2.03 f 0.34, respectively, and the differences between groups was statistically significant (t = 8.88, P < 0.01). Mean diameter of ulcers before and after therapy was 6.16 5 0.33 and 3.03 + 0.43, respectively, and the difference between groups was statistically significant (t = 7.67, P < 0.01). Subjective evaluation of benefit from the therapy showed that 24 patients (80%) healed completely. In a study of 25 patients with self-diagnosed recurrent aphthous ulceration, oral acyclovir (400 mg twice daily for 1 year) did not prevent the recurrence of recurrent aphthous ulceration [4]. Pedersen suggested that acyclovir tablets (800 mg twice daily) prescribed for 10 weeks were effective in preventing recurrent aphthous ulceration [2]. In our study, it was observed that the frequency of RAS decreased and the diameter of ulcers became significantly smaller (P < 0.01). One of the explanations of the high success rate in our study and
Pedersen’s [2] study, could be the higher dose used compared to the study of Wormser et al. [4]. The results of our study theoretically suggest that, when VZV is the cause, oral acyclovir therapy given in high doses may be effective in preventing recurrences of aphthous stomatitis. However, further and more detailed studies are needed to confirm this link.
Post-operative exuberant granulation treated with topical clobetasol propionate
liferation of granulation tissue hampers the healing process. Such “proud flesh” has been treated in different ways, for instance with excision, curettage and/or electrocauterization or application of silver nitrate.
tissue
To the Editor: Formation of granulation tissue is a basic step in wound healing. Sometimes a hyperpro-
Sedat 6ztiirkcan Yalqin Cumhuriyet
* , Serap
Uniuersity,
Gztiirkcan,
Faculty
Sibel Akinci,
of Medicine,
58140.Sivas,
A. Nevzat
Turkey
References HI
Archard HO. Biology and pathology of the oral mucosa. In: Fitzpatrick TB, Eisen AZ, Wolff K et al. Eds. Dermatology in General Medicine, 3rd Edn. McGraw-Hill, New York, 1987:1152-1259. Dl Pedersen A. Acyclovir in the prevention of severe aphthous ulcers. Arch Dermatol 1992;128:119-120. In: Tiiziin Y, Kotogyan A, [31 Tiiziin Y. Viral dermatozlar. Saylan T, Eds. Dermatoloji. Anka Ofset, Ystanbul, 1985:201-226. GP, Mack L, Lenox T, Hewlett D, Goldfarb J, [41 Wormser Yarrish RL, Reitano M. Lack of effect of oral acyclovir on prevention of aphthous stomatitis. Otolaryngol Head Neck Surg 1988;98:14-17. zoster virus and recurrent aphthous 151 Pedersen A. Varicella ulceration. Lancet 1989;27:1203. 161Fletcher C, Bean B. Evaluation of oral acyclovir therapy. Drug Intel1 Clin Pharm 1985;19:518-524. following the introduction of [71 Collins P. Viral sensitivity acyclovir. Am J Med 1988;85:129-134. new antiviral drugs. J Am Acad El Bryson YJ. Promising Dermatol 1988;18:212-218. [91 Nahata MC. Clinical use of antiviral drugs. Drug Intel1 Clin Pharm 1987;21:399-405.
PII SO926-9959(96)00020-7
* Corresponding
author
Treatment laser
to the Editor
of melasma with the Q-switched ruby
To the Editor: In their article on classification and treatment of melasma [l], Katsambas and Antoniou present a complex spectrum of treatment modalities for the handling of this cosmetically disturbing condition. They also discuss laser irradiation as a possible source for the management of melasma. Their paragraph on lasers concludes that the role of lasers has yet to be established in this concern. Accordingly, based on a previous report by Taylor [2] and on our own experiences [3], we suggest that the Q-switched ruby laser should be listed among “non-recommended therapies” for the treatment of melasma because of refractoriness or worsening of the hyperpigmentation after Q-switched ruby laser irradiation.
Reply: Treatment ruby laser
Daisy Kopera ‘, Ulrich Hohenleutner b a Department of Dermatology, platz 8, A-8036 Graz, Austria b Department of Dermatology, Josef StrauJ Allee 11, D-93024
Uniuersity
of Graz,
Auenhrugger-
University of Regensburg, Regensburg, Germany
Franz
References 111 Katsambas A, Antoniou Ch. Melasma. Classification and treatment. J Eur Acad Dermatol Venereol 1995;4:217-223. [2] Taylor CR, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation. J Dermato1 Surg Oncol 1994;20:592-597. [3] Kopera D, Hohenleutner U. Melasma: keine Indikation Wr den Rubinlaser. Z Ham Geschl 1995;70:414-416.
PII SO926-9959(96)00016-5
of melasma with the Q-switched
To the Editor: We totally agreewith the comment with regard to the role of Q-switched laser in the treatment of melasma.We firmly believe that for the time being, lasersand in particular Q-switched laser, have no role in the treatment of melasma.The reason why we did not categorize lasersunder the non-re-
Effects of oral acyclovir on prevention rent aphthous stomatitis ’
of recur-
To the Editor: Recurrent aphthous stomatitis @AS) is characterized by recurrent, painful, single ’ This paper was presented in a joint meeting tional Society of Dermatology and the Dermatology ogy Society, 6-9 June 1995, Istanbul, Turkey.
of the Intemaand Venereol-
commendedtherapies, is that we believe that in the future there are possibilities for a positive contribution of lasersin the treatment of melasma. Andreas Katsambas Department of Dermatology, Athens, Greece
Uniuersity
of Athens,
10673
SSDI 0926-9959(96)00017-7
or multiple ulcerations of the oral mucosa without signsof systemic disease[l]. The causeof RAS has nit been determined [2,3]. Various etiological factors, such as hypersensitivity, endocrine disturbances, trauma, avitaminosis, environmental stress, emotional problems, foods, gastrointestinal disease, and a number of systemic diseasesof uncertain origin, such as Behget’s syndrome and infectious agents(bacteria and viruses) have been thought to be
Letters
to the Editor
associated with RAS [ 1,4]. Links to certain viral pathogens, such as herpes simplex, adenovirus, and Coxsackie virus, have been suggested but not established [4]. In addition to the above viruses, reactivation of locally latent varicella zoster virus (VZV) may be a cause of aphthous ulcerations [5]. Acyclovir is a specific antiviral agent that is highly active against several herpes viruses, including herpes simplex 1 and 2, VZV, and Epstein-Barr virus [6-91. We carried out this study in order to evaluate the preventive effect of oral acyclovir, an effective drug against VZV, on RAS. Thirty patients suffering from RAS were included in the study. Patients were given acyclovir (Zovirax) tablets for 3 months (1000 mg/day in 5 separate administrations of 200 mg each) and were controlled monthly. Patients’ ages ranged between 22 and 52 years and the mean age was 35.23 + 1.68. Duration of RAS ranged between 1 and 20 years, and the mean duration was 5.76 k 0.81 years. The mean frequency of recurrences before and after therapy was 4.43 * 0.22 and 2.03 f 0.34, respectively, and the differences between groups was statistically significant (t = 8.88, P < 0.01). Mean diameter of ulcers before and after therapy was 6.16 5 0.33 and 3.03 + 0.43, respectively, and the difference between groups was statistically significant (t = 7.67, P < 0.01). Subjective evaluation of benefit from the therapy showed that 24 patients (80%) healed completely. In a study of 25 patients with self-diagnosed recurrent aphthous ulceration, oral acyclovir (400 mg twice daily for 1 year) did not prevent the recurrence of recurrent aphthous ulceration [4]. Pedersen suggested that acyclovir tablets (800 mg twice daily) prescribed for 10 weeks were effective in preventing recurrent aphthous ulceration [2]. In our study, it was observed that the frequency of RAS decreased and the diameter of ulcers became significantly smaller (P < 0.01). One of the explanations of the high success rate in our study and
Pedersen’s [2] study, could be the higher dose used compared to the study of Wormser et al. [4]. The results of our study theoretically suggest that, when VZV is the cause, oral acyclovir therapy given in high doses may be effective in preventing recurrences of aphthous stomatitis. However, further and more detailed studies are needed to confirm this link.
Post-operative exuberant granulation treated with topical clobetasol propionate
liferation of granulation tissue hampers the healing process. Such “proud flesh” has been treated in different ways, for instance with excision, curettage and/or electrocauterization or application of silver nitrate.
tissue
To the Editor: Formation of granulation tissue is a basic step in wound healing. Sometimes a hyperpro-
Sedat 6ztiirkcan Yalqin Cumhuriyet
* , Serap
Uniuersity,
Gztiirkcan,
Faculty
Sibel Akinci,
of Medicine,
58140.Sivas,
A. Nevzat
Turkey
References HI
Archard HO. Biology and pathology of the oral mucosa. In: Fitzpatrick TB, Eisen AZ, Wolff K et al. Eds. Dermatology in General Medicine, 3rd Edn. McGraw-Hill, New York, 1987:1152-1259. Dl Pedersen A. Acyclovir in the prevention of severe aphthous ulcers. Arch Dermatol 1992;128:119-120. In: Tiiziin Y, Kotogyan A, [31 Tiiziin Y. Viral dermatozlar. Saylan T, Eds. Dermatoloji. Anka Ofset, Ystanbul, 1985:201-226. GP, Mack L, Lenox T, Hewlett D, Goldfarb J, [41 Wormser Yarrish RL, Reitano M. Lack of effect of oral acyclovir on prevention of aphthous stomatitis. Otolaryngol Head Neck Surg 1988;98:14-17. zoster virus and recurrent aphthous 151 Pedersen A. Varicella ulceration. Lancet 1989;27:1203. 161Fletcher C, Bean B. Evaluation of oral acyclovir therapy. Drug Intel1 Clin Pharm 1985;19:518-524. following the introduction of [71 Collins P. Viral sensitivity acyclovir. Am J Med 1988;85:129-134. new antiviral drugs. J Am Acad El Bryson YJ. Promising Dermatol 1988;18:212-218. [91 Nahata MC. Clinical use of antiviral drugs. Drug Intel1 Clin Pharm 1987;21:399-405.
PII SO926-9959(96)00020-7
* Corresponding
author