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Failure of smallpox vaccine in treatment of recurrent aphthous stomatitis
“ There is extensive superficial ulcerat,ion on the tongue, lips, bu~~;rl mu~~osa, :,110 palate, aud the process extends down to the glottis. Therr is much ragge
Discussion “ I)r. Adolph Rostenberg, Jr. : hIany possibilit,ies have IKYII thought teriological standpoint. I should merely like to suggest the possibility of even though the case does not, particularly resemble a viral infection. “Another possible cause would be that this man is seusitive to the amalgam or that some other dental source provides continuous irritation. speculations for which t,herc is no ev-idence.
of from a IGIV a viral origin. food or to au These ar’e ~,nl:,
’ ‘Dr. Paul Weichselbaum : This patient u-as follov~etl for approximately one month at the University of Illinois Dispensary. We could find nothing of significance m~c~c~logically or bacteriologically. “He was referred to Dr. Xaury &Passler of our Dental Therapeutics l)epart,ment. Dr. Massler has collected six cases of this particular malady to date, and he says that. the? all follow a definite pattern. They all have a sudden onset, are exceedingly chronic, and subside wit,hout treatment. Dr. Massler has done virus studies, but can offer no hell) ah to the etiology. “This patient had some amelioration of symptoms for several weeks after the use of aureomycin mouthwash. Then he experienced a recurrence of the ulcers, with severe pain. Dr. Massler has titled this disease desquamative gingivitis. In addition to the usual precipitating factors “Dr. H. H. Rodin, So&h Bend, Ind.: of the viral ulcerative stomatitis such as food allergy, drugs, and infection, one should also Recently we had the opportunity to observe consider the possibility of an ulcerative colitis. such a case in which the aphthous stomatitis was the only objective symptom. I am very grateful to the discussers for their “Dr. George C. Wells (bzj invitationi: helpful suggestions. I might s:ty that the consensus at the University of Chicago was in favor of pemphigus because of the rather ragged epithelium and because the man himself However, I am not altogether in agreement.. 1 o’er said he had seen bullae in the mouth. tainly could find no pemphigus cells in t,he smear, but I still find smears from the mouth difficult to interpret in regard to pemphigus. “This man is extremely neurotic and very diflicult to help. He takes a great int,eresl Howin his disease, and I wondered if he were using anything to produce fresh lesions. over, the lesions extend down as far as the arytenoids, and this makes artefact unlikely.” ‘I’. ,r. ( ,.
Failure of Smallpox Vaccine iu Treatment of Recurrent Aphthous Stomatitis. A. H. Kutscher, S. L. Lane, and E. V. Zegarelli. Arch. Dermat. 65 8yph. 68: 21?> .4ugust, 1953. Although a viral etiology has been suggested for recurrent aphthous stomatitis, most Some investigators have not been able to isolate a virus from recurrent aphthous lesions. investigators, however, have reported that patients with recurrent aphthous stomatitis were benefited by vaccination with smallpox vaccine and particularly by the use of intra dermal injections of smallpox vaccine. This study was attempted in an effort to COP roborate the latter positive findings. Each patient presented had a history of recurrent aphthous stomatitis of at least one year’s duration (many much longer) and had been observed for a prolonged period
ABSTRACTS
OF
CIJRRENT
I,ITER.\Tl-RE
111
during the course of placebo and other unsuccessful therapy. Tn no case was any evidence of accompanying skin lesions noted. Five intradermal injections of smallpox vaccine were administered to each of the 12 patients (four men and eight women, aged 27 to 51) with recurrent aphthous stomatitis On the first visit the contents of one-half of one capillary tube in the following manner: of vaccine was mixed with 0.5 C.C. of sterile saline and injected intradermally; at the second visit, one week later, the full contents of one vaccine tube was mixed with 0.5 cc. of sterile saline and injected intradermally; at subsequent weekly intervals the contents tubes wel’e ot’ two capillary tubes, then three capillary tubes, and flnall~v four capillary diluted with sterile saline to make up 0.5 C.C. of solution and injected intradermally. Of the 12 patients studied, none has remained permanently free of lesions following therapy. The severity, number, frequency, and duration of the lesions were neither favor:rl)ly uor adversely atfected permanently in any case by smallpox vaccine therapy. ‘I’. J. (‘.
Angular Stomatitis
Treated with Silicate Ointment.
68: 336, September,
A. J. Reiches.
Arch.
Dermat.
6r Syph.
1953.
“The treatment of pseudoariboflavinotic angular stomatitis depends on the llnding and discontinuance of primary irritants and sensitizing substances. If antibiotics are being used, the transitory angular stomatitis usually clears soon after use of the antibiotic is stopped. However, conditions occurring as a result of dental malocclusions, poor-fitting dentures, or of other chronic traumatic origin are often ditlicult to treat. Corrections of malocclusions and of artificial dentures and the protection of the irritated area from saliva are not easily obtained. “Results for 13 patients who had angular stomatitis not caused by aribotlavinosis are herein reported. For these patients I have found the use of Silocote ointment (an ointment compounded of 30v0 silicone oils in a petrolatum base) containing 3% boric acid Five of the patients had ill-fitting dentures. or 2$& ammoniated mercury very practical. Consistent results were obtained on the other eight, whose conditions were healed after Bmong the five patients with the ill-fitting three to eight days of this local treatment. dentures as an obvious cause, four had comparatively good results, but one had a recurrence one week after discontinuance of treatment but promptly responded again to Hilicote ‘l’. J. (1. ointment. ”
Chronic Discoid Lupus Erythematosus. September,
E. L. Glicksberg.
Arch,
1)ermat.
& Syph. 68: 341,
1943.
“In May 1952, M. F., a white woman aged 33, first noticed the appearance of a circular, raised lesi6n in the left maxillary area. It was purplish and swollen and had a red border. In December, 1952, her left ear lobe became swol1en, red, and distended. This last,ed for about a week and is now subsiding. L‘The patient had a ‘nervous breakdown’ in 1944. She had one miscarriage at the 1949, the patient had a mod 10th week of pregnancy in 1949. From April to November, erately severe seborrheic dermatitis of the scalp and groin. Cutaneous examination reveals a circu “The general physical condition is normal. lar, superficial, papular inflammatory lesion in the left maxillary area. It has an erythematous, indurated border and is clearing in the center, with atrophy. Ko crusts arc present. The left ear lobe is slightly edematous. A roentgenogram of the chest was normal. “The hemogram and urine were normal. Serologic tests of the blood were negative. “Histologic examination of a biopsy specimen was reported as follows: ‘A moderate In areas this process is found amount of hyperkeratosis is seen throughout the section. The remainder of the epidermis is slightly atrophic, with the in dilated follicular orifices. There is mild hyperpigmentntion of the basal-cell rete pegs effaced for the most part.
Discussion “ I)r. Adolph Rostenberg, Jr. : hIany possibilit,ies have IKYII thought teriological standpoint. I should merely like to suggest the possibility of even though the case does not, particularly resemble a viral infection. “Another possible cause would be that this man is seusitive to the amalgam or that some other dental source provides continuous irritation. speculations for which t,herc is no ev-idence.
of from a IGIV a viral origin. food or to au These ar’e ~,nl:,
’ ‘Dr. Paul Weichselbaum : This patient u-as follov~etl for approximately one month at the University of Illinois Dispensary. We could find nothing of significance m~c~c~logically or bacteriologically. “He was referred to Dr. Xaury &Passler of our Dental Therapeutics l)epart,ment. Dr. Massler has collected six cases of this particular malady to date, and he says that. the? all follow a definite pattern. They all have a sudden onset, are exceedingly chronic, and subside wit,hout treatment. Dr. Massler has done virus studies, but can offer no hell) ah to the etiology. “This patient had some amelioration of symptoms for several weeks after the use of aureomycin mouthwash. Then he experienced a recurrence of the ulcers, with severe pain. Dr. Massler has titled this disease desquamative gingivitis. In addition to the usual precipitating factors “Dr. H. H. Rodin, So&h Bend, Ind.: of the viral ulcerative stomatitis such as food allergy, drugs, and infection, one should also Recently we had the opportunity to observe consider the possibility of an ulcerative colitis. such a case in which the aphthous stomatitis was the only objective symptom. I am very grateful to the discussers for their “Dr. George C. Wells (bzj invitationi: helpful suggestions. I might s:ty that the consensus at the University of Chicago was in favor of pemphigus because of the rather ragged epithelium and because the man himself However, I am not altogether in agreement.. 1 o’er said he had seen bullae in the mouth. tainly could find no pemphigus cells in t,he smear, but I still find smears from the mouth difficult to interpret in regard to pemphigus. “This man is extremely neurotic and very diflicult to help. He takes a great int,eresl Howin his disease, and I wondered if he were using anything to produce fresh lesions. over, the lesions extend down as far as the arytenoids, and this makes artefact unlikely.” ‘I’. ,r. ( ,.
Failure of Smallpox Vaccine iu Treatment of Recurrent Aphthous Stomatitis. A. H. Kutscher, S. L. Lane, and E. V. Zegarelli. Arch. Dermat. 65 8yph. 68: 21?> .4ugust, 1953. Although a viral etiology has been suggested for recurrent aphthous stomatitis, most Some investigators have not been able to isolate a virus from recurrent aphthous lesions. investigators, however, have reported that patients with recurrent aphthous stomatitis were benefited by vaccination with smallpox vaccine and particularly by the use of intra dermal injections of smallpox vaccine. This study was attempted in an effort to COP roborate the latter positive findings. Each patient presented had a history of recurrent aphthous stomatitis of at least one year’s duration (many much longer) and had been observed for a prolonged period
ABSTRACTS
OF
CIJRRENT
I,ITER.\Tl-RE
111
during the course of placebo and other unsuccessful therapy. Tn no case was any evidence of accompanying skin lesions noted. Five intradermal injections of smallpox vaccine were administered to each of the 12 patients (four men and eight women, aged 27 to 51) with recurrent aphthous stomatitis On the first visit the contents of one-half of one capillary tube in the following manner: of vaccine was mixed with 0.5 C.C. of sterile saline and injected intradermally; at the second visit, one week later, the full contents of one vaccine tube was mixed with 0.5 cc. of sterile saline and injected intradermally; at subsequent weekly intervals the contents tubes wel’e ot’ two capillary tubes, then three capillary tubes, and flnall~v four capillary diluted with sterile saline to make up 0.5 C.C. of solution and injected intradermally. Of the 12 patients studied, none has remained permanently free of lesions following therapy. The severity, number, frequency, and duration of the lesions were neither favor:rl)ly uor adversely atfected permanently in any case by smallpox vaccine therapy. ‘I’. J. (‘.
Angular Stomatitis
Treated with Silicate Ointment.
68: 336, September,
A. J. Reiches.
Arch.
Dermat.
6r Syph.
1953.
“The treatment of pseudoariboflavinotic angular stomatitis depends on the llnding and discontinuance of primary irritants and sensitizing substances. If antibiotics are being used, the transitory angular stomatitis usually clears soon after use of the antibiotic is stopped. However, conditions occurring as a result of dental malocclusions, poor-fitting dentures, or of other chronic traumatic origin are often ditlicult to treat. Corrections of malocclusions and of artificial dentures and the protection of the irritated area from saliva are not easily obtained. “Results for 13 patients who had angular stomatitis not caused by aribotlavinosis are herein reported. For these patients I have found the use of Silocote ointment (an ointment compounded of 30v0 silicone oils in a petrolatum base) containing 3% boric acid Five of the patients had ill-fitting dentures. or 2$& ammoniated mercury very practical. Consistent results were obtained on the other eight, whose conditions were healed after Bmong the five patients with the ill-fitting three to eight days of this local treatment. dentures as an obvious cause, four had comparatively good results, but one had a recurrence one week after discontinuance of treatment but promptly responded again to Hilicote ‘l’. J. (1. ointment. ”
Chronic Discoid Lupus Erythematosus. September,
E. L. Glicksberg.
Arch,
1)ermat.
& Syph. 68: 341,
1943.
“In May 1952, M. F., a white woman aged 33, first noticed the appearance of a circular, raised lesi6n in the left maxillary area. It was purplish and swollen and had a red border. In December, 1952, her left ear lobe became swol1en, red, and distended. This last,ed for about a week and is now subsiding. L‘The patient had a ‘nervous breakdown’ in 1944. She had one miscarriage at the 1949, the patient had a mod 10th week of pregnancy in 1949. From April to November, erately severe seborrheic dermatitis of the scalp and groin. Cutaneous examination reveals a circu “The general physical condition is normal. lar, superficial, papular inflammatory lesion in the left maxillary area. It has an erythematous, indurated border and is clearing in the center, with atrophy. Ko crusts arc present. The left ear lobe is slightly edematous. A roentgenogram of the chest was normal. “The hemogram and urine were normal. Serologic tests of the blood were negative. “Histologic examination of a biopsy specimen was reported as follows: ‘A moderate In areas this process is found amount of hyperkeratosis is seen throughout the section. The remainder of the epidermis is slightly atrophic, with the in dilated follicular orifices. There is mild hyperpigmentntion of the basal-cell rete pegs effaced for the most part.