lesions occur. Additional lesions arise with re-exposure when hyperpigmented macules activate, developing a violet-colored middle surrounded by erythematous rings. The major categories of agents thought to cause fixed Lichen planus-like (Lichenoid) reactions It is well established that some oral drug reactions have clinical, histopathological, and even immunopathological features in common with idiopathic lichen planus, pemphigoid, pemphigus, and erythema multiforme (Worsnop, Wee, Natkunarajah, Moosa, & Marsden, 2012; Kumarasinghe, et al., 2019). Typically, lesions are isolated, but bilaterally symmetrical involvement is common. Clinically, lichen planus-like lesions may manifest as both papuloreticular and erosive lesions, with the latter characterized by shallow, irregular ulcerations or erosions, with a peripheral border of fine keratotic striae, often radiating from the lesion center. Erythema multiforme-like reactions Some drug-induced vesiculobullous or ulcerative lesions that mimic other immunological diseases are erythema multiforme-like reactions (Durso, 2008; Kalmar, 2016; Lewin, Farley-Loftus, & Pomeranz, 2011; Massot & Gimenez- Arnau, 2014; Fitzpatrick, Cohen, & Clark 2019). As in idiopathic or virally induced cases, drug-induced erythema multiforme-like reactions have a rapid onset and variable expression, ranging from lesions limited to the oral mucosa to widespread mucocutaneous involvement. Sulfonamides, sulfonylureas, and barbiturates are among the most common culprits in drug-induced erythema multiforme. Pemphigoid-like reactions The distribution of pemphigoid-like reactions varies from limited oral mucosal lesions to other mucosal or cutaneous sites. The clinical manifestations of these lesions include vesicles or bullae that break down into shallow ulcerations. The involvement of the gingiva tissues may be generalized or multifocal, with marked erythema and erosion of the superficial gingiva (desquamative gingivitis). In 2012, Kanjanabuch and colleagues reported a case of atenolol- Pemphigus-like reactions The most common cause of pemphigus-like reactions is thiol-containing drugs (Pietkiewicz, Gornowicz-Porowska, Bowszyc-Dmochowska, & Dmochowski, 2015). Drugs implicated include penicillamine, rifampicin, diclofenac, phenol drugs, and, rarely, captopril, other ACE-inhibitors, Candidiasis Candida is present in the mouths of up to 60% of healthy people, but overt infection is associated with immunosuppression (as in HIV infection and corticosteroid use), diabetes, use of broad-spectrum antibiotics, hematological cancer, and treatment with chemotherapy or irradiation (Durso, 2008; Henke Yarbro et al., 2004; Pankhurst, 2012; Radulescu, 2016; Fitzpatrick, Cohen, & Clark 2019). This opportunistic mucosal infection, usually caused by Candida albicans , is classified into four types: 1. Pseudomembranous candidiasis (thrush) : Discrete white plaques appear on the buccal mucosa and/or mucosa of the throat and tongue. 2. Erythematous candidiasis : Smooth red patches appear on the hard/soft palate, buccal mucosa, and/or dorsum of the tongue. 3. Hyperplastic candidiasis : White adherent patches or plaques typically appear on the buccal mucosa. 4. Denture-related stomatitis : This type is often associated with angular cheilitis.
drug eruption include antibiotics (especially trimethoprim- sulfamethoxazole), antiepileptics, nonsteroidal anti- inflammatory drugs (NSAIDs), and phenothiazines. Medications may produce a site-specific eruption pattern. Many drugs have been associated with mucocutaneous eruptions resembling lichen planus (lichenoid reactions). Notably, lichenoid lesions have been associated with the use of dental restorative materials (McParland & Warnakulasuriya, 2012; Kumarasinghe, et al., 2019). Contact with restorations containing amalgams or other materials has been associated with lesions that clinically and histologically resemble lichen planus. The etiology of these lesions presumably has an allergic or toxic component or may be related to the presence of plaque on the restorations. Substituting other materials for amalgams may improve some oral lesions (Syed, Chopra, & Sachdev, 2015; Kumarasinghe, et al., 2019). These lesions initially manifest as erythematous macules or patches followed by short-lived vesicles or bullae and ragged and shallow ulcerations. Hemorrhagic ulceration and crusting of the labial vermilion zone are common. Stevens-Johnson syndrome and toxic epidermal necrolysis – more severe reactions – additionally involve conjunctivitis of the ocular mucosa and urethritis of the genital mucosa. In toxic epidermal necrolysis, diffuse bullae formation and subsequent denudation affect significant proportions of the skin and mucosal surfaces. induced mucous membrane pemphigoid. (Atenolol is used to treat hypertension.) Other medications implicated in pemphigoid-like reactions include thiol-containing drugs and sulfonamide derivatives, as well as therapeutic classes of NSAIDs, cardiovascular agents, antimicrobials, and antirheumatics (Stavropoulos, Soura, & Antoniou, 2013; Yuan & Woo, 2015).
and other drugs. Drug-induced pemphigus vulgaris rarely manifests clinically with vesicles. Typically, characterization is irregular ulcerations with ragged borders that may coalesce to involve large areas of the mucosa.
When possible, the underlying risk factors for oropharyngeal candidiasis should be diagnosed and addressed to optimize management (Pankhurst, 2012; van de Veerdonk, & Netea, 2016). Antimicrobials and antifungals may be provided as topical or systemic therapy. Prescription topical treatments include nystatin suspension and clotrimazole troches or lozenges. Oral fluconazole is another commonly prescribed treatment. More recently, eugenol, which is the main phenolic component of Cinnamomum and Clove essential oil, has been used to inhibit growth and different virulence factors of Candida, including strains with decreased susceptibility to antifungals, particularly fluconazole. However, further investigations, including animal and in vivo studies, toxicology studies and clinical trials, are needed to improve formulations and develop novel antifungal agents based on eugenol (Didehdar, Chegini, & Shariati, 2022). Systematic reviews have evaluated the effects of interventions to treat oropharyngeal candidiasis in various populations. Results from a large Cochrane analysis
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