Laser in the Treatment of Refractory Oral Lichenoid Drug Reaction and Lichenoid Contact Lesion: a Case Report
نویسندگان
چکیده
Adresa za dopisivanje Kobkan Thongprasom Chulalongkorn University Faculty of Dentistry Oral Medicine Department Bangkok 10330, Thailand tel: +66-2-2188942 faks: +66-2-2188941 [email protected] Sažetak Pacijentica u dobi od 54 godine bila je primljena s jakim bolovima u gingivi i obraznim sluznicama. Oralnim pregledom uočene su plamenocrvene desni i ulcerirane lezije s bijelim strijama prekrivene pseudomembranama na objema obraznim sluznicama. Bolovala je od hipertenzije, dislipidemije, subkliničkog hipotiroidizma i artritisa. Bila je pod terapijom atorvastatina, hidroklorotijazida, valsartana, levotiroksina i nesteroidnih protuupalnih lijekova (NSAID). Oralne lezije pacijentice blago su se smanjile nakon terapije kremom s pimekrolimusom, 0,1-postotnim triamkinolon-acetonidom u orabazi i injekcijama. Nakon što je Diclofenac zamijenjen Tenoxicamom i oralne lezije tretirane različitim steroidima, stanje se znatno poboljšalo. Na temelju biopsije bukalne sluznice dijagnosticiran je lihen planus. Patch-test pokazao je pozitivnu reakciju na živu, zlatni natrijev tiosulfat i platinu. Nakon godinu dana na lijevoj obraznoj sluznici pojavila se crvena, okrugla papilomatozna lezija. Patohistološkim nalazom potvrđeno je da je riječ o nespecifičnom ulkusu s kroničnom upalom. Lezije su buknule nakon zamjene amalgamskih ispuna u zubima krunama. Nakon terapije ugljično-dioksidnim laserom, lezije su se donekle smanjile. Direktna i indirektna imunofluorescencija lezija bila je negativna. Ovaj prvi prikaz slučaja pokazuje da tijekom palijativne terapije refraktorne oralne lihenoidne lezije snažnim topikalnim steroidima sedam godina nije bilo nuspojava. U ovom slučaju CO 2 -laser može biti alternativna terapija. Ključne riječi Lihen planus, oralni; Patch testovi; laseri, plinski; steroidi; klobetasol; fluokinolon acetonid 1 Odjel za oralnu medicinu Stomatološkog fakulteta Sveučilišta Chulalongkorn, Bangkok, Tajland Oral Medicine Department, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand 2 Odjel za oralnu maksilofacijalnu kirurgiju Stomatološkog fakulteta Sveučilišta Chulalongkorn, Bangkok, Tajland Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Chulalongkorn University 3 Odjel za farmakologiju Stomatološkog fakulteta Sveučilišta Chulalongkorn, Bangkok, Tajland Pharmacology Department, Faculty of Dentistry, Chulalongkorn University
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