今日の臨床サポート

口内炎(舌炎、アフタなど)

著者: 引地尚子 公立大学法人九州歯科大学歯学部

監修: 近津大地 東京医科大学

著者校正/監修レビュー済:2021/11/24
患者向け説明資料

概要・推奨   

  1. アフタ性口内炎に対してはステロイド局所投与がおそらく推奨される(推奨度2G
  1. アフタ性口内炎を随伴するベーチェット病の場合、アフタに対しては、ステロイド局所投与することがおそらく推奨される(推奨度2G
  1. PFAPA症候群の場合、全身的にはステロイド治療を行うことがおそらく推奨される(推奨度2S/CS
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲
  1. 閲覧にはご契約が必要となりま す。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が
  1. Hunter舌炎の患者の舌炎に対しては、原因に応じてビタミンB12あるいは葉酸を投与することがおそらく推奨される(推奨度2o)。
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
引地尚子 : 特に申告事項無し[2021年]
監修:近津大地 : 特に申告事項無し[2021年]

改訂のポイント:
  1.  定期レビューを行った(変更なし)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 口内炎とは、口腔粘膜に生じる比較的広範囲の炎症の総称である。口内炎のうち、口唇、舌、歯肉などの部位に限局して炎症が生じた場合は、各々口唇炎、舌炎、歯肉炎などの部位名で称される。
  1. 口内炎は、アフタ性口内炎、カタル性口内炎、潰瘍性口内炎、壊疽性口内炎、疱疹性口内炎、ニコチン性口内炎、放射性口内炎、抗がん剤による口内炎、感染による口内炎などを含む。
  1. 口腔粘膜病変のなかにも、口腔扁平苔癬、天疱瘡、多形滲出紅班など炎症を伴うものがある。
  1. 上述のとおり、口唇、舌、歯肉などの部位に限局して炎症が生じた場合は、各々口唇炎、舌炎、歯肉炎などの部位名で称され、それぞれ“口唇炎”、“舌炎”、“歯肉炎”として取り扱うことが多い。
問診・診察のポイント  
問診:
  1. 症状の経過の確認(既往歴:全身的背景がある場合がある;家族歴:家族性の場合がある;現病歴:再発が多い)

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: G Hatemi, A Silman, D Bang, B Bodaghi, A M Chamberlain, A Gul, M H Houman, I Kötter, I Olivieri, C Salvarani, P P Sfikakis, A Siva, M R Stanford, N Stübiger, S Yurdakul, H Yazici, EULAR Expert Committee
雑誌名: Ann Rheum Dis. 2008 Dec;67(12):1656-62. doi: 10.1136/ard.2007.080432. Epub 2008 Jan 31.
Abstract/Text OBJECTIVES: To develop evidence-based European League Against Rheumatism (EULAR) recommendations for the management of Behçet disease (BD) supplemented where necessary by expert opinion.
METHODS: The multidisciplinary expert committee, a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), consisted of nine rheumatologists (one who was also a clinical epidemiologist and one also a Rehabilitation Medicine doctor), three ophthalmologists, one internist, one dermatologist and one neurologist, representing six European countries plus Tunisia and Korea. A patient representative was also present. Problem areas and related keywords for systematic literature research were identified. Systematic literature research was performed using Medline and the Cochrane Library databases from 1966 through to December 2006. A total of 40 initial statements were generated based on the systematic literature research. These yielded the final recommendations developed from two blind Delphi rounds of voting.
RESULTS: Nine recommendations were developed for the management of different aspects of BD. The strength of each recommendation was determined by the level of evidence and the experts' opinions. The level of agreement for each recommendation was determined using a visual analogue scale for the whole committee and for each individual aspect by the subgroups, who consider themselves experts in that field of BD. There was excellent concordance between the level of agreement of the whole group and the "experts in the field".
CONCLUSION: Recommendations related to the eye, skin-mucosa disease and arthritis are mainly evidence based, but recommendations on vascular disease, neurological and gastrointestinal involvement are based largely on expert opinion and uncontrolled evidence from open trials and observational studies. The need for further properly designed controlled clinical trials is apparent.

PMID 18245110  Ann Rheum Dis. 2008 Dec;67(12):1656-62. doi: 10.1136/ar・・・
著者: Crispian Scully, Meir Gorsky, Francina Lozada-Nur
雑誌名: J Am Dent Assoc. 2003 Feb;134(2):200-7.
Abstract/Text BACKGROUND: Recurrent aphthous stomatitis, or RAS, is a common oral disorder of uncertain etiopathogenesis for which symptomatic therapy only is available. This article reviews the current data on the etiopathogenesis, diagnosis and management of RAS in a primary care setting.
METHODS: The authors reviewed publications on Medline from 1995 through 2000, the period since the last major reviews were published.
RESULTS: RAS may have an immunogenetic background owing to cross-reactivity with Streptococcus sanguis or heat shock protein. Predisposing factors seen in a minority include haematinic (iron, folate or vitamin B12) deficiency, stress, food allergies and HIV infection. While topical corticosteroids remain the mainstay for therapy, a number of other immunomodulatory modalities now are available.
CONCLUSIONS: There is still no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore therapy can attempt only to suppress symptoms rather than to address the basic issues of susceptibility and prevention.
CLINICAL IMPLICATIONS: In the majority of patients, symptomatic relief of RAS can be achieved with topical corticosteroids alone, with other immunomodulatory topical agents or by combination therapy.

PMID 12636124  J Am Dent Assoc. 2003 Feb;134(2):200-7.
著者: Koichi Kusuhara
雑誌名: Nihon Rinsho Meneki Gakkai Kaishi. 2011;34(5):401-7.
Abstract/Text Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome is a non-hereditary autoinflammatory disease, characterized by relatively regular recurrence of febrile episodes of 3-6 days duration, accompanied by aphthous stomatitis, pharyngitis/tonsillitis, and/or cervical adenititis. It is considered to be the most common periodic fever syndrome in Japan. Although no responsible gene is identified, some genetic factors may confer the predisposition toward this disorder. Important differential diagnosis includes hereditary periodic syndromes and cyclic neutropenia. Although its etiology is still to be elucidated, a recent study suggested an environmentally triggered activation of complement and IL-1β/IL-18 during PFAPA syndrome flares, with induction of Th1-chemokines and subsequent retention of activated T cells in peripheral tissues. This study also demonstrated the possibility that IP-10/CXCL10 might serve as a potential biomarker to differentiate PFAPA syndrome from other periodic fever syndromes. Therapeutic strategy for PFAPA syndrome has not been well established. Recent advances in the understating of etiology and pathophysiology might lead to re-evaluation of recent therapeutic options and/or development of new treatment.

PMID 22041428  Nihon Rinsho Meneki Gakkai Kaishi. 2011;34(5):401-7.
著者: Felice Femiano, Alessandro Lanza, Curzio Buonaiuto, Fernando Gombos, Monica Nunziata, Silvia Piccolo, Nicola Cirillo
雑誌名: Pediatr Infect Dis J. 2007 Aug;26(8):728-32. doi: 10.1097/INF.0b013e31806215f9.
Abstract/Text Aphthous ulcers are the most common oral mucosal lesions in the general population. These often are recurrent and periodic lesions that cause clinically significant morbidity. Many suggestions have been proposed but the etiology of recurrent aphthous stomatitis (RAS) is unknown. Several precipitating factors for aphthous ulcers appear to operate in subjects with genetic predisposition. An autoimmune or hypersensitivity mechanism is widely considered possible. Sometimes aphthous ulcers can be the sign of systemic diseases, so it is essential to establish a correct diagnosis to determine suitable therapy. Before initiating medications for aphthous lesions, clinicians should determine whether well-recognized causes are contributing to the disease and these factors should be corrected. Various treatment modalities are used, but no therapy is definitive. Topical medications, such as antimicrobial mouth-washes and topical corticosteroids (dexamethasone, triamcinolone, fluocinonide, or clobetasol), can achieve the primary goal to reduce pain and to improve healing time but do not improve recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective.

PMID 17848886  Pediatr Infect Dis J. 2007 Aug;26(8):728-32. doi: 10.10・・・
著者: L Preeti, Kt Magesh, K Rajkumar, Raghavendhar Karthik
雑誌名: J Oral Maxillofac Pathol. 2011 Sep;15(3):252-6. doi: 10.4103/0973-029X.86669.
Abstract/Text Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence, etiopathogenesis remains unclear. This review article summarizes the clinical presentation, diagnostic criteria, and recent trends in the management of recurrent apthous stomatitis.

PMID 22144824  J Oral Maxillofac Pathol. 2011 Sep;15(3):252-6. doi: 10・・・
著者: R W Barrons
雑誌名: Am J Health Syst Pharm. 2001 Jan 1;58(1):41-50; quiz 51-3.
Abstract/Text The clinical features, etiology, and treatment of recurrent aphthous ulcers (RAU) are discussed. Aphthous ulcers are among the most common oral lesions in the general population, with a frequency of up to 25% and three-month recurrence rates as high as 50%. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. RAU is classified as minor, major, and herpetiform on the basis of ulcer size and number. The cause of RAU is idiopathic in most patients. The most likely precipitating factors are local trauma and stress. Other associated factors include systemic diseases and nutritional deficiencies, food allergies, genetic predisposition, immune disorders, the use of certain medications, and HIV infection. The primary goals of therapy for RAU are relief of pain, reduction of ulcer duration, and restoration of normal oral function. Secondary goals include reduction in the frequency and severity of recurrences and maintenance of remission. Topical medications, such as antimicrobial mouthwashes and topical corticosteroids, can achieve the primary goals but have not been shown to alter recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective. Levamisole has shown variable efficacy in reducing ulcer frequency and duration in patients with minor RAU. Oral corticosteroids should be reserved for severe cases of major RAU that do not respond to topical agents. Thalidomide is effective but, because of its toxicity and cost, should be used only as an alternative to oral corticosteroids. RAU can be effectively managed with a variety of topical and systemic medications.

PMID 11194135  Am J Health Syst Pharm. 2001 Jan 1;58(1):41-50; quiz 51・・・
著者: S Jurge, R Kuffer, C Scully, S R Porter
雑誌名: Oral Dis. 2006 Jan;12(1):1-21. doi: 10.1111/j.1601-0825.2005.01143.x.
Abstract/Text Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is a common condition which is characterized by multiple recurrent small, round or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors typically presenting first in childhood or adolescence. RAS occurs worldwide although it appears most common in the developed world. The aetiology of RAS is not entirely clear. Despite many studies trying to identify a causal microorganism, RAS does not appear to be infectious. A genetic predisposition is present, as shown by strong associations with genotypes of IL-1beta; IL-6 in RAS patients, and a positive family history in about one-third of patients with RAS. Haematinic deficiency is found in up to 20% of patients. Cessation of smoking may precipitate or exacerbate RAS in some cases. Ulcers similar to RAS may be seen in human immunodeficiency virus disease and some other immune defects, and drugs, especially non-steroidal anti-inflammatory drugs and nicorandil may produce lesions clinically similar to RAS. Topical corticosteroids can often control RAS. However, the treatment of RAS remains unsatisfactory, as most therapies only reduce the severity of the ulceration and do not stop recurrence.

PMID 16390463  Oral Dis. 2006 Jan;12(1):1-21. doi: 10.1111/j.1601-0825・・・
著者: V Kontogiannis, R J Powell
雑誌名: Postgrad Med J. 2000 Oct;76(900):629-37.
Abstract/Text Behçet's disease is a systemic vasculitis of unknown aetiology characteristically affecting venules. Onset is typically in young adults with recurrent oral and genital ulceration, uveitis, skin manifestations, arthritis, neurological involvement, and a tendency to thrombosis. It has a worldwide distribution but is prevalent in Japan, the Middle East, and some Mediterranean countries. International diagnostic criteria have been proposed, however diagnosis can be problematical, particularly if the typical ulcers are not obvious at presentation. Treatment is challenging, must be tailored to the pattern of organ involvement for each patient and often requires combination therapies.

PMID 11009577  Postgrad Med J. 2000 Oct;76(900):629-37.
著者: H M Feder, J C Salazar
雑誌名: Acta Paediatr. 2010 Feb;99(2):178-84. doi: 10.1111/j.1651-2227.2009.01554.x. Epub 2009 Nov 4.
Abstract/Text AIMS: We describe the presentations and clinical outcomes of pediatric patients diagnosed with PFAPA (Periodic Fever, Aphthous lesions, Pharyngitis, and cervical Adenitis).
MATERIALS AND METHODS: The medical records of children with recurrent fever and referred between 1998 and 2007 to a tertiary pediatric care hospital were reviewed. Children who met clinical criteria for PFAPA were then asked to participate in a follow-up study.
RESULTS: One hundred and five children met study criteria for PFAPA which included at least six episodes of periodic fever. Most (62%) were males, the mean age at onset of PFAPA was 39.6 months (80% were <5 years at onset), the mean duration of individual fever episodes was 4.1 days, and the mean interval between episodes was 29.8 days. Accompanying signs and symptoms included aphthous stomatitis (38%), pharyngitis (85%), cervical adenitis (62%), headache (44%), vomiting with fever spikes (27%) and mild abdominal pain (41%). A prodrome (usually fatigue) preceded the fever in 62% of patients. Parents noted that when their child with PFAPA had fever, other family members remained well. Laboratory tests in patients with PFAPA were nonspecific. Individual episodes of fever usually resolved with a single oral dose ( approximately 1 mg/kg) of prednisilone. The interval between fever episodes shortened in 50% of patients who used prednisilone. PFAPA resolved spontaneously (mean length 33.2 months) in 211105 (20%) patients. PFAF'A episodes continued (mean length 23 months) at the end of this study in 661105 (63%) patients. Cimetidine therapy was associated with the resolution of the fevers in 7/26 (27%) patients; tonsillectomy was associated with the resolution of the fevers in 11/11 (100%) patients.
CONCLUSION: PFAPA can usually be defined by its clinical characteristics. Individual febrile episodes usually resolve dramatically with oral prednisilone. The cause of PFAPA is unknown and research is needed to define its etiology. The overall prognosis for children with PFAPA is excellent.

PMID 19889105  Acta Paediatr. 2010 Feb;99(2):178-84. doi: 10.1111/j.16・・・
著者: Werner Garavello, Lorenzo Pignataro, Lorenzo Gaini, Sara Torretta, Edgardo Somigliana, Renato Gaini
雑誌名: J Pediatr. 2011 Jul;159(1):138-42. doi: 10.1016/j.jpeds.2010.12.014. Epub 2011 Feb 6.
Abstract/Text OBJECTIVE: To seek evidence supporting a role for tonsillectomy or adenotonsillectomy in the management of affected children with periodic fever with aphthous stomatitis, pharnygitis, and adenitis (PFAPA) syndrome.
STUDY DESIGN: A comprehensive literature search was conducted to identify all published English-language observational and randomized studies evaluating the efficacy of tonsillectomy or adenotonsillectomy on PFAPA syndrome. A combination of keywords was used to identify relevant articles.
RESULTS: A total of 15 studies including 149 treated children were found, including 13 observational noncomparative studies and 2 randomized controlled trials. The pooled rate of complete resolution emerging from the combined analysis of all treated children was 83% (95% CI, 77%-89%). A meta-analysis of the two randomized controlled trials showed homogeneity of the results (P=.37, Breslow-Day test) and a common odds ratio for complete resolution of 13 (95% CI, 4-43; P<.001).
CONCLUSIONS: Surgery appears to be a possible option for management of PFAPA syndrome. Available evidence is limited, however, and the precise role of surgery remains to be clarified. We suggest considering this option when symptoms markedly interfere with the child's quality of life and medical treatment has failed.

Copyright © 2011 Mosby, Inc. All rights reserved.
PMID 21300374  J Pediatr. 2011 Jul;159(1):138-42. doi: 10.1016/j.jpeds・・・
著者: Martin J Burton, Andrew J Pollard, James D Ramsden
雑誌名: Cochrane Database Syst Rev. 2010 Sep 8;(9):CD008669. doi: 10.1002/14651858.CD008669. Epub 2010 Sep 8.
Abstract/Text BACKGROUND: PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome) is a rare clinical syndrome of unknown cause usually identified in children.
OBJECTIVES: To assess the efficacy of tonsillectomy (with or without adenoidectomy) in children with PFAPA.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 1); MEDLINE (PubMed); EMBASE; CINAHL; mRCT (metaRegister of clinical trials, including ClinicalTrials.gov); NRR (National Research Register); LILACS; KoreaMed; IndMed; PakMediNet; China Knowledge Network; CAB Abstracts; Web of Science; BIOSIS Previews; ICTRP (International Clinical Trials Registry Platform) and Google. The date of the last search was 21 January 2010.
SELECTION CRITERIA: Randomised studies comparing adeno-/tonsillectomy with non-surgical treatment.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data.
MAIN RESULTS: Two trials involving 67 children were included. One high quality study demonstrated a dramatic benefit of adenotonsillectomy in children with PFAPA diagnosed according to rigid, standard criteria with a relative 'risk' (RR) of symptom resolution after 18 months of 12.63 (95% CI 1.81 to 87.98) and a lower rate of episodes per patient-month (rate ratio 0.07; 95% CI 0.04 to 0.13). A less methodologically rigorous study enrolled some children with PFAPA, but probably included others with alternative types of recurrent pharyngitis, and performed tonsillectomy alone. This also demonstrated a significant benefit for surgery at six months: RR 1.93 (95% CI 1.11 to 3.36); rate ratio episodes per patient-month 0.10 (95% CI 0.04 to 0.28). The pooled relative risk of symptom resolution was 3.25 (95% CI 1.78 to 5.92) and the resulting number needed to treat (NNT) 2 (95% CI 1 to 3).
AUTHORS' CONCLUSIONS: The trials included in this review reported follow up at 18 and six months respectively but it is well-established that children with PFAPA recover spontaneously and treatment can be administered to try and reduce the severity of individual episodes. Therefore, the parents and carers of children with PFAPA must weigh the risks and consequences of surgery (hospitalisation, a predictable period of time postoperatively away from school/nursery, the risks of surgery) against the alternative of a finite period of recurrent episodes of disease at predictable intervals, potentially requiring time off school and the regular use of medication. It is uncertain whether adenoidectomy combined with tonsillectomy adds any additional benefit to tonsillectomy alone.

PMID 20824883  Cochrane Database Syst Rev. 2010 Sep 8;(9):CD008669. do・・・
著者: Dimitrios Assimakopoulos, George Patrikakos, Christina Fotika, Moses Elisaf
雑誌名: Am J Med. 2002 Dec 15;113(9):751-5.
Abstract/Text Benign migratory glossitis, or geographic tongue, is usually an asymptomatic inflammatory disorder of unknown etiology that affects the epithelium of the tongue. Local loss of filiform papillae leads to ulcer-like lesions that rapidly change the color and size. Histopathologic findings parallel the clinical appearance, and may have a psoriasiform pattern. The disorder is characterized by exacerbations and remissions. In most cases, patients do not require treatment other than reassurance about the benign nature of the disorder.

PMID 12517366  Am J Med. 2002 Dec 15;113(9):751-5.
著者: Masaya Ishibashi, Genichi Tojo, Masahiko Watanabe, Takahiro Tamabuchi, Takashi Masu, Setsuya Aiba
雑誌名: J Dermatol Case Rep. 2010 Dec 31;4(4):57-9. doi: 10.3315/jdcr.2010.1058.
Abstract/Text BACKGROUND: Geographic tongue, or benign migratory glossitis, is usually an asymptomatic inflammatory disorder of the tongue mucosa of unknown etiology. It is characterized by circinate, erythematous, ulcer-like lesions of the dorsum and lateral border of the tongue due to loss of filiform papillae of the tongue epithelium. Symptomatic treatments have not been evaluated rigorously.
MAIN OBSERVATION: We describe herein two cases of adult patients with persistent and painful geographic tongue successfully treated with topical application of 0.1% tacrolimus ointment.
CONCLUSION: To our knowledge, this is the first report of successful treatment with topical 0.1% tacrolimus for symptomatic geographic tongue. Clinical trials are needed to confirm the efficacy and the safety of topical tacrolimus in treating geographic tongue.

PMID 21886753  J Dermatol Case Rep. 2010 Dec 31;4(4):57-9. doi: 10.331・・・
著者: Andreas Körber, Nadine Voshege
雑誌名: CMAJ. 2012 Jan 10;184(1):68. doi: 10.1503/cmaj.111013. Epub 2011 Nov 7.
Abstract/Text
PMID 22065353  CMAJ. 2012 Jan 10;184(1):68. doi: 10.1503/cmaj.111013. ・・・
著者: G M Sarti, R I Haddy, D Schaffer, J Kihm
雑誌名: Am Fam Physician. 1990 Jun;41(6):1751-5.
Abstract/Text Black hairy tongue is a benign disorder characterized by hypertrophy of the filiform papillae of the tongue. A brownish-black discoloration of the papillae occurs. The etiology is unclear, but the disorder has been associated with numerous predisposing conditions. Although black hairy tongue is usually cured by removal of these factors, a variety of measures, particularly brushing of the tongue, may aid in resolution.

PMID 2190456  Am Fam Physician. 1990 Jun;41(6):1751-5.
著者: Dennis F Thompson, Tiffany L Kessler
雑誌名: Pharmacotherapy. 2010 Jun;30(6):585-93. doi: 10.1592/phco.30.6.585.
Abstract/Text Black hairy tongue (BHT) is a benign, self-limiting disorder characterized by abnormally hypertrophied and elongated filiform papillae on the surface of the tongue. The prevalence of BHT is quite variable, ranging from 0-53.8% depending on the population. Many predisposing factors to BHT exist, and several drugs and drug classes have been implicated in causing this disorder. A modified Naranjo adverse drug reaction probability nomogram specific for BHT was used to rate causality for the available published case reports of drug-induced BHT. From the available data, antibiotics and drugs capable of inducing xerostomia are the drug classes that have modest evidence of causality and a rational mechanism. The presence of underlying predisposing factors in these cases along with the variable prevalence of BHT make drawing firm conclusions difficult. Treatment for BHT involves eliminating any predisposing issues and practicing scrupulous oral hygiene. Drug therapy and physical removal of the elongated filiform papillae are available for resistant cases. Clinicians should be aware of the prevalence, the predisposing factors and drug classes that may play a role in the development, and the treatment of BHT.

PMID 20500047  Pharmacotherapy. 2010 Jun;30(6):585-93. doi: 10.1592/ph・・・
著者: Gottfried Novacek
雑誌名: Orphanet J Rare Dis. 2006 Sep 15;1:36. doi: 10.1186/1750-1172-1-36. Epub 2006 Sep 15.
Abstract/Text Plummer-Vinson or Paterson-Kelly syndrome presents as a classical triad of dysphagia, iron-deficiency anemia and esophageal webs. Exact data about epidemiology of the syndrome are not available; the syndrome is extremely rare. Most of the patients are white middle-aged women, in the fourth to seventh decade of life but the syndrome has also been described in children and adolescents. The dysphagia is usually painless and intermittent or progressive over years, limited to solids and sometimes associated with weight loss. Symptoms resulting from anemia (weakness, pallor, fatigue, tachycardia) may dominate the clinical picture. Additional features are glossitis, angular cheilitis and koilonychia. Enlargement of the spleen and thyroid may also be observed. One of the most important clinical aspects of Plummer-Vinson syndrome is the association with upper alimentary tract cancers. Etiopathogenesis of Plummer-Vinson syndrome is unknown. The most important possible etiological factor is iron deficiency. Other possible factors include malnutrition, genetic predisposition or autoimmune processes. Plummer-Vinson syndrome can be treated effectively with iron supplementation and mechanical dilation. In case of significant obstruction of the esophageal lumen by esophageal web and persistent dysphagia despite iron supplementation, rupture and dilation of the web are necessary. Since Plummer-Vinson syndrome is associated with an increased risk of squamous cell carcinoma of the pharynx and the esophagus, the patients should be followed closely.

PMID 16978405  Orphanet J Rare Dis. 2006 Sep 15;1:36. doi: 10.1186/175・・・
著者: K Atmatzidis, B Papaziogas, T Pavlidis, Ch Mirelis, T Papaziogas
雑誌名: Dis Esophagus. 2003;16(2):154-7.
Abstract/Text Plummer-Vinson syndrome is characterized by dysphagia, iron deficiency, anemia and the presence of esophageal web or webs. Two cases of this syndrome are reported in middle-aged women, which were treated over the last eight years. Both patients presented with dysphagia, anemia, sideropenia, glossitis and cheilitis. Radiological examination of the pharynx showed the presence of webs in both cases. The patients were treated with iron supplementation, which resulted in elimination of the symptoms. Both patients remain in good general condition and without any dysphagic complaints, 5 and 8 years after the diagnosis, respectively.

PMID 12823219  Dis Esophagus. 2003;16(2):154-7.
著者: Jordi Graells, Rosa Maria Ojeda, Cristina Muniesa, Jesus Gonzalez, Jose Saavedra
雑誌名: J Am Acad Dermatol. 2009 Mar;60(3):498-500. doi: 10.1016/j.jaad.2008.09.011.
Abstract/Text The classic oral manifestations of vitamin B(12) deficiency are considered nonspecific. We describe 4 patients with oral linear lesions associated with vitamin B(12) deficiency. Patients were free of neurologic symptoms and anemia at diagnosis. We believe that glossitis with linear lesions is an early clinical sign of vitamin B(12) deficiency. We recommend the determination of vitamin B(12) in such patients, even in the absence of anemia.

PMID 19231648  J Am Acad Dermatol. 2009 Mar;60(3):498-500. doi: 10.101・・・
著者: C Pétavy-Catala, V Fontès, N Gironet, B Hüttenberger, G Lorette, L Vaillant
雑誌名: Ann Dermatol Venereol. 2003 Feb;130(2 Pt 1):191-4.
Abstract/Text INTRODUCTION: The association of manifestations in the mouth and Vitamin B12 deficiency is already known. The signs are not specific to Vitamin B12 deficiency, however they may reveal the deficiency and this is often ignored and leads to delays in diagnosis. We report two cases of Vitamin B12 deficiency revealed by stomatodynia, glossitis and erosions in the mouth.
OBSERVATIONS: Two women aged 51 and 76 years consulted, one for atrophic glossitis and the other for stomatodynia that had progressed over the past few months. No other symptoms were present. The biological examinations revealed isolated macrocytosis without anemia. Vitamin B12 could not be measured in the serum. The symptoms regressed in less than one month following replacement therapy.
DISCUSSION: As with our two patients, the majority of cases of Vitamin B12 deficiency reported in the literature were only discovered several months or years after their onset, or were treated for other causes. Vitamin B12 deficiency leads to severe neuropathies. The neurological damage is reversible when replacement therapy is initiated early. Since the oral signs appear before the modification in the systemic markers of deficiency, it is crucial that these signs be recognized and diagnosed before the occurrence of severe after effects.

PMID 12671582  Ann Dermatol Venereol. 2003 Feb;130(2 Pt 1):191-4.
著者: Julia S Lehman, Alison J Bruce, Roy S Rogers
雑誌名: J Periodontol. 2006 Dec;77(12):2090-2. doi: 10.1902/jop.2006.060169.
Abstract/Text BACKGROUND: Glossodynia, or painful sensation of the tongue, can have a spectrum of etiologies, such as local infection, trauma, nerve damage, glossitis, or the enigmatic neuropathic pain syndrome, burning mouth disorder (BMD; also known as burning mouth syndrome). Careful history-taking, physical examination, and appropriate laboratory screening can differentiate these causes of glossodynia and direct further therapy.
METHODS: A 73-year-old woman presented with several months of glossodynia having previously been diagnosed by her primary care physician with primary BMD. Subsequently, she consulted an otolaryngologist, who pursued further diagnostic evaluation.
RESULTS: Examination revealed the presence of a beefy, red, smooth tongue, and further laboratory evaluation yielded a low serum vitamin B(12) level and macrocytosis. Three months of oral vitamin B(12) supplementation led to partial restoration of serum vitamin B(12) levels and a modest improvement in symptoms. Her final diagnoses were atrophic glossitis and glossodynia secondary to vitamin B(12) deficiency, most likely due to pernicious anemia.
CONCLUSIONS: The results of this case have important clinical implications for the diagnostic evaluation and management of patients with glossodynia and apparent BMD. Pathogenic mechanisms of nutrient deficiency in atrophic glossitis are discussed.

PMID 17209796  J Periodontol. 2006 Dec;77(12):2090-2. doi: 10.1902/jop・・・

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