A 54-year-old female presented with severe pain on the gingiva and buccal mucosa. Oral findings revealed generalized fiery red gingiva, ulcerative with white striae covered by pseudo-membranes on both buccal mucosae. She had hypertension, dyslipidemia, subclinical hypothyroidism and arthritis. She was treated with atorvastatin, hydrochlorothiazide, valsartan, levothyroxine and non-steroidal anti-inflammatory drug (NSAIDs). Her oral lesions were a slight improvement from a previous treatment with pimecrolimus cream, triamcinolone acetonide 0.1% orabase and injection. After diclofenac was replaced with tenoxicam and oral lesions were treated with various topical steroids, the lesions showed marked improvement. The biopsy from the buccal mucosa revealed oral lichen planus. Patch test showed positivity to mercury, gold sodium thiosulfate and palladium. One year later the left buccal mucosa showed red, round papillomatous-like lesions. The histopathological report showed a non-specific ulcer with chronic inflammation. The lesions flared up after replacing amalgam with crowns. After CO2 laser treatment, the lesions showed some improvement. Direct and indirect immunofluorescence of the lesions proved to be negative. This first case report showed that the palliative treatment of refractory oral lichenoid lesions with potent topical steroids for 7 years had no side-effects. CO2 laser can be an alternative treatment of refractory lesion in this case.
Background: Purpura is a common adverse effect of dermatological procedures and can compromise the patients'appearance especially when they occur on the face. Topical vitamin K oxide has been known to be effective in treatment of purpura from vascular laser and minor surgical procedures. However its effectiveness on purpuric skin with minimal ablation produced by Q-switched Nd-YAG laser has not been studied Methods: Twenty volunteers had two areas of skin lasered on the upper inner arm using Q-switched Nd:YAG 1064nm laser at slightly purpuric settings. Vitamin K and 5% urea cream were blindly applied to the purpura twice daily as randomly allocated for 10 days. Photographs were taken on days 0, 1,2,4,8, and 10. Improvement of purpura using VAS and adverse effects were recorded. Results: Twenty volunteers with average age of 35.9 years completed the study. Evaluation by investigators showed no difference in reduction of purpura between the 2 regimens although vitamin K showed a faster onset. Interestingly subjects detected fading of the vitamin K-applied site significantly from the 2nd day after application. All lesions eventually lightened by the 6th day. Conclusion: In this study topical vitamin K oxide induced lightening of purpura faster than 5% urea cream.
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