Introduction: Psoriasis is a chronic inflammatory skin disease that typically affects the extremities, trunk, scalp, and nails. Psoriatic cheilitis as an exclusive presentation is very rare and to our knowledge, only 6 cases have been reported to date. The absence of cutaneous lesions causes diagnostic difficulties that can result in misdiagnosis and inadequate treatment. Observation: We reported the case of a 21-year-old woman with a seven years history of scaly plaques of the vermillion of the lips as the only disease manifestation. Her cheilitis was associated with significant psychiatric morbidity. Oral biopsy showed a psoriasiform pattern. Local applications of betamethasone was proposed. Discussion: Although lip psoriasis is extremely rare, it can be the sole presentation of psoriasis even in the absence of accompanying skin lesions, other oral manifestations or a family history of psoriasis. Conclusion: Lip psoriasis should be considered in the differential diagnosis of chronic or recurrent treatment-resistant labial lesions.
Erythema multiforme is an acute mucocutaneous hypersensitivity reaction with various etiological factors, including herpes simplex virus, medications, autoimmune diseases, and malignancies, but the most common cause is infection by herpes simplex virus. The most characteristic feature is the presence of “target lesions.” There are no specific diagnostic tests for EM, and the diagnosis is based on clinical signs and symptoms and biopsy if required. We report a case of recurrent herpes-associated erythema multiforme managed with prophylactic acyclovir for 6 months: a 17-year-old boy had recurrent cutaneous lesions as well as lesions in the oral cavity and lips. Positive serology for herpes simplex virus and histopathological examination confirmed the diagnosis.
Medication-related osteonecrosis of the jaw (MRONJ) is a well-known complication of antiresorptive treatments and was first described with bisphosphonate treatment and recently with denosumab, and other anti-angiogenic drugs. It has been reported that MM patients have the highest risk of MRONJ mainly in patients who received combination of pamidronate and zoledronate. Neither clinical nor radiologic features are pathognomonic for MRONJ, in fact bone metastasis may have overlapping characteristics and must be excluded in histologic examination. We report a case of a multiple myeloma patient treated with zoledronic acid and whose initial clinical presentation was challenging to distinguish between bone metastasis and MRONJ.
Medication-related osteonecrosis of the jaw (MRONJ) is defined as an area of exposed bone, or bone that can be probed through an intraoral or extraoral fistula persisted for greater than 8 weeks in patient with current or previous treatment with bisphosphonates, denosumab, or antiangiogenic therapy without history of radiation therapy to the jaw or obvious metastatic disease of the jaw. The physiopathology remains a controversial subject including the possible involvement of vitamin D deficiency. Purpose: discuss the involvement of vitamin D deficiency in MRONJ development. This through a series of five clinical cases and a review of the literature. Observations: A series of 5 clinical cases of MRONJ associated with vitamin D deficiency whose management was medico-surgical were included. The series included 2 women and 3 men of average age 54,8 years who were treated for malignant diseases and whose average serum vitamin D level was 10 ng / ml. Remission was complete in 4 cases and partial in 1 case. Discussion: Several epidemiological studies have shown a high prevalence of hypovitaminosis D in different apparently healthy populations. Moreover, Vitamin D deficiency has recently been incriminated as an added risk factor for MRONJ. It has been postulated through experimental and control case studies that systemic conditions associated with cancer patients with a vitamin D deficiency combined with tooth extraction may increase the risk of MRONJ. Conclusion: MRONJ is a known complication of Bisphosphonate. Additional processes would be involved in the genesis of MRONJ including the possible role of a vitamin D deficiency but the scientific evidence of their involvement is not yet fully characterized.
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