One hundred thirteen patients with fixed drug eruption (FDE) were studied for any drug-specific clinical pattern. The causative drugs were identified and confirmed by provocation tests. A trimethoprim-sulfamethoxazole combination caused maximum incidence (36.3%), followed by tetracycline (15.9%), pyrazolones (14.2%), sulfadiazine (12.4%), dipyrine (9.3%), acetaminophen (7.9%), aspirin (1.7%), thiacetazone (0.88%), and levamizole (0.88%). Sulfas, including trimethoprim-sulfamethoxazole, induced lesions on the lips (91%) and trunk and limbs (89%), with only minimal involvement of mucosae. Tetracycline caused lesions only on the glans penis, sparing other sites. Pyrazolones affected mainly the lips and mucosae, with a few lesions of the trunk and limbs. Dipyrine, aspirin, and acetaminophen caused lesions of the trunk and limbs, sparing the lips, genitalia, and mucosae. Levamizole caused associated constitutional disturbances with extensive skin lesions, as did thiacetazone. The current study indicates that the clinical pattern and distribution of lesions in FDE are influenced by the drug in question, and the study of the pattern may provide useful information in selecting the most likely causative drug, especially when the details of the drugs are unknown.
Among one hundred patients with oral cancer in Trivandrum, South India, 40 suffered from oral submucous fibrosis, a chronic condition characterized by blanching and stiffness of the oral mucosa. Histologically, submucous fibrosis is associated with a marked atrophy of the oral epithelium. Oral biopsies were taken from 30 patients, either in areas remote from the cancer or in the vicinity of the cancer. Epithelial atypia was observed in 11.5% in areas remote from the cancer and in 71.4% in the vicinity of the cancer. Though the biopsies were taken from areas normally unkeratinized, the majority revealed keratinization in varying degrees. Clinically, leukoplakias were found in 46.7%. Since all patients chewed tobacco, it is most likely that the epithelial changes and the cancers are the results of this habit, primarily because the atrophic oral epithelium in submucous fibrosis is more vulnerable to action of carcinogens. The authors postulate that submucous fibrosis is due to a hypersensitivity to chilli, a theory supported by the occurrence of submucous fibrosis among chillieating populations in South East Asia.
The lactate dehydrogenase isoenzyme pattern of biopsies from Indian oral leukoplakia, submucous fibrosis and carcinoma of the oral mucosa as well as that of oral mucous membrane biopsies from clinically normal Indian persons has been studied. The LDHIV/LDHII isoenzyme ratios found for leukoplakias, carcinomas and control biopsies did not differ significantly. The mean isoenzyme ratio of Indian control biopsies was significantly above that reported for Danish control biopsies. Submucous fibrosis was accompanied by a significant depression of the isoenzyme ratio. No clear correlation between LDH isoenzyme pattern and epithelial thickness was found. Smoking and chewing habits, which may be correlated with prevalence and localization of oral leukoplakias and carcinomas, did not significantly influence the isoenzymatic structure. Although final conclusions cannot be drawn, the high isoenzyme ratio of the Indian control material may represent an early precancerous condition, unrelated to smoking and chewing, preceding the histopathological manifestations of precancerous lesions.
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