Herbal Toothpowder Induced Erythema Multiforme

Abstract

Herbal toothpowders are available in market in a wide varieties, which consist of various ingredients. In rural areas of the developing countries, they are still used for cleansing teeth. Erythema multiforme (EM) is an acute mucocutaneous disorder that is believed to be a sequel of a cytotoxic immunologic attack on keratinocytes which express non-self-antigens. A 31-year-old male who used herbal toothpowder for oral-hygiene maintenance presented with ulcers in mouth, encrustation on lips and target lesions on both hands, suggesting Erythema multiforme. An oral biopsy confirmed the diagnosis. To the best of our knowledge, there is no report of an association of herbal extracts and EM in the English literature. With this report, we present a rare new triggering factor of Erythema mutiforme, thus adding it to the endless list of aetiologies.

Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

“…Oral Hypersensitivity Reactions . Oral hypersensitivity reactions (OHRs) have a variety of manifestations: acute onset of EM ulcers, red and white reticular lesions such as lichenoid reactions, fixed drug eruption (usually seen as ulcers on the lip vermilion after exposure to drugs with resolution on withdrawal and relapse on rechallenge), swelling of the lips, and oral allergy syndrome (itching with or without swelling of oral structures and oropharynx) [ 3 , 44 , 45 ].…”

“…OHRs and PCS are usually self-limiting. Nevertheless, pain control and anti-inflammatory agents can help diminish the healing time [ 3 , 44 , 45 ].…”

“…Acute traumatic ulcers usually present as solitary lesions of nonspecific clinical shapes ( Figure 3 ) [ 11 , 12 ], whereas viral stomatitis appear as multiple small symmetrical ulcers, which sometimes coalesce to form larger lesions with scalloped borders ( Figure 4 ) [ 11 , 13 ]. Allergic stomatitis tend to involve any site intraorally with various clinical features usually with a history of synchronous exposure to contactants or systemic allergens [ 3 , 44 ]. Although chemotherapy-induced stomatitis can be quite diffuse, its commencement is chronologically related to therapeutic agents, which differentiate it from other acute oral ulcerations [ 46 , 47 ].…”