Retinoids and proliferative verrucous leukoplakia (PVL). A preliminary study

Abstract

Objective. A study is made of the efficacy and adverse effects of retinoid therapy applied to the white lesions of proliferative verrucous leukoplakia (PVL). Material and methods. The results of retinoid therapy were evaluated in 17 patients diagnosed with PVL. Topical retinoids were used in 5 patients, in the form of two daily applications of 0.1% 13-cis-retinoic acid in orabase for an average of 6.17+/-3.13 months. Systemic retinoids were used in 11 patients, with the administration of 25 mg/day of acitretin in tablet form for an average of 5.41+/-2.02 months. One patient successively received the topical and systemic retinoid formulations. The course and results were evaluated on a blind basis by two investigators. The adverse effects of the medication were also assessed. Results. Clinical improvement was recorded for 7 lesions (38.8%) (six involving systemic treatment and one as a result of topical application). Clinical worsening was recorded in the same proportion (5 lesions with systemic therapy and two with topical treatment), while four lesions (22.4%) showed no changes (one lesion with systemic therapy and three with topical treatment). Adverse effects were documented in all the patients administered the systemic formulation, versus in only one patient administered topical retinoids. The most frequent problems were desquamation and pruritus. Conclusion. Although topical or systemic retinoic acid produces some improvement in about one-third of all patients with PVL, further studies are needed to assess the efficacy and safety of these products, in view of the important percentage of individuals who worsen despite therapy, and the frequent appearance of adverse effects.

Laser analgesic during orthodontic therapy

“…Their administration in low doses on the first or second day of the initial phase would not considerably affect the process of tooth movement. Nevertheless, most of these medicaments have side effects on the teeth movement if used in a long period of time (due to the inhibition effect to the prostaglandins) 21 . The systemic side effects should not be neglected as well [22][23][24] .…”

“…Ovo je u skladu sa izveštajima koji podržavaju efikasnost analgetičke terapije 10,21,25 . Pregled literature pokazuje da su najprepisivaniji analgetici NSAID, dok nema izveštaja o upotrebi lekova metamizola tokom ortodontskog tretmana.…”

“…Ipak, većina ovih lekova ima neželjene efekte na pomeranje zuba ako se koristi u dužem vremenskom periodu (zbog efekta inhibicije prostaglandina) 21 . Ne treba zanemarivati sistemske neželjene efekte [22][23][24] .…”

A case of oral multiple primary cancer including Spindle Cell Carcinoma

“…Malignant conversion to SCC resulting from administration of vitamin A derivatives (retinoids) in PVL patients has been reported previously [12,13]. Thus, although retinoids are useful drugs for treatment of keratinizing lesions such as leukoplakia, these drugs should be administered carefully based on the possible development of multiple cancer in cases requiring long-term treatment for multiple leukoplakia, and particularly in cases of PVL.…”

“…More than 150 cases of PVL have been reported [10][11][12][13][14][15][16] and the rate of malignant conversion during the disease course is higher than 70% [11]. Malignant conversion to SCC and verrucous carcinoma (VC) has been reported [10][11][12][13][14][15][16], but there has been no case of conversion of PVL with an anaplastic change to SPCC. Thus, the present case provides the first example of such a course of PVL.…”