Topical Tacrolimus and Periodontal Therapy in the Management of a Case of Oral Chronic GVHD Characterized by Specific Gingival Localization

Abstract

Background. Chronic graft versus host disease (cGVHD) is a complication following bone marrow transplantation. The oral lesions are difficult to control with a systemic pharmacological therapy. Case Description. A 63-year-old female patient, who underwent an allogeniec transplantation for acute myeloid leukemia, developed a chronic oral and cutaneous GVHD. The patient was treated with topical tacrolimus 0.1%, twice daily for two months, and underwent a protocol of oral hygiene characterized by 3 appointments of scaling, root planning, and daily oral hygiene instructions. The patient showed marked resolution of gingival lesions and a significant improvement of related pain and gingival inflammatory indexes. Clinical Implications. This case report suggests that treatment with topical tacrolimus and professional oral hygiene may be helpful in the management of chronic oral GVHD with severe gingival involvement.

Tratamento das manifestações orais da doença enxerto contra o hospedeiro crônica: revisão sistêmica da literatura

“…Um relato de caso 30 associou o uso do tacrolimus e raspagem periodontal em pacientes com DECHc em gengiva e descreveram que a terapia periodontal permitiu um adequado controle de placa bacteriana reduzindo as queixas álgicas; o tacrolimus agiu como um inibidor inflamatório, favorecendo a cicatrização na região. Seu uso deve ser descontinuado assim que possível, devido ao seu efeito carcinogênico, principalmente encontrado no tratamento de lesões cutâneas.…”

“…12 Foi encontrado uma publicação tipo carta ao editor relatando uma melhora em dois pacientes com padrão liquenoide da DECHc oral. 30 Seu mecanismo de ação por inibição de TNF alfa pode ser útil para futuras pesquisas. Não foram encontrados recomendações e evidências de uso nos consensos para terapia em cavidade oral.…”

Oral chronic graft-versus-host disease: A short review

“…It can involve any site in the oral cavity, but according to literature, the most commonly sites include buccal, glossal and labial mucosa. [2,5,7,9,[11][12][13][14][15][16]19].…”

“…Oral pain, dental caries, taste disorders, dry mouth and other oral problems are frequent complains among most patients undergoing allo-HSCT, resulting discomfort, diminished oral health, taste disturbance, impaired oral cavity function, difficulty in speaking and swallowing, and decreased in food intake and weight loss, thus reducing qualityof-life [2,3,7,9,12,13,15,19]. Additionally, sclerodermatous changes could cause perioral fibrosis restricting opening and interfering with oral function, including hindering alimentation, the maintenance of oral hygiene and the provision of dental care [3,5,11,13,15].…”

“…Additionally, sclerodermatous changes could cause perioral fibrosis restricting opening and interfering with oral function, including hindering alimentation, the maintenance of oral hygiene and the provision of dental care [3,5,11,13,15]. Thus, oral hygiene is particularly difficult and the periodontal status often worsens [19].…”