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Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Supportive care - Health Professional Information [NCI] - Graft-versus-Host Disease

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Submucosal and/or dermal fibrosis can occur in persistent cases of chronic GVHD. This scleroderma-like complication can be subtle and appear as slight mucosal or skin tightness, or it can progress to skin thickening and fibrosis. Intraoral submucosal fibrotic bands have been noted to significantly restrict the oral opening. Successful management of GVHD with systemic therapy will usually see resolution and/or significant resolution of this problem. However, in rare instances, surgical or chemical techniques to disrupt fibrotic bands can be required to improve the oral opening.

Management of Oral GVHD

  • Topical steroids:
    • Rinses: dexamethasone elixir (Decadron 0.1 mg/mL).
    • Gels, creams:
      • fluocinonide (Fluonex)
      • clobetasol (Temovate)
      • halobetasol (Ultravate)
      • betamethasone (Celestone)
    • Powders: beclomethasone (Beclovent) (inhalers applied to mucosa).
  • Other topical immunosuppressants:
    • azathioprine rinse (Imuran; 5–10 mg/mL)
    • cyclosporin (Neoral)
  • Antifungals (when concomitant oral fungal infection is documented):
    • Topical preparations:
      • nystatin (Mycostatin)
      • clotrimazole (Mycelex)
      • amphotericin solution (Amphocin; in the United States, this is compounded)
    • Systemic agents:
      • fluconazole (Diflucan)
      • itraconazole (Sporanox)
  • PUVA.
  • Sialogogues:
    • cevimeline (Evoxac)
    • pilocarpine (Salagen)
    • bethanechol
  • Topical anesthetics:
    • lidocaine (Xylocaine)
    • dyclonine (Dyclone)
    • diphenhydramine (Benadryl)
    • doxepin (Zonalon)
  • Dental caries prevention:
    • Oral hygiene (dental plaque removal)
    • Fluorides:
      • Adult patients: brush-on products, rinses, home-use trays
      • Pediatric patients: brush-on gel (if patient can dependably expectorate the fluoride gel after application)

      If drinking water does not contain enough fluoride to prevent tooth decay, oral fluoride (e.g., drops or vitamins) should be provided to children younger than 12 years.

    • Remineralizing solution (calcium phosphate ± fluoride preparations)

References:

  1. Schubert MM, Sullivan KM: Recognition, incidence, and management of oral graft-versus-host disease. NCI Monogr (9): 135-43, 1990.
  2. Demarosi F, Bez C, Sardella A, et al.: Oral involvement in chronic graft-vs-host disease following allogenic bone marrow transplantation. Arch Dermatol 138 (6): 842-3, 2002.
  3. Abdelsayed RA, Sumner T, Allen CM, et al.: Oral precancerous and malignant lesions associated with graft-versus-host disease: report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93 (1): 75-80, 2002.
  4. Schubert MM, Peterson DE: Oral complications of hematopoietic cell transplantation. In: Appelbaum FR, Forman SJ, Negrin RS, et al., eds.: Thomas' Hematopoietic Cell Transplantation: Stem Cell Transplantation. 4th ed. Oxford, UK: Wiley-Blackwell, 2009, pp 1589-1607.
  5. Schima W, Pokieser P, Forstinger C, et al.: Videofluoroscopy of the pharynx and esophagus in chronic graft-versus-host disease. Abdom Imaging 19 (3): 191-4, 1994 May-Jun.
  6. Jacobsohn DA, Margolis J, Doherty J, et al.: Weight loss and malnutrition in patients with chronic graft-versus-host disease. Bone Marrow Transplant 29 (3): 231-6, 2002.
  7. Loughran TP Jr, Sullivan K, Morton T, et al.: Value of day 100 screening studies for predicting the development of chronic graft-versus-host disease after allogeneic bone marrow transplantation. Blood 76 (1): 228-34, 1990.
  8. Yamada H, Chihara J, Hamada K, et al.: Immunohistology of skin and oral biopsies in graft-versus-host disease after bone marrow transplantation and cytokine therapy. J Allergy Clin Immunol 100 (6 Pt 2): S73-6, 1997.
  9. Epstein JB, Nantel S, Sheoltch SM: Topical azathioprine in the combined treatment of chronic oral graft-versus-host disease. Bone Marrow Transplant 25 (6): 683-7, 2000.

WebMD Public Information from the National Cancer Institute

Last Updated: September 04, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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