K Chinnusamy, T Nandagopal, K Nagaraj, S Sridharan
aloe vera, irritant contact mucositis, naranjo probability scale
K Chinnusamy, T Nandagopal, K Nagaraj, S Sridharan. Aloe vera induced oral mucositis: a case report. The Internet Journal of Pediatrics and Neonatology. 2008 Volume 9 Number 2.
A two years old previously normal female child was brought to our pediatric department with severe stomatitis (figure 1). She developed the lesion overnight without much systemic manifestations. Fig. 2 & 3 shows the course of recovery of the child in one week.
Aloe Vera Induced Irritant Contact Mucositis
History from the mother revealed that on the previous evening she found her child chewing the fleshy leaf of an
History were negative for any infection in the recent past or any drug in-take prior to onset of the event. The child was on her regular food habits.
On general examination, she was moderately built, afebrile and conjunctival mucosa appeared slightly pale. No evidence of jaundice or generalized lymphadenopathy. Vital parameters were within normal limits. Systemic examination was normal.
Local Examination of the Oral Cavity
Oral cavity showed severe mucositis involving the lips and buccal mucosa. The lesion appeared boggy and erythematous with few areas of pin point hemorrhages. The skin of the peri-oral area which came in contact with the aloe vera juice also showed dermatitis. No significant regional lymphadenitis noted.
Complete Blood count and peripheral blood smear showed microcytic, hypochromic anemia and a normal leukocyte count. Renal, Liver function test and serum proteins estimations were within normal limits. A cytological smear from the mucosal lesion showed normal squamous epithelial cells and a few leucocytes in a dirty background. Swab taken from the lesion on culture showed Streptococcus viridians and negative in fungal studies.
The child was managed symptomatically with proper oral hygiene, topical emollients and analgesics. The lesions healed in one week leaving a post inflammatory hypopigmented area. The etiological association of aloe vera with the clinical presentation is analyzed with Naranjo's probability scale(1) in table 1.
> 9 =Definite ADR
5-8 = Probable ADR
1-4 = Possible ADR
< 1 = Doubtful ADR
According to the results from Naranjo's probability scale, a conclusion of “Probably”
Irritant Contact mucositis:
It is the result of inflammation arising from the release of pro-inflammatory cytokines from epithelial cells, usually in response to noxious stimuli. The three main pathophysiological changes are Skin barrier disruption, Epithelial cellular changes, and Cytokine release.
Irritant contact mucositis falls into three categories- Simple Acute irritant mucositis which occurs within minutes after exposure or Acute delayed, occurring 8-12 hours and Cumulative irritant mucositis which may be delayed by weeks after exposure.
Irritant contact mucositis is a clinical diagnosis. History of contact with an offending agent and subsequent development of lesions in the exposed areas suggests the diagnosis. Treatment is symptomatic and preventing further exposures.
Aloe vera: A perennial plant, belonging to the family
The role of
Clinicians must remember that the growing popularity on the use of Aloe products may stimulate its use 'as is' by the patients. Since because our patient gave a very clear history of
Dr Krishnakumar Chinnusamy II yr DCH Post Graduate Institute of Social Pediatrics Government Stanley Medical College Chennai 600 001, Tamil Nadu, India Telephone: 91-9884274520 Email: firstname.lastname@example.org