ALLERGIC MUCOSAL REACTION TO

SYSTEMIC DRUG ADMINISTRATION

Kelainan Jaringan Lunak Akibat Alergi Obat

drg. H. Supriatno., M.Kes., MDSc., Ph.D

Departemen Ilmu Penyakit Mulut FKG UGM
An allergic reaction of the oral mucosa to
the systemic administration of a medication
is called Stomatitis Medicamentosa

The Oral Mucosal Disease:

1. Anaphylactic stomatitis
2. Intraoral fixed drug eruptions
3. Lichenoid drug reaction
4. Lupus erythematosus-like eruptions
5. Pemphigus-like drug reactions
6. Nonspecific vesiculoerosive or aphthouslike
lesions
1. Anaphylactic Stomatitis

Anaphylactic
stomatitis arises
after the allergen
enter the
circulation and
binds to IgE-mast
cell complexes
Clinical features :
- The patterns of mucosal alterations are varied
- Anaphylactic stomatitis (AS) may ocur alone
or in conjuction with urticarial skin lesions or
other signs and symptoms of anaphylactic.
- It appears as localized areas of erythema and
edema which can develop into vesiculerosive
lesions and are located most frequently on the
labial mucosa.
Histopathoogic features:

-It reveals a nonspecific pattern of subacute

mucositis that contains lymphocites
intermixed with eosinophils and neutrophyls

- Fixed drugs eruptions show a mixe

inflammatory cellular infiltrate that consist of
lymphocytes, eosinophils, neutrophils, often
combined with spongiosis and exocytosis of
epitheliu.
Treatments

- Replace with another drug

- Topical corticosteroids for localized
acute reactions
- Adrenaline, corticosteroids, and antihistamins
2. Intraoral fixed drug eruptions
3. Lichenoid drug reaction
4. Lupus erythematosus-like eruptions
5. Pemphigus-like drug reactions
6. Nonspecific vesiculoerosive or
aphthous like lesions
Characteristic of Erythema multiform
7. Allergic Contact Stomatitis
(Stomatitis Venenata)
Allergen:
Food, chewing gum, candies, dentifrices,
mouthwashes, glove, ruber dam materials,
topical anesthetic, restorative material,
acrylic denture material, dental impression
materials, and denture adhesive preparation
The oral mucosa is much less sensitive than
the surface of the skin :
 The periode of contact is often brief
 The saliva dilutes, digest, and removes many antigens
 The limited keratinization of oral mucosa makes hapten
binding more difficult, and the hig vascularity tends to
remove any antigen quickly
 The antigen may not be recognized (lower density of
Langerhans cells and T lymphocite)
8. Perioral Dermatitis
A unique inflamatory skin
Caused: cosmetic with corticosteroid
9. Contact Stomatitis from Artificial
Cinnamon Flavoring
Cinnamon oil is used as a flavoring agent in
confectionery, ice cream, soft drink, alcoholic
beverages, gum, candies, toothpaste, breath
fresheners, mouthwashes and dental floss
Gingiva : plasma cell gingivitis
10. Angioedema (Quincke’s Diseases)
Itis not mediated by IgE, but by Angiotensin
converting enzyme (ACE) inhibitor and
complement

Tongue angioedema Lip angioedema

Face angioedema
11. Stevens–Johnson syndrome
 Stevens–Johnson syndrome (SJS)
and toxic epidermal
necrolysis (TEN) are two forms of a life-
threatening skin condition, in which cell
death causes the epidermis to separate
from the dermis
 The syndrome is thought to be
a hypersensitivity complex that affects
the skin and the mucous membranes.
Although the majority of cases
are idiopathic (without a known cause),
the main class of known causes is
medication, followed by infections and,
rarely, cancers.
Symptoms
 SJS usually begins with fever,
sore throat, and fatigue, which is
misdiagnosed and usually treated
with antibiotics.
 Ulcers and other lesions begin to
appear in the mucous membranes,
almost always in the mouth and
lips but also in the genital and
anal regions.
 Those in the mouth are usually
extremely painful and reduce the
patient's ability to eat or drink.
  Conjunctivitis of the eyes occurs
in about 30% of children who
develop SJS.
 A rash of round lesions about an
inch across arises on the face,
trunk, arms and legs, and soles of
the feet, but usually not the scalp.
THANK YOU