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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Infiltrative plaque on the mucous membrane of the soft palate&#46; B&#44; Clinical appearance after 2 weeks of multidrug therapy with the World Health Organization recommended regimen &#40;rifampicin&#44; clofazimine&#44; dapsone&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the excellent article by Moronta Castellano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on oral manifestations of Hansen disease&#46; The authors report findings that are specific for the disease and those that occur independently&#46; Consistent with data published to date&#44; the authors confirm involvement of the palatine mucosa as the most common lesion&#46; The findings affecting the palate were plaques or lepromas&#44; which are histologically characterized by the presence of a dense lymphohistiocytic infiltrate with no granulomas in which Fite-Faraco and Ziehl Neelsen staining revealed mycobacteria&#46; In this series&#44; most patients were receiving multidrug treatment for Hansen disease at the time of the evaluation of the oral lesions&#46; An interesting aspect not addressed in the text is the progress of these findings during specific treatment of the multibacillary forms of the disease&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In our experience&#44; based on imported cases&#44; we have observed how specific oral lesions from patients with multibacillary forms of the disease responded early after initiation of multidrug treatment&#46; The first patient was a 38-year-old man from Brazil who had been diagnosed with histoid leprosy based on clinical&#44; histopathologic&#44; and microbiological characteristics&#44; with a high bacillary load in samples obtained from the skin smear and the nasal mucosa&#46; The physical examination revealed multiple nodules and shiny plaques mainly on the face&#46; Of particular interest on the oral mucosa&#44; we observed a plaque affecting most of the soft palate and forming a central cleft &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The patient was prescribed multidrug treatment according to the World Health Organization recommended regimen &#40;rifampicin&#44; clofazimine&#44; dapsone&#41;&#46; The first clinical check-up during the 2 subsequent weeks revealed a marked improvement in the oral lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; The second case involved a 27-year-old woman from Brazil who had been diagnosed with lepromatous leprosy and erythema nodosum leprosum as the first manifestation of the disease&#46; In this case&#44; facial involvement was minimal or nonexistent&#44; with only small lepromas on the ear lobes&#46; A plaque similar to that in the first case was observed on the oral mucosa&#44; again on the soft palate&#44; although it was less thick and extensive&#46; After initiation of multidrug therapy with rifampicin&#44; clofazimine&#44; dapsone&#44; and prednisone&#44; involvement of the palatine mucosa resolved in 10 days&#44; with no further changes on the skin surface&#46; Furthermore&#44; in both patients&#44; we observed how this improvement in the oral lesions occurred in parallel to the favorable progress of nasal symptoms &#40;congestion&#44; rhinorrhea&#41;&#46; The latter observation could be explained by the fact that the oral lesions developed after extension of the bacillus from the nasal mucosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Another aspect of interest in these patients is the presence of lesions on the oral mucosa secondary to poor oral-dental hygiene&#44; either as a consequence of a limitation secondary to the presence of deformities &#40;or mutilations in advanced cases&#41; or because of a loss of motivation for self-care&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In summary&#44; while our observation is based on isolated cases&#44; we wondered whether the early response of the oral lesions could act as an additional tool for monitoring adherence to multidrug therapy&#46; Similarly&#44; this initial response in the oral mucosa could reinforce the patient&#8217;s perception of the benefits of treatment&#46;</p></span>"
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Letters to the Editor
Comment on «Characteristics of Oral Lesions in Patients With Hansen Disease»
Réplica a «Caracterización de lesiones bucales de pacientes con enfermedad de Hansen»
A. Pulido Pérez
Corresponding author
ana.pulido@salud.madrid.org

Corresponding author.
, L.M. Nieto-Benito, M. Bergón-Sendín, R. Suárez-Fernández
Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the excellent article by Moronta Castellano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on oral manifestations of Hansen disease&#46; The authors report findings that are specific for the disease and those that occur independently&#46; Consistent with data published to date&#44; the authors confirm involvement of the palatine mucosa as the most common lesion&#46; The findings affecting the palate were plaques or lepromas&#44; which are histologically characterized by the presence of a dense lymphohistiocytic infiltrate with no granulomas in which Fite-Faraco and Ziehl Neelsen staining revealed mycobacteria&#46; In this series&#44; most patients were receiving multidrug treatment for Hansen disease at the time of the evaluation of the oral lesions&#46; An interesting aspect not addressed in the text is the progress of these findings during specific treatment of the multibacillary forms of the disease&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In our experience&#44; based on imported cases&#44; we have observed how specific oral lesions from patients with multibacillary forms of the disease responded early after initiation of multidrug treatment&#46; The first patient was a 38-year-old man from Brazil who had been diagnosed with histoid leprosy based on clinical&#44; histopathologic&#44; and microbiological characteristics&#44; with a high bacillary load in samples obtained from the skin smear and the nasal mucosa&#46; The physical examination revealed multiple nodules and shiny plaques mainly on the face&#46; Of particular interest on the oral mucosa&#44; we observed a plaque affecting most of the soft palate and forming a central cleft &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The patient was prescribed multidrug treatment according to the World Health Organization recommended regimen &#40;rifampicin&#44; clofazimine&#44; dapsone&#41;&#46; The first clinical check-up during the 2 subsequent weeks revealed a marked improvement in the oral lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; The second case involved a 27-year-old woman from Brazil who had been diagnosed with lepromatous leprosy and erythema nodosum leprosum as the first manifestation of the disease&#46; In this case&#44; facial involvement was minimal or nonexistent&#44; with only small lepromas on the ear lobes&#46; A plaque similar to that in the first case was observed on the oral mucosa&#44; again on the soft palate&#44; although it was less thick and extensive&#46; After initiation of multidrug therapy with rifampicin&#44; clofazimine&#44; dapsone&#44; and prednisone&#44; involvement of the palatine mucosa resolved in 10 days&#44; with no further changes on the skin surface&#46; Furthermore&#44; in both patients&#44; we observed how this improvement in the oral lesions occurred in parallel to the favorable progress of nasal symptoms &#40;congestion&#44; rhinorrhea&#41;&#46; The latter observation could be explained by the fact that the oral lesions developed after extension of the bacillus from the nasal mucosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Another aspect of interest in these patients is the presence of lesions on the oral mucosa secondary to poor oral-dental hygiene&#44; either as a consequence of a limitation secondary to the presence of deformities &#40;or mutilations in advanced cases&#41; or because of a loss of motivation for self-care&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In summary&#44; while our observation is based on isolated cases&#44; we wondered whether the early response of the oral lesions could act as an additional tool for monitoring adherence to multidrug therapy&#46; Similarly&#44; this initial response in the oral mucosa could reinforce the patient&#8217;s perception of the benefits of treatment&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pulido P&#233;rez A&#44; Nieto-Benito LM&#44; Berg&#243;n-Send&#237;n M&#44; Su&#225;rez-Fern&#225;ndez R&#46; R&#233;plica a &#171;Caracterizaci&#243;n de lesiones bucales de pacientes con enfermedad de Hansen&#187;&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;384&#8211;385&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Infiltrative plaque on the mucous membrane of the soft palate&#46; B&#44; Clinical appearance after 2 weeks of multidrug therapy with the World Health Organization recommended regimen &#40;rifampicin&#44; clofazimine&#44; dapsone&#41;&#46;</p>"
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                      "titulo" => "Caracterizaci&#243;n de lesiones bucales de pacientes con enfermedad de Hansen"
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                        0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral manifestation in leprosy&#58; a cross-sectional study of 100 cases with literature review"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Vohra"
                            1 => "M&#46;S&#46;U&#46; Rahman"
                            2 => "B&#46; Subhada"
                            3 => "R&#46;V&#46;C&#46; Tiwari"
                            4 => "M&#46;S&#46; Nabeel Althaf"
                            5 => "M&#46;J&#46; Gahlawat"
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                      "doi" => "10.4103/jfmpc.jfmpc_766_19"
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                        "tituloSerie" => "J Family Med Prim Care&#46;"
                        "fecha" => "2019"
                        "volumen" => "8"
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                        "paginaFinal" => "3694"
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                    0 => array:2 [
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                          "autores" => array:2 [
                            0 => "J&#46;M&#46; N&#250;&#241;ez Mart&#237;"
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Article information
ISSN: 15782190
Original language: English
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