Journal Information
Vol. 112. Issue 5.
Pages 463-466 (May 2021)
Vol. 112. Issue 5.
Pages 463-466 (May 2021)
Case and Research Letters
DOI: 10.1016/j.adengl.2019.10.014
Open Access
Successful Treatment of White Sponge Nevus with Oral Doxycycline: A Case Report and Review of the Literature
Tratamiento del nevus blanco esponjoso. Aportación de un caso con respuesta a doxiciclina oral y revisión de la literatura
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E. Amores-Martína,
Corresponding author
eamoresmartin@gmail.com

Corresponding author.
, G. Melé-Ninota, E. Del Alcázar Viladomiua, M.T. Fernández-Figuerasb
a Servicio de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, Spain
b Servicio de Anatomía Patológica, Hospital Universitari Sagrat Cor, Barcelona, Spain
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Table 1. Published Cases of White Sponge Nevus: Therapeutic Guidelines, Clinical Responses, and Recurrences
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To the Editor:

White sponge nevus (WSN) is a rare and benign disease that usually affects the oral mucosa and manifests as white spongy plaques. Because it is usually clinically asymptomatic, treatment of WSN is focused on improving the aesthetics and texture of the mucosa.1 Given the low prevalence of this condition, description of the available therapeutic options is limited to isolated clinical case reports and short cases series.

A 46-year-old male non-smoker with no relevant personal history was seen for oral lesions that had been present since childhood. Clinical examination revealed bilateral, whitish, soft plaques that were located on the buccal mucosa and the lateral aspects of the tongue and remained adhered after scraping (Fig. 1A and B). The patient had no similar lesions in other locations and reported no relevant family history. Although the lesions were asymptomatic, they had a significant aesthetic impact on the patient. A biopsy of one of the lesions on the buccal mucosa revealed epithelial hyperplasia, edema, and discrete cytoplasmic clearance in squamous cells. Taken together with the clinical context, these findings were compatible with WSN.

Figure 1.

Wrinkled, whitish lesions on the sides of the tongue (A) and on the buccal mucosa (B). Clinical improvement of the lesions on the side of the tongue (C) and on the buccal mucosa (D) after treatment with oral doxycycline.

(0.34MB).

Treatment for 2 months with topical triamcinolone acetonide (0.1%) and retinoic acid (0.1%) in oral adhesive excipient resulted in no clinical improvement, and it was decided to begin treatment with oral doxycycline (100 mg/d) for 6 weeks. The extension and texture of the lesions improved by the end of the treatment cycle, providing an acceptable aesthetic result, and the patient remained stable for the next 6 months (Fig. 1C and D).

WSN is a rare, autosomal dominant disease with incomplete penetrance, despite isolated reports of cases with no family history.1,2 It was first described by Hyde in 1909.1 Clinically, it is characterized by bilateral, well-defined, villous white plaques with a spongy texture, usually located on the oral mucosa, often with involvement of the bite line and the anterior third of the buccal mucosa.1,3 It usually manifests during childhood or adolescence, with no sexual predisposition, and the lesions tend to remain stable throughout life. Histology shows acanthosis with intercellular edema and vacuolization, as well as parakeratotic or orthokeratotic hyperkeratosis in the superficial layers.4,5 Diagnosis is based on clinical–pathological correlation and, where possible, analysis of mutations in keratin 4 (KRT4) and keratin 13 (KRT13), genes responsible for epithelial keratinization.1 The differential diagnosis should primarily include oral candidiasis, frictional leukokeratosis, leukoedema, leukoplakia, and lichen planus.1,2

Although WSN is a benign and asymptomatic disease, its effects on mucosa texture and aesthetics are a source of discomfort for many patients. Multiple treatments have been tested for WSN (Table 1). Some have proven of little benefit, producing variable results, and there is no well-defined therapeutic protocol.

Table 1.

Published Cases of White Sponge Nevus: Therapeutic Guidelines, Clinical Responses, and Recurrences

Authors  Sex  Age  Family History  Treatment  Response  Recurrence/Maintenance Therapy 
Otobe et al.3  23  Yes  Tetracycline rinses (0.25%, 5 mL for 1 min) 2 times per day for 12 weeks  Partial  No 
  27  Yes  Tetracycline rinses (0.25%, 5 mL for 1 min) 2 times per day for 12 weeks  Partial  No 
  46  No  Tetracycline rinses (0.25%, 5 mL for 1 min) 2 times per day for 12 weeks  Complete  No 
  24  No  Tetracycline rinses (0.25%, 5 mL for 1 min) 2 times per day for 12 weeks  Complete  5 months 
Lamey et al.6M1.5YesTetracycline 250 mg once per day for 4 weeks  No  -
Penicillin 250 mg once per day for 2 weeks  No 
M24YesTetracycline 250 mg 4 times per day for 4 weeks  Partial  8 weeks/Tetracycline 250 mg/wk
Tetracycline 250 mg once per day for 30 weeks  Partial 
M52NoAmoxicillin 250 mg 3 times per day for 4 weeks  Partial  8 weeks/Amoxicillin 250 mg/wk
Minocycline 50 mg 2 times per day for 6 weeks  No 
F11NoPenicillin 250 mg 4 times per day for 4 weeks  Partial  Yes/Penicillin 250 mg/wk
Penicillin 250 mg once per day for 20 weeks  Partial 
M32YesTetracycline 250 mg 4 times per day for 4 weeks  Partial  10 weeks/No
Amoxicillin 250 mg 3 times per day for 4 weeks  Partial 
  Yes  Amoxicillin 125 mg 3 times per day for 4 weeks  No 
Otobe et al.4  10  No  Tetracycline rinses (0.25%) 2 times per day for 12 weeks  Complete  4 months 
Lim et al.7F36NoPenicillin G procaine 1.2 MU IM once per day for 3 days  No  -
Tetracycline rinse (0.25%), single dose  Partial 
Contreras-Steyls et al.5  26  Yes  Doxycycline 200 mg once per day and tetracycline rinses (0.25%) 2 times per day for 12 weeks  Complete 
Satriano et al.8  15  Yes  Chlorhexidine rinse (0.12%, 5 mL for 45 seconds) 2 times per day for 8 days  Partial  Chlorhexidine rinses 1 wk per month 
  50  Yes  Chlorhexidine rinse (0.12%, 5 mL for 45 seconds) 2 times per day for 8 days  Partial  Chlorhexidine rinses 1 wk per month 
Piqué et al.2M46NoAmoxicillin 500 mg 3 times per day for 10 days  No 
Retinoic acid (0.01% aqueous solution) for 4 weeks  Complete  Intermittent regimen of topical retinoids 
Becker et al.9  12  No  Tetracycline rinses (0.25%, 2 times per day) for 12 weeks  Partial  Tetracycline rinses ad libitum 
Amores-Martín et al.*M46NoOral adhesive excipient containing 0.1% triamcinolone acetonide and 0.1% retinoic acid once per day for 8 weeks  No 
Doxycycline 100 mg once per day for 6 weeks  Partial  No 

Abbreviations: F, female; IM, intramuscular; MU, million units; M, male.

*

Present case.

Partial and complete responses have been described in patients treated with topical tetracyclines. The best results have been described in patients treated with 0.025% tetracycline rinses 2 times per day for 12 weeks. However, good responses have been reported in 2 cases treated with oral tetracyclines, in line with our findings. The paucity of publications makes it difficult to establish the best route of tetracycline administration. In WSN, the beneficial effect of second-generation tetracyclines such as doxycycline and minocycline can be attributed both to their anti-inflammatory effects and their modulation of epithelial keratinization.1 These properties constitute an advantage over tetracycline.10

Although WSN is not considered of microbiological origin, most of the treatments for which good outcomes have been reported to date are antimicrobial therapies, including oral and topical antibiotics and antiseptics such as chlorhexidine.8 This suggests that certain microorganisms may play a role in disease expression in genetically predisposed individuals. However, further evidence is required to support this hypothesis.

Analysis of therapeutic response as a function of a family history of WSN suggests that the absence of a family history does not greatly increase the likelihood of a response to treatment, but is associated with a greater clinical response.

The new WSN case presented here, in which the patient showed a satisfactory clinical response to oral doxycycline (100 mg/d for 6 weeks), provides additional data on the use of oral tetracyclines to treat this condition. We believe it is important to have a knowledge of the clinical evidence supporting the different treatments used to date to ensure selection of the most appropriate therapies for these patients.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

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Please cite this article as: Amores-Martín E, Melé-Ninot G, Del Alcázar Viladomiu E, Fernández-Figueras MT. Tratamiento del nevus blanco esponjoso. Aportación de un caso con respuesta a doxiciclina oral y revisión de la literatura. Actas Dermosifiliogr. 2021;112:463–466.

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