Holistic Management of Recurrent Oral Ulcers as an Oral Manifestation of Delayed-Type Hypersensitivity in Psychosomatic Patients

Satrya Ayu E. Prayudha, Kus Harijanti, Priyo Hadi, Azimatul Karimah

Abstract

Background: Recurrent oral ulcers often cause oral pain. The clinical appearance might be similar but can be caused by different etiologies. One of the etiologies is hypersensitivity triggered by a psychological disorder. Purpose: To report the recurrent multiple oral ulcers as an oral manifestation of hypersensitivity in patients with previously undetected psychosomatic disorders. Case: A 51-year-old female patient complained of painful recurrent multiple oral ulcers for 11 years and accompanied xerostomia, fever, nausea, vomiting, headache, and diarrhea. The patient experienced sleep disturbance, no allergic history, and was under a neurologist’s therapy because of lower back pain. Extra-oral: there were pale conjunctiva and submandibular gland enlargement. Intra-oral: multiple ulcers and sticky saliva. Case Management: Holistic management of this case included anamnesis, clinical examination, blood test and symptomatic therapy, in conjunction with an internist, neurologist, psychiatrist, and dermatologist. No predisposing factor was found by the internist and neurologist. DASS score was 17 indicating anxiety and depression. A psychosomatic disorder was diagnosed by a psychiatrist and the patient was prescribed antidepressants and received psychotherapy. Findings of skin and oral lesions were always preceded by the consumption of shrimp ingredients so the patient was referred to a dermatologist for allergy tests. The result of a Skin Prick Test was positive (+3). Discussion: Dysregulation of HPA axis caused by prolonged psychiatric disorders causes hypocortisol. Hypocortisol suppresses humoral immune responses and increases cellular immune responses that stimulate cytotoxic T cell reactivity resulting in hypersensitivity of type IVC and manifest as recurrent oral ulcers. In conclusion, clinical findings of recurrent multiple oral ulcers might be an oral manifestation of hypersensitivity induced by psychological disorders. Holistic management with a multidiscipline approach was needed for patient recovery.

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Paper Citation


in Harvard Style

Prayudha S., Harijanti K., Hadi P. and Karimah A. (2017). Holistic Management of Recurrent Oral Ulcers as an Oral Manifestation of Delayed-Type Hypersensitivity in Psychosomatic Patients.In Proceedings of the 7th International Meeting and the 4th Joint Scientific Meeting in Dentistry - Volume 1: TIMNAS7-JSMID4, ISBN 978-989-758-341-4, pages 157-164. DOI: 10.5220/0007294201570164


in Bibtex Style

@conference{timnas7-jsmid417,
author={Satrya Ayu E. Prayudha and Kus Harijanti and Priyo Hadi and Azimatul Karimah},
title={Holistic Management of Recurrent Oral Ulcers as an Oral Manifestation of Delayed-Type Hypersensitivity in Psychosomatic Patients},
booktitle={Proceedings of the 7th International Meeting and the 4th Joint Scientific Meeting in Dentistry - Volume 1: TIMNAS7-JSMID4,},
year={2017},
pages={157-164},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0007294201570164},
isbn={978-989-758-341-4},
}


in EndNote Style

TY - CONF

JO - Proceedings of the 7th International Meeting and the 4th Joint Scientific Meeting in Dentistry - Volume 1: TIMNAS7-JSMID4,
TI - Holistic Management of Recurrent Oral Ulcers as an Oral Manifestation of Delayed-Type Hypersensitivity in Psychosomatic Patients
SN - 978-989-758-341-4
AU - Prayudha S.
AU - Harijanti K.
AU - Hadi P.
AU - Karimah A.
PY - 2017
SP - 157
EP - 164
DO - 10.5220/0007294201570164