Aphthoid Pospischill-Feyrter

Very severe form of gingivostomatitis herpetica, occurring especially in immunosuppressed children.

Mostly occurring in children, rarely in adults.

Herpes virus infection in an immunodeficiency situation.

Mucous membranes, skin and genital area are often affected. On the face, the corners of the mouth may be affected. Vesicles (vagant aphthoid) often appear on the acra. It spreads towards the edges. Superinfection is common. Reduced AZ.

• Anamnesis
• clinic
• Perhaps biopsy
• EM
• Culture
• PCR
• Microtrack
• Rule out meningism
• Search for immunosuppression if necessary

Oral, genital area, acral.

Healing after 1-2 weeks.

Systemic therapy

• Aciclovir
• Administration: at 3x 5mg/kg bw/d i.v. or 5x 200mg/d p.o., at immunosuppression 10mg/kg bw/d i.v.
• KI: Hypersensitivity, lactation (since transfer to breast milk)
• ADVERSE REACTIONS (very common): headache, nausea
• CAVE:
  • In elderly patients there is an increased risk for the occurrence of reversible neurological disorders.
  • Adjust dosage if renal function is impaired.
  • Enough fluid intake

• Valaciclovir
• Add.: 500 mg 2x/d for 7d
• CI: hypersensitivity, lactation
• ADVERSE REACTIONS (common): headache, nausea
• CAVE:
  • Adjust dosage if renal function is impaired
  • Hydration state

• Famciclovir
• Application: 500 mg 2x/d
• For pat. >50 yrs, 500mg 3x/d should be given to prevent zoster neuralgia
• Independent on meals
• WW: probenecid
• CI: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir
• CAVE:
  • In patients at risk of dehydration, especially elderly patients, adequate hydration should be ensured
  • Efficacy may be reduced in black patients

• Foscarnet
• In immunosuppression and aciclovir resistance
• Administer: 3 x 40 mg/kg bw/d i.v.
• KI: hypersensitivity, pregnancy, lactation
• SNW (very common): granulocytopenia, anorexia, hypokalaemia, hypomagnesaemia, hypocalcaemia, paraesthesias, headache, dizziness, nausea, vomiting, diarrhoea, rash, increased serum creatinine, fever, fatigue, chills, asthenia
• CAVE:
  • Adjust dosage if renal function is impaired
  • Enough fluid intake

• Brivudine tablets
• off-label use
• Add: 125 mg 1x/d for 7 days
• WW: 5-fluorouracil preparations (time interval at least 4 weeks)
• NWM (common): nausea
• KI: 5-fluorouracil therapy, pregnancy, lactation, hypersensitivity to ingredient, not tested in children and adolescents

• Lidocaine lozenges
  • Application: max. 12 pieces/d
  • KI: <12 y.
• Lidocaine mouth gel
  • A: On painful areas: > 12 yrs: up to 4x daily
  • KI: Pregnancy and lactation

• Chlorhexidine (mouth rinse 0.2%)
• Apply after brushing the teeth
• 6-12 yrs: after dental consultation
• >12 yrs: rinse mouth for 1 minute 2x daily

• Camilla extract
• Administration: 3 times daily or more
• >6 years: In 1 glass of warm water ½ coffee spoon
• 1-6 years: 1, 5 ml in 1 L water 1x tgl.
• KI: Hypersensitivity to ingredients

• Dexpanthenol solution
• Add: undiluted or diluted with boiled water, gargle several times daily
• KI: Hypersensitivity to ingredients
• Bed rest

• Paracetamol
if necessary
• Sufficient fluid and calorie intake

1. Ozcan, D., et al., Mucocutaneous disorders in renal transplant recipients receiving sirolimus-based immunosuppressive therapy: a prospective, case-control study. Clin Transplant, 2013. 27(5): p. 742-8.
2. Parent, D., [Oral ulcerations]. Rev Med Brux, 2011. 32(4): p. 210-8.
3. Woitzek, K., F. Dusemund, and B. Muller, [Sick or made sick? Recurrent episodes of cutaneous and subcutaneous ulcers, colitis, arthralgia and hair loss... a systemic disease or iatrogenic?]. Ther Umsch, 2010. 67(12): p. 629-34.
4. Kakabadze, T., et al., Oral lesions in HIV-positive patients in Georgia. Georgian Med News, 2008(165): p. 60-5.
5. Greenspan, D., et al., Oral mucosal lesions and HIV viral load in the Women's Interagency HIV Study (WIHS). J Acquir Immune Defic Syndr, 2000. 25(1): p. 44-50.
6. Naraqi, S., et al., Clinical manifestations of infections with herpesviruses after kidney transplantation: a prospective study of various syndromes. Ann Surg, 1978. 188(2): p. 234-9.