Aphthoid Pospischill-Feyrter

Last Updated: 2019-08-27

Author(s): Anzengruber F., Navarini A.

ICD11: -

Suspicion of the most severe form of gingivostomatitis herpetica in immunosuppressed children.

Mostly in children, rarely in adults.

Herpes virus infection in a situation of immune deficiency.

Mucosa, skin and genital area often affected. The corners of the mouth can be affected on the face. Vesicles (vagant aphthoid) often appear on the acres. Spreading towards the edge. Superinfection often occurs. Reduced general condition.

Exclude anamnesis, clinic, biopsy, EM, culture, PCR, Microtrak, meningism. Search for immunosuppression if necessary.

Oral, genital area, acra.

Healing after 1-2 weeks of therapy.

Systemic Therapy

  • Acyclovir (Zovirax®)
  • Application: at 3x 5mg/kg bw/d IV or 5x 200mg/d p.o., with immunosuppression 10mg/kg bw/d IV
  • KI: hypersensitivity, breastfeeding (because of transfer to breast milk)
  • NW (very common): headache, nausea
  • CAVE:
  • In older patients there is an increased risk of reversible neurological disorders.
  • Adjustment of dosage for reduced kidney function.
  • Sufficient liquid supply. 

 

  • ​​​​​​​valaciclovir (Valtrex®)
  • 500 mg 2x/d for 7 days
  • AI: Hypersensitivity, lactation.
  • Side effects (frequent): headache, nausea.
  • CAVE:
  • Adjustment of dosage for reduced kidney function.
  • Hydration state.

 

  • Famciclovir (Famvir®)
  • Application: 500 mg 2x/d
  • For patients >50 years, 500mg 3x/d should be given to prevent zoster neuralgia.
  • Independent of meals.
  • Drug interaction: Probenecid.
  • AI: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir.
  • CAVE:
  • Patients at risk of dehydration, especially older patients, should pay attention to adequate hydration.
  • Efficacy in black patients may be reduced. 

 

  • ​​​​​​​Foscarnet (Foscavir®)
  • For immunosuppression and acyclovir resistance
  • Application: 3 x 40 mg/kg bw/d IV
  • AI: hypersensitivity, pregnancy, lactation.
  • Side effects (very common): granulocytopenia, anorexia, hypokalemia, hypomagnesemia, hypocalcaemia, paresthesia, headache, dizziness, nausea, vomiting, diarrhea, rash, increased serum creatinine, fever, fatigue, chills, asthenia.
  • CAVE:
  • Adjustment of dosage for reduced kidney function.
  • Enough fluid intake. 

 

  • ​​​​​​​Brivudine (Brivex®- Tbl.)
  • Off-label-use
  • Daily dosage: 125 mg 1x/d for 7 days
  • Drug interaction: 5-fluorouracil preparations (at least 4 weeks apart).
  • Side effects (frequent): Nausea.
  • AI: 5-fluorouracil therapy, pregnancy, lactation, hypersensitivity to ingredients, not tested on children and adolescents. 

 

  • ​​​​​​​Lidocaine (Anginova® lozenges)
  • Application: max. 12 pieces/d
  • KI: <12 J.
  • Lidocaine (Dynexan® Mouth Gel)
  • A: For painful areas: > 12 years: up to 4 times a day
  • KI: Pregnancy and lactation 

 

  • ​​​​​​​Chlorhexidine (Chlorhexame® Mouthwash 0.2%)
  • Application: Apply after brushing teeth
  • 6-12 years: after consultation with a dentist
  • 12 yrs: 2x daily mouth rinse for 1 minute 

 

  • ​​​​​​​Camomile extract (Kamillosan® liq)
  • Application: 3 times daily or more often
  • 6 years: In 1 glass of warm water ½ Coffee spoon
  • 1-6 years: 1.5 ml in 1 l water 1x daily
  • AI: Hypersensitivity to ingredients. 

 

  • ​​​​​​​Dexpanthenol (Bepanthen® solution)
  • To use: garnish undiluted or diluted with boiled water several times a day.
  • AI: Hypersensitivity to ingredients.
  • Bed rest.

 

  • If necessary paracetamol.
  • Sufficient intake of fluids and calories.

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