Correspondence

Nicotine Patches for Aphthous Ulcers Due to Behçet's Syndrome

N Engl J Med 2000; 343:1816-1817December 14, 2000

Article

To the Editor:

We describe a woman with Behçet's syndrome characterized by recurrent oral and genital aphthous ulcers, severe eye involvement, and the onset of arthritis at the age of 29 years. She had started smoking at the age of 17 and regularly smoked 20 cigarettes a day (total history of smoking, approximately 20 pack-years). At the age of 35, during a remission of symptoms of Behçet's syndrome, she stopped smoking without the use of nicotine-replacement therapy. Within two weeks after she had quit, several large and extremely painful buccal aphthous ulcers developed, with no genital involvement. These ulcerations were identical to those she had had previously. Various local treatments were not effective. Since nicotine-replacement therapy has been effective in treating recurrent aphthous ulcers after smoking cessation,1 we prescribed nicotine polacrilex gum (Nicorette, Pharmacia and Upjohn, Guyancourt, France; strength, 2 mg). Unfortunately, excessive pain prevented the patient from chewing the gum, as well as from taking nicotine polacrilex tablets (Nicorette Microtabs, Pharmacia and Upjohn; 2-mg tablets with buccal release; not marketed in the United States). Ultimately, therapy with a nicotine patch (NiQuitin, SmithKline Beecham, Nanterre, France; dose, 14 mg per 24 hours) led to a regression of all aphthous ulcers within a few days. A month later, after the patient had stopped using the nicotine patches, four aphthous ulcers developed within a week. These ulcers rapidly regressed once she resumed using the nicotine patches.

Recurrent aphthous ulcers are less common among users of smokeless tobacco than among nonusers,2 and among smokers than among nonsmokers.3,4 Nicotine polacrilex gum can be used to treat aphthous ulcers that develop after smoking cessation.1,5 Our findings suggest that oral ulcers associated with Behçet's syndrome may in some cases be related to the cessation of smoking and that nicotine-replacement therapy may be useful for such ulcers. This treatment has also been suggested for ulcerative colitis.6

Philippe Scheid, M.D.
Abraham Bohadana, M.D.
Yves Martinet, M.D., Ph.D.
Université Henri Poincaré, 54500 Nancy-Vandoeuvre, France

6 References

1. 1

   Bittoun R. Recurrent aphthous ulcers and nicotine. Med J Aust 1991;154:471-472
   Web of Science | Medline

2. 2

   Grady D, Ernster VL, Stillman L, Greenspan J. Smokeless tobacco use prevents aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1992;74:463-465
   CrossRef | Medline

3. 3

   Shapiro S, Olson DL, Chellemi SJ. The association between smoking and aphthous ulcers. Oral Surg Oral Med Oral Pathol 1970;30:624-630
   CrossRef | Medline

4. 4

   Axell T, Henricsson V. Association between recurrent aphthous ulcers and tobacco habits. Scand J Dent Res 1985;93:239-242
   Medline

5. 5

   Christen AG, McDonald JL Jr, Christen JA. The impact of tobacco use and cessation on nonmalignant and precancerous oral and dental diseases and conditions. Indianapolis: Indiana University School of Dentistry, 1991.
   

6. 6

   Sandborn WJ. Nicotine therapy for ulcerative colitis: a review of rationale, mechanisms, pharmacology, and clinical results. Am J Gastroenterol 1999;94:1161-1171
   CrossRef | Web of Science | Medline

Citing Articles (17)

Citing Articles

1. 1

   R.V. Subramanyam. (2011) Occurrence of recurrent aphthous stomatitis only on lining mucosa and its relationship to smoking – A possible hypothesis. Medical Hypotheses 77:2, 185-187
   CrossRef

2. 2

   Samantha C. Hill, Anastasios Stavrakoglou, Ian R. Coutts. (2010) Nicotine replacement therapy as a treatment for complex aphthosis. Journal of Dermatological Treatment 21:5, 317-318
   CrossRef

3. 3

   C. Scully, A. Hegarty. 2010. The Oral Cavity and Lips. , 1-129.
   CrossRef

4. 4

   Neil Cox, J. L. Jorizzo, J. F. Bourke, C. O. S. Savage. 2010. Vasculitis, Neutrophilic Dermatoses and Related Disorders. , 1-95.
   CrossRef

5. 5

   G. Ciancio, M. Colina, R. La Corte, A. Lo Monaco, F. De Leonardis, F. Trotta, M. Govoni. (2010) Nicotine-patch therapy on mucocutaneous lesions of Behcet's disease: a case series. Rheumatology 49:3, 501-504
   CrossRef

6. 6

   N. H. Cox, I. H. Coulson. 2010. , 1.
   CrossRef

7. 7

   B. Wechsler, L.T.H. Du-Boutin, Z. Amoura. (2009) Enfermedad de Behet. EMC - Aparato Locomotor 42:3, 1-14
   CrossRef

8. 8

   JJ Goedert, BM Scoppio, R Pfeiffer, L Neve, AB Federici, LR Long, BM Dolan, M Brambati, M Bellinvia, C Lauria, L Preiss, V Boneschi, D Whitby, L Brambilla. (2008) Treatment of classic Kaposi sarcoma with a nicotine dermal patch: a phase II clinical trial. Journal of the European Academy of Dermatology and Venereology 22:9, 1101-1109
   CrossRef

9. 9

   Kamile Marakoğlu, Recep Erol Sezer, Hülya Çakmak Toker, İsmail Marakoğlu. (2007) The recurrent aphthous stomatitis frequency in the smoking cessation people. Clinical Oral Investigations 11:2, 149-153
   CrossRef

10. 10

    Yin Ruixing, Bi Qi, Liu Tangwei, Li Jiaquan. (2007) Effects of Nicotine on Angiogenesis and Restenosis in a Rabbit Model. Cardiology 107:2, 122-131
    CrossRef

11. 11

    Paul A. Yates, Joseph B. Michelson. (2006) Beh??et Disease. International Ophthalmology Clinics 46:2, 209-233
    CrossRef

12. 12

    Cem Evereklioglu. (2005) Current Concepts in the Etiology and Treatment of Behçet Disease. Survey of Ophthalmology 50:4, 297-350
    CrossRef

13. 13

    T. Kanekura, Y. Mera, K. Mera, H. Saruwatari, T. Kanzaki. (2005) Efficacy of transdermal nicotine patches for eosinophilic pustular folliculitis. British Journal of Dermatology 152:5, 1074-1075
    CrossRef

14. 14

    T. Kanekura, Y. Uchino, T. Kanzaki. (2003) A case of malignant atrophic papulosis successfully treated with nicotine patches. British Journal of Dermatology 149:3, 660-662
    CrossRef

15. 15

    Johannes Jacobi, James J. Jang, Uma Sundram, Hayan Dayoub, Luis F. Fajardo, John P. Cooke. (2002) Nicotine Accelerates Angiogenesis and Wound Healing in Genetically Diabetic Mice. The American Journal of Pathology 161:1, 97-104
    CrossRef

16. 16

    Robert Meador, George Ehrlich, Joan M. Feldt. (2002) Behçet’s disease: Immunopathologic and therapeutic aspects. Current Rheumatology Reports 4:1, 47-54
    CrossRef

17. 17

    (2001) Current Awareness. Pharmacoepidemiology and Drug Safety 10:3, 263-278
    CrossRef