Aphthous stomatitis induced by piroxicam

The most frequent adverse mucocutaneous reactions induced by piroxicam is photodermatitis, but maculopapular or lichenoid eruptions, urticaria, erythema multiforme, toxic epidermal necrolysis, and pruritus can occur. On the other hands, among the undesirable reactions affecting the oral mucosa from systemic medication, erosive and ulcerative stomatitis is frequent, mainly caused by antihypertensives and antiangina drugs. Authors describe a 49-year-old man with an acute aphthous stomatitis. The erosions and ulcers, localized on the lateral borders of the tongue and oral mucosa, were very painful, circular and sharply delimited, 2 to 3 mm in diameter, with a red border, and covered by a yellowish white pseudomembrane. They were associated with dysphagia and sialorrhea. The patient reported occasional low back pain treated orally with piroxicam. Therefore patch and prick test with piroxicam were negative. An oral provocation test was performed with increasing doses of piroxicam. Aphthous stomatitis relapsed 48 hours from the last dose. This report emphasizes the role of exposure test in diagnosis of adverse mucocutaneous reactions, mainly when the suspected drugs are nonsteroidal anti-inflammatory drugs. In these patients, an exposure test should be performed only in the hospital and in specialized centers equipped for emergency and not in patients with severe adverse mucocutaneous reactions, such as anaphylaxis, angioedema, erythema multiforme, and Stevens-Johnson syndrome.