Acta Dermato-Venereologica 99-9CompleteContent | Page 16

813 INVESTIGATIVE REPORT Usefulness of Psychiatric Intervention in a Joint Consultation for the Treatment of Burning Mouth Syndrome: A Monocentric Retrospective Study Vinciane LE BRIS 1 , Myriam CHASTAING 1 , Martine SCHOLLHAMMER 1 , Emilie BRENAUT 1,2 and Laurent MISERY 1,2 Department of Dermatology, University Hospital of Brest, and 2 Laboratory of Neurosciences (EA4685), University of Western Brittany, Brest, France 1 Primary burning mouth syndrome is a term used for chronic oral mucosal pain with no identifiable organic cause. The aim of the study was to evaluate the use- fulness of a psychiatric intervention for treating bur- ning mouth syndrome based on a joint consultation with a psychiatrist and a dermatologist. The study was proposed to all patients who visited this consultation group between 2001 and 2017 for the treatment of pri- mary burning mouth syndrome. The patients answe- red a questionnaire that was administered via mail. Of the 57 patients diagnosed with primary burning mouth syndrome, 38 were included. Seven patients (18.4%) no longer had pain; 8 (21.1%) estimated that the pain had decreased by greater than 50%; 11 (28.9%) es- timated the decrease at between 30 and 50%, and 12 (31.6%) estimated a less than 30% decrease. Only 14 patients (36.8%) remained under treatment with antidepressants, as compared to 63.2% before the psychiatric intervention. This psychiatric intervention could be considered a valuable tool in the global bur- ning mouth syndrome treatment strategy. Key words: burning mouth syndrome; anxiety; depression; antidepressant; psychiatric intervention. Accepted Nov 20, 2018; E-published Nov 21, 2018 Acta Derm Venereol 2019; 99: 813–817. Corr: Laurent Misery, Department of Dermatology, University Hospital, FR-29609 Brest, France. E-mail: [email protected] P rimary burning mouth syndrome (BMS) is a term used for a chronic disorder that is defined by the International Headache Society as an “intraoral burning or dysaesthetic sensation recurring daily for more than 2 h per day over more than 3 months, without clinically evident causative lesion” (1). Symptoms include burning pain or discomfort on the tongue, lips, teeth or in the entire oral cavity, occasionally associated with dysgeusia or xerostomia, without any identifiable organic cause. Its prevalence has been estimated at between 0.1 and 3.9% of the general population (2, 3). In a recent study, the incidence of BMS was 11.4 per 100,000 person-years (4). It is most common in perimenopausal or post-me­ nopausal women (4). The pathophysiology is currently misunderstood. BMS has been shown to be associated with a neuropathic component, with underlying damage to the nerves (e.g., small-fiber neuropathies) and/or a SIGNIFICANCE Primary burning mouth syndrome is a term used for chronic oral mucosal pain with no identifiable organic cause. Bur- ning mouth syndrome are frequently associated with psy- chiatric disorders. We conducted a monocentric study to evaluate the usefulness of a psychiatric intervention in a joint consultation with a psychiatrist and a dermatologist. Most of our patients demonstrated a significant decrease in pain and a small percentage of patients were comple- tely symptom-free after such interventions. The psychiatric intervention seems to be a good and lasting therapeutic option, and should be integrated in the global strategy in burning mouth syndrome treatment. psychiatric component, with co-morbidities (anxiety, depression or/and personality disorder) and putative triggering stressful events in the genesis of this disease (5–8). Patient quality of life is impaired (9). There are no treatment guidelines, and multiple pharmacological agents have been trialed, in particular, antidepressants (10, 11). Recently, a Cochrane review of studies of in­ terventions for treating BMS concluded that there was insufficient evidence to support or refute the use of any interventions in managing BMS and encouraged the assessment of the role of neuropathic pain treatments and psychiatric therapies in the treatment of BMS (12). Since 2001, in our department, we have organized a joint consultation with a psychiatrist (MC) and a derma­ tologist (LM then MS) (13). In this consultation, many outpatients are found to suffer from BMS. We conducted a self-reported retrospective and uncontrolled study to evaluate the usefulness of psychiatric intervention in this consultation. PATIENTS AND METHODS The study was proposed to all primary BMS patients who came to the consultation with the dermatologist and psychiatrist between 2001 and 2017 in the Dermatology Department of the University Hospital of Brest, France. The inclusion criteria were BMS as­ sessed by the presence of symptoms of pain in the oral mucosa, with or without subjective oral dryness or loss or alteration of taste sensation, normal oral mucosa and the presence of pain on most days for more than 4 months. Somatic causes, such as diabetes mellitus or vitamin or nutritional deficiency, were excluded based on standard laboratory tests. The following exclusion criteria This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3094 Acta Derm Venereol 2019; 99: 813–817