The Effects of Hyaluronic Acid Gel on Oral Mucositis in Children Receiving Chemotherapy
Year 2025,
Volume: 3 Issue: 1, 1 - 6, 30.04.2025
Serap Keskin Tunç
,
Yusuf Rodi Mızrak
,
Gamze Aksu
,
Kamuran Karaman
,
Mahide Büşra Başkan
Abstract
Aim Oral mucositis (OM) is a common side effect of systemic chemotherapy (CT) in cancer patients. The aim of this study was to investigate the effect of hyaluronic acid (HA) gel on OM in children receiving CT.
Material and method A total of 40 pediatric patients aged between 3 and 18 years who were diagnosed with leukemia and treated with CT in the inpatient setting were included. The patients were randomly divided into groups. The HA group (n=20) received HA gel and the control group (n=20) received sodium bicarbonate. The grade of OM was evaluated based on the World Health Organization Common Toxicity Criteria Scale. The pain severity was assessed using the Visual Analog Scale (VAS).
Results Of the patients, 21 (52.5%) were girls and 19 (47.5%) were boys. The mean age was 9.37±5.11 (range, 3 to 18) years. The majority of the patients (77.5%) had a diagnosis of pro-B-cell acute lymphoblastic leukemia (ALL). There was no statistically significant difference in the number of OM lesions and VAS scores between the groups (p>0.05).
Conclusion The study results show that both standard oral care with sodium bicarbonate and HA gel have similar effects on pain relief and regression of OM in pediatric cancer patients undergoing CT. The HA gel is a feasible alternative for the pediatric population.
Ethical Statement
This study was approved by the Van Yuzuncu Yil Non-Interventional Clinical Research Ethics Committee with the Approval No: 06/03.07.2019.
Supporting Institution
This study received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.
Project Number
NCT05818007
References
- Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453–61.
- Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and treatment of chemotherapy and radiotherapy induced oral mucositis. Medicina. 2019;55(2):25.
- Erdem O, Güngörmüş Z. The effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy. Holist Nurs Pract. 2014;28(4):242–6.
- Sonis ST, Sonis AL, Lieberman A. Oral complications in patients receiving treatment for malignancies other than of the head and neck. J Am Dent Assoc. 1978;97(3):468–72.
- Lockhart PB, Sonis ST. Relationship of oral complications to peripheral blood leukocyte and platelet counts in patients receiving cancer chemotherapy. Oral Surg Oral Med Oral Pathol. 1979;48(1):21–8.
- Abramoff MMF, Lopes NNF, Lopes LA, Dib LL, Guilherme A, Caran EM, et al. Low-level laser therapy in the prevention and treatment of chemotherapy-induced oral mucositis in young patients. Photomed Laser Surg. 2008;26(4):393–400.
- cCarthy GM, Awde JD, Ghandi H, Vincent M, Kocha WI. Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil. Oral Oncol. 1998;34(6):484–90.
- Van Sebille YZA, Stansborough R, Wardill HR, Bateman E, Gibson RJ, Keefe DM. Management of mucositis during chemotherapy: from pathophysiology to pragmatic therapeutics. Curr Oncol Rep. 2015;17(11):50.
- Di Fede O, Canepa F, Maniscalco L, Tozzo P, Matranga D, Giuliana G. Oral mukozitin önlenmesi ve tedavisi: sodyum bikarbonatın diğer ajanlara karşı etkinliği: sistematik bir inceleme. BMC Oral Health. 2023;23(1):4.
- Nolan A, Baillie C, Badminton J, Rudralingham M, Seymour RA. The efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration. J Oral Pathol Med. 2006;35(8):461–5.
- Al-Bayaty F, Abdulla MA. A comparison of wound healing rate following treatment with aftamed and chlorine dioxide gels in streptozotocin-induced diabetic rats. Evid Based Complement Alternat Med. 2012;2012:468764.
- Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair Regen. 1999;7(2):79–89.
- Buchsel PC. Polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair): a bioadherent oral gel for the treatment of oral mucositis and other painful oral lesions. Expert Opin Drug Metab Toxicol. 2008;4(11):1449–54.
- Lee JH, Jung JY, Bang D. The efficacy of topical 0.2% hyaluronic acid gel on recurrent oral ulcers: comparison between recurrent aphthous ulcers and the oral ulcers of Behçet’s disease. J Eur Acad Dermatol Venereol. 2008;22(5):590–5.
- Shahrabi M, Solduzian M, Babaie MH, Mousavi SA, Goodarzi N, Ravari NS, et al. The effects of a combination oral spray (Mucosamin®) for the prevention of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: a double blind randomized clinical trial. Support Care Cancer. 2022;30(10):7963–72.
- Mohammed AI, Celentano A, Paolini R, Low JT, Silke J, O’Reilly LA, et al. High molecular weight hyaluronic acid drastically reduces chemotherapy-induced mucositis and apoptotic cell death. Cell Death Dis. 2023;14(7):453.
- Hashemi A, Bahrololoumi Z, Khaksar Y, Saffarzadeh N, Neamatzade H, Foroughi E. Mouth-rinses for the prevention of chemotherapy induced oral mucositis in children: a systematic review. Iran J Pediatr Hematol Oncol. 2015;5(2):106–12.
- Curra M, Soares Junior LAV, Martins MD, Santos PS. Chemotherapy protocols and incidence of oral mucositis: an integrative review. Einstein (São Paulo). 2018;16(1):eRW4007.
- Lin HX, Hua YJ, Chen QY, Luo DH, Sun R, Qiu F, et al. Randomized study of sinusoidal chronomodulated versus flat intermittent induction chemotherapy with cisplatin and 5-fluorouracil followed by traditional radiotherapy for locoregionally advanced nasopharyngeal carcinoma. Chin J Cancer. 2013;32(9):502–11.
- Yang Z, Li M, Xiao L, Yi Z, Zhao M, Ma S. Hyaluronic acid versus dexamethasone for the treatment of recurrent aphthous stomatitis in children: efficacy and safety analysis. Braz J Med Biol Res. 2020;53(8):e9458.
- McGuire DB, Fulton JS, Park J, Brown CG, Correa MEP, Eilers J, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21(11):3165–77.
- Dodd MJ, Dibble SL, Miaskowski C, MacPhail L, Greenspan D, Paul SM, et al. Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(1):39–47.
- Saxen MA, Ambrosius WT, Rehemtula AKF, Russell AL, Eckert GJ. Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(4):356–61.
- Kapoor P, Sachdeva S, Sachdeva S. Topical hyaluronic acid in the management of oral ulcers. Indian J Dermatol. 2011;56(3):300.
- Ruggiero T, Pol R, Camisassa D, Simiele S, Giaccone L, Carossa S. Treatment of symptomatic oral mucositis with sodium hyaluronate and synthetic amino acid precursors of collagen in patients undergoing haematopoietic stem cell transplantation. J Biol Regul Homeost Agents. 2018;32(3):737–43.
- Yıldırım S, Özener HÖ, Doğan B, Kuru B. Effect of topically-applied hyaluronic-acid on pain and palatal epithelial wound healing: an examiner-blind, randomized, controlled clinical trial. J Periodontol. 2017;88(12):e1–14.
Year 2025,
Volume: 3 Issue: 1, 1 - 6, 30.04.2025
Serap Keskin Tunç
,
Yusuf Rodi Mızrak
,
Gamze Aksu
,
Kamuran Karaman
,
Mahide Büşra Başkan
Project Number
NCT05818007
References
- Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453–61.
- Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and treatment of chemotherapy and radiotherapy induced oral mucositis. Medicina. 2019;55(2):25.
- Erdem O, Güngörmüş Z. The effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy. Holist Nurs Pract. 2014;28(4):242–6.
- Sonis ST, Sonis AL, Lieberman A. Oral complications in patients receiving treatment for malignancies other than of the head and neck. J Am Dent Assoc. 1978;97(3):468–72.
- Lockhart PB, Sonis ST. Relationship of oral complications to peripheral blood leukocyte and platelet counts in patients receiving cancer chemotherapy. Oral Surg Oral Med Oral Pathol. 1979;48(1):21–8.
- Abramoff MMF, Lopes NNF, Lopes LA, Dib LL, Guilherme A, Caran EM, et al. Low-level laser therapy in the prevention and treatment of chemotherapy-induced oral mucositis in young patients. Photomed Laser Surg. 2008;26(4):393–400.
- cCarthy GM, Awde JD, Ghandi H, Vincent M, Kocha WI. Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil. Oral Oncol. 1998;34(6):484–90.
- Van Sebille YZA, Stansborough R, Wardill HR, Bateman E, Gibson RJ, Keefe DM. Management of mucositis during chemotherapy: from pathophysiology to pragmatic therapeutics. Curr Oncol Rep. 2015;17(11):50.
- Di Fede O, Canepa F, Maniscalco L, Tozzo P, Matranga D, Giuliana G. Oral mukozitin önlenmesi ve tedavisi: sodyum bikarbonatın diğer ajanlara karşı etkinliği: sistematik bir inceleme. BMC Oral Health. 2023;23(1):4.
- Nolan A, Baillie C, Badminton J, Rudralingham M, Seymour RA. The efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration. J Oral Pathol Med. 2006;35(8):461–5.
- Al-Bayaty F, Abdulla MA. A comparison of wound healing rate following treatment with aftamed and chlorine dioxide gels in streptozotocin-induced diabetic rats. Evid Based Complement Alternat Med. 2012;2012:468764.
- Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair Regen. 1999;7(2):79–89.
- Buchsel PC. Polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair): a bioadherent oral gel for the treatment of oral mucositis and other painful oral lesions. Expert Opin Drug Metab Toxicol. 2008;4(11):1449–54.
- Lee JH, Jung JY, Bang D. The efficacy of topical 0.2% hyaluronic acid gel on recurrent oral ulcers: comparison between recurrent aphthous ulcers and the oral ulcers of Behçet’s disease. J Eur Acad Dermatol Venereol. 2008;22(5):590–5.
- Shahrabi M, Solduzian M, Babaie MH, Mousavi SA, Goodarzi N, Ravari NS, et al. The effects of a combination oral spray (Mucosamin®) for the prevention of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: a double blind randomized clinical trial. Support Care Cancer. 2022;30(10):7963–72.
- Mohammed AI, Celentano A, Paolini R, Low JT, Silke J, O’Reilly LA, et al. High molecular weight hyaluronic acid drastically reduces chemotherapy-induced mucositis and apoptotic cell death. Cell Death Dis. 2023;14(7):453.
- Hashemi A, Bahrololoumi Z, Khaksar Y, Saffarzadeh N, Neamatzade H, Foroughi E. Mouth-rinses for the prevention of chemotherapy induced oral mucositis in children: a systematic review. Iran J Pediatr Hematol Oncol. 2015;5(2):106–12.
- Curra M, Soares Junior LAV, Martins MD, Santos PS. Chemotherapy protocols and incidence of oral mucositis: an integrative review. Einstein (São Paulo). 2018;16(1):eRW4007.
- Lin HX, Hua YJ, Chen QY, Luo DH, Sun R, Qiu F, et al. Randomized study of sinusoidal chronomodulated versus flat intermittent induction chemotherapy with cisplatin and 5-fluorouracil followed by traditional radiotherapy for locoregionally advanced nasopharyngeal carcinoma. Chin J Cancer. 2013;32(9):502–11.
- Yang Z, Li M, Xiao L, Yi Z, Zhao M, Ma S. Hyaluronic acid versus dexamethasone for the treatment of recurrent aphthous stomatitis in children: efficacy and safety analysis. Braz J Med Biol Res. 2020;53(8):e9458.
- McGuire DB, Fulton JS, Park J, Brown CG, Correa MEP, Eilers J, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21(11):3165–77.
- Dodd MJ, Dibble SL, Miaskowski C, MacPhail L, Greenspan D, Paul SM, et al. Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(1):39–47.
- Saxen MA, Ambrosius WT, Rehemtula AKF, Russell AL, Eckert GJ. Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(4):356–61.
- Kapoor P, Sachdeva S, Sachdeva S. Topical hyaluronic acid in the management of oral ulcers. Indian J Dermatol. 2011;56(3):300.
- Ruggiero T, Pol R, Camisassa D, Simiele S, Giaccone L, Carossa S. Treatment of symptomatic oral mucositis with sodium hyaluronate and synthetic amino acid precursors of collagen in patients undergoing haematopoietic stem cell transplantation. J Biol Regul Homeost Agents. 2018;32(3):737–43.
- Yıldırım S, Özener HÖ, Doğan B, Kuru B. Effect of topically-applied hyaluronic-acid on pain and palatal epithelial wound healing: an examiner-blind, randomized, controlled clinical trial. J Periodontol. 2017;88(12):e1–14.