Stomatitis nicotina is a diffuse white patch on the hard palate, usually caused by tobacco smoking, usually pipe or cigar smoking. It is painless, and it is caused by a response of the palatal oral mucosa to chronic heat. A more pronounced appearance can occur with reverse smoking, sometimes distinguished from stomatitis nicotina by the term reverse smokers stomatitis. While stomatitis nicotina that is caused by heat is not a premalignant condition (i.e. it does not carry an increased risk of transformation to oral cancer), the condition that is caused by reverse smoking is premalignant. Signs and symptoms
The palate may appear gray or white and contain many papules or nodules that are slightly elevated with red dots in their center. These red dots represent the ducts of minor salivary glands which have become inflamed by heat. The condition is painless. If a denture is normally worn while smoking, then the mucosa underneath the denture appears unaffected by the condition. In severe cases, the mucosa may show fissuring and develop a "dried lake bed" appearance. Other changes associated with tobacco use may be evident such as brown or black extrinsic staining of teeth from tar and other components of tobacco smoke. Causes
The cause of nicotine stomatitis is thought to be chemical or thermally induced keratosis. The chemicals in tobacco may act as irritants in this condition. Chronic heat exposure is also responsible. Pipe smoking produces more heat on the palate than any other forms of smoking.
Formal diagnostic criteria and definition of the disease was established in 2016, which will allow for better understanding and the ability to appropriately track and research CD. In 2017, international consensus diagnostic criteria for idiopathic multicentric Castleman disease (iMCD) were established for the first time. In 2018, the first treatment guidelines for iMCD were established. In 2020 the first evidence based diagnostic criteria and treatment guidelines were established for unicentric Castleman disease. World Castleman Disease Day was established in 2018 and is held every year on July 23. This date was chosen for Benjamin Castlemans initial case series describing Castleman disease, which was published in July 1956, and the diagnostic criteria for idiopathic multicentric Castleman disease, which were published in the journal Blood on March 23, 2017. Castleman Disease Collaborative Network
The Castleman Disease Collaborative Network (CDCN) was founded in 2012 and is the largest organization focused on Castleman disease. It is a global initiative dedicated to research and treatment for Castleman disease (CD) and to improve survival for all patients with CD. The CDCN works to achieve this by facilitating collaboration among the global research community, mobilizing resources, strategically investing in high-impact research, and supporting patients and their loved ones. References
Further reading
Fajgenbaum, David (2019). Chasing My Cure: A Doctors Race to Turn Hope into Action; a Memoir. New York: Ballantine Books. ISBN 9781524799618. OCLC 1144129598. Book by the founder of the Castleman Disease Collaborative Network.