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\begin{document}

\title{STEROID INDUCED INFLAMMATORY PAPILLARY HYPERPLASIA? -- A NEW ENTITY IN A
NON-DENTURE WEARING PATIENT}



\author[1]{Abhishek Gupta}%
\author[2]{RAM Lamichhane}%
\author[3]{ANJU REDHU}%
\affil[1]{Chitwan Medical College, Bharatpur-10, Chitwan, Nepal}%
\affil[2]{KIST MEDICAL COLLEGE}%
\affil[3]{PGIDS}%


\vspace{-1em}



  
  \date{June 17, 2024}


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\selectlanguage{english}
\begin{abstract}
Inflammatory papillary hyperplasia (IPH) is a benign lesion of the
palatal mucosa, usually found in denture wearers. This case history
report describes an example of the dentate patients with no history of
wearing maxillary prostheses and highlights the importance of
professional awareness to diagnose IPH among non-denture-wearing
patients.%
\end{abstract}%



\sloppy


\textbf{Title page:}

\textbf{TITLE:} STEROID INDUCED INFLAMMATORY PAPILLARY HYPERPLASIA? -- A
NEW ENTITY IN A NON-DENTURE WEARING PATIENT

\textbf{Running Title :} INFLAMMATORY PAPILLARY HYPERPLASIA IN A
NON-DENTURE WEARING PATIENT

\textbf{Key words:} , Inflammatory papillary hyperplasia, Steroid
induced, On denture

\textbf{Key Clinical Message:} Inflammatory papillary hyperplasia can be
seen even in a non-denture wearer, probably because of topical steroid
use.

\textbf{Authors Details:}

\begin{enumerate}
\tightlist
\item
  Abhishek Gupta , Assistant Professor, Incharge, Department of Oral
  Medicine and Radiology, Chitwan Medical College
\item
  \textbf{Ram Sudan Lamichhane} , Associate Professor and Head,
  Department of Oral Pathology, KIST Medical college and Teaching
  hospital
\item
  Anju Redhu Senior Resident, Department of Oral Medicine and Radiology,
  PGIDS
\end{enumerate}

\textbf{Corresponding author:}

Dr. Abhishek Gupta ,

Assistant Professor, Incharge, Department of Oral Medicine and
Radiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal, 44207

gupta.abhishek@gmail.com

\textbf{STEROID INDUCED INFLAMMATORY PAPILLARY HYPERPLASIA? -- A NEW
ENTITY IN A NON-DENTURE WEARING PATIENT}

\textbf{INTRODUCTION:}

Inflammatory papillary hyperplasia is a lesion of the mucosa which
usually involves the hard palate only, but which may occasionally extend
to the mucosa of the residual ridges.\textsuperscript{1} The lesion is a
painless, firm, pink or red, nodular proliferation of the mucosa. Most
patients are unaware of its presence.\textsuperscript{1,2} In general,
IPH is associated with the use of removable upper dentures although in
rare instance it also has been found in dentulous patients with no
history of a dental prosthesis.\textsuperscript{3} It is more prevalent
in males (20.5 \%) than females (6.9 \%), and usually located in
anterior region of maxilla (79\%).\textsuperscript{4} Predisposing
factors like, smoking, use of tobacco, alcohol consumption, Candidal
infection, patients wearing a maxillary complete denture against a
mandibular distal extension partial denture, sex of the patient and
various systemic diseases like diabetes mellitus are considered to be
responsible for IPH.\textsuperscript{5} In the literature reviewed, we
have found only three cases of IPH in non-denture-wearing patients till
date. This case report describes IPH in a patient who has never worn a
maxillary denture and identifies etiologic factors for this rare
presentation.

\textbf{CASE HISTORY/EXAMINATION:}

A 75-year-old man reported to the department of oral medicine and
radiology with the chief complaint of growth in the mid-palatal region
(Figure 1 ) since 4 months. Patient had the significant history of
bronchial asthma since 10 years and was on inhalational steroidal
therapy. There was no other relevant medical history reported by the
patient. Also, patient had no history of ever wearing a removable
prosthesis. Clinical examination revealed a dentulous maxilla with a
midpalatal lesion characterized by multiple papillary projections
covering approximately about 1cm \selectlanguage{ngerman}× 1 cm area of palate. The overlying
mucosa appeared erythematous. There were neither the history of bleeding
or pus discharge nor was it present on palpation. The provisional
diagnosis of IPH was arrived on the basis the clinical appearance and
examination. Patient was prescribed for topical application of
antifungal gel , (clotrimazole 1 \% w/v ) QID for 2 weeks, followed by
which patient have reported (telephonic communication) of decrease in
size of the lesion. Patient have not visited our department amid Covid
19 situation.

\textbf{DISCUSSION:}

IPH is a clinical entity or a lesion which is most commonly associated
with the patients of maxillary complete denture. Previous literature
reviewed has reported most of the cases with the ill-fitting denture or
long term usage /night wearers as the possible etiological factor.
However, IPH can occur in non denture wearers too. IPH occurring in the
non denture wearer is a rare entity, till now only 3 cases has been
reported. The first case was in the year 1990, The patient presented in
this case report \textsuperscript{6} was a 10-year-old black girl
without a history of a dental prosthesis. It is conjectured that poor
oral hygiene and a habit of mouth breathing contributed to the
occurrence of inflammatory papillary hyperplasia in this patient. The
lesion was surgically removed, and the patient was followed up for a
period of 18 months without recurrence of the
lesion.\textsuperscript{6}the second case was in a 60-year-old man with
the hard palatal nodular lesion with the history of tobacco smoking and
poor oral hygiene and had no history of ever wearing a removable
prosthesis. diagnosis of IPH was made with a palatal mucosal biopsy, and
the patient was advised to quit smoking. The topical application of
miconazole 2\%, three times a day for 3 weeks, was
prescribed.\textsuperscript{7} the third case was A 29 years old healthy
woman In routine intraoral examination, a red pebbly plaque with
irregular and poorly defined borders on palatal vault was inspected.
Nystatin suspension was advised. Reexamination was done after one week
and reduction in lesion size and erythema was
observed.\textsuperscript{8} The case which has been reported here was
75 year old man with no history of denture had developed lesion in mid
palatal region. Patient had the history of usage of inhalational
steroids, hence it can be hypothesized that this would have led to the
development of the lesion. Yet further research is required in this
regard about the etiopathogenesis of IPH in such cases.

\textbf{CONCLUSION}

To conclude, This case emphasizes the awareness among the oral
diagnostician about the IPH in non-denture patients, and other possible
etiological factors.

\textbf{ACKNOWLEDGMENTS}

We thank Dr. Arti Sitaula for her assistance in case recording.

\textbf{CONFLICT OF INTEREST}

The authors declare that there is no conflict of interests regarding the
publication of this paper.

\textbf{AUTHORSHIP LIST:}

Author Contributions:

Author 1: Clinical Diagnosis and selection of case. Literature Search
done, Edited and reviewed

the manuscript.

Author 2: Clinical Diagnosis and selection of case. Edited and reviewed
the manuscript

Author 3: Written the manuscript at initial phase. Edited and reviewed
the manuscript.

\subsection*{}

{\label{section}}

\subsection*{ETHICAL APPROVAL}

{\label{ethical-approval}}

\subsection*{Written Consent was taken from the
patient}

{\label{written-consent-was-taken-from-the-patient}}

\subsection*{}

{\label{section-1}}

\subsection*{SOURCE OF FUND}

{\label{source-of-fund}}

\subsection*{No any source of funding}

{\label{no-any-source-of-funding}}

\subsection*{DATA AVAILABILITY}

{\label{data-availability}}

\subsection*{The data is available with the correspondence author and can
be availed on
request.}

{\label{the-data-is-available-with-the-correspondence-author-and-can-be-availed-on-request.}}

\textbf{REFERENCES:}

\begin{enumerate}
\tightlist
\item
  Rohit, Gupta A. Reactive Lesions of Orofacial Region.
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\item
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\item
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\item
  Cruz-Olivo EA, Castro PP, Garzón-Rayo H. Surgical and nonsurgical
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\item
  Rajput C, Shah H, Mehta S, Goyal T, Karia V, Shah V. Etiology and
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\item
  Thwaites MS, Jeter TE, Ajagbe O. Inflammatory papillary hyperplasia:
  review of literature and case report involving a 10-year-old child.
  Quintessence Int. 1990 Feb;21(2):133-8.
\item
  Vaqués PG, Salas EJ, Roig AM, López-López J, Gual-Vaqués P, Jané-Salas
  E, Marí-Roig A. Inflammatory Papillary Hyperplasia in a
  Non-Denture-Wearing Patient: A Case History Report. International
  Journal of Prosthodontics. 2017 Jan 1;30(1).
\item
  Sadrabad MJ, Ameli N, Iranaq MH. Denture free inflammatory papillary
  hyperplasia: a rare case report. Koomesh. 2019;21(1).
\end{enumerate}

\textbf{List of figure captions/legends}

Figure 1 : Showing the multiple papillary projection wrt mid palatal
region\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/IMG-20191216-135333/IMG-20191216-135333}

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\end{figure}

\selectlanguage{english}
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