Improvement on Literature-Based Management and Counseling of Oral Mucositis acrossDermatologic Entities
Abstract
Background: Dermatologists often have limited exposure to the management of oral mucositis, despite its frequent occurrence in patients with autoimmune blistering conditions, severe cutaneous drug reactions, congenital blistering disorders, and other dermatologic diseases. This gap in familiarity presents a challenge in providing optimal care for affected patients. Furthermore, oral mucositis can significantly impact quality of life, nutrition, and overall health, necessitating a standardized and evidence-based approach to treatment. Given the overlap between dermatologic conditions and oral mucosal involvement, equipping dermatologists with structured management tools is essential. To address this, we conducted a comprehensive literature review and developed clinical decision-support tools in the form of smartphrases (dotphrases) to standardize treatment approaches.
Methods: A literature review was performed on updated oral mucositis management guidelines, focusing on studies involving cancer patients undergoing chemoradiation therapy, as this population has the most robust evidence base. Using this information, we developed comprehensive dotphrases detailing treatment options based on their mechanism of action, patient selection criteria, dosing recommendations, adverse effects, and supporting literature references. These dotphrases underwent review by the UCSD Palliative Care Department and UCSD Nutritionists, with their feedback incorporated since January 2025 to enhance clinical applicability. We also distributed pre- and post-intervention survey to evaluate how the confidence of a single institution dermatology department was affected by implementation of these updated guidelines.
Results: The finalized guidelines include structured treatment guidance for oral mucositis of any etiology, ensuring ease of use and integration into clinical workflows. Each treatment option is detailed with:
Mechanism of Action: Clarifying how each intervention mitigates mucositis.
Potential Patients: Identifying patients who may benefit from specific treatments.
Dosing: Standardized dosages as reported in clinical studies.
Adverse Effects: Known side effects to guide risk-benefit discussions.
Literature Reference: A supporting recent publication for evidence-based application.
Additionally, we developed five general-purpose dotphrases to support clinical management:
Malnutrition Screening Tool: A standardized method to identify patients at risk of
malnutrition.
Assessment and Plan for Oral Mucositis: Includes WHO scoring and a severity-based treatment algorithm.
After Visit Summary (AVS): Patient-friendly instructions based on individualized treatment plans.
Treatment Guide: A reference tool for integrating treatment-specific dotphrases into workflows.
Nutritional Recommendations: General dietary guidance for patients at high risk of malnutrition while awaiting formal nutrition consultation.
Conclusions: Our structured dotphrases provide a standardized, evidence-based approach to managing oral mucositis across various patient populations, including those under dermatologic care. By incorporating expert input from palliative care and nutrition specialists, we have ensured clinical relevance and usability. This project has already been implemented by the UCSD palliative care providers since its review and approval in February 2025. Confidence in management and counseling of oral mucositis has improved with implementation of these literature-based smartphrases. The implementation of these smartphrases will hopefully facilitate improved patient outcomes through streamlined assessment, treatment, and follow-up care. Future directions include assessing clinician adoption and patient outcomes following the implementation of these tools in clinical practice.