Critical Commentary 3: Steroid Dysregulation and Stomatodynia (Burning Mouth Syndrome)

In their Focus Article, Woda et al1 state that stomatodynia (burning mouth syndrome) is a neuropathic disorder involving mostly the peripheral nervous system (PNS)2 but sometimes also the central nervous system (CNS).3 They note that the causes of these neuropathic disorders are unknown and hypothesize that changes in steroid levels are involved in the occurrence and/or persistence of stomatodynia, with glucocorticoids contributing to the occurrence of stomatodynia and low neuroactive steroid levels (related to age in women) preventing recovery.

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4. Amenábar JM, Pawlowski J, Hilgert JB, et al. Anxiety and salivary cortisol levels in patients with burning mouth syndrome: Case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:460–465.

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9. Roglio I, Giatti S, Pesaresi M, et al. Neuroactive steroids and peripheral neuropathy. Brain Res Rev 2008;57: 460–469.

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15. Murakami K, Fellous A, Baulieu EE, Robel P. Pregnenolone binds to microtubule-associated protein 2 and stimulates microtubule assembly. Proc Natl Acad Sci U S A 2000;97:3579–3584.

16. Karchewski LA, Bloechlinger S, Woolf CJ. Axonal injury- dependent induction of the peripheral benzodiazepine receptor in small-diameter adult rat primary sensory neurons. Eur J Neurosci 2004;20:671–683.

17. Papadopoulos V, Baraldi M, Guilarte TR, et al. Translocator protein (18kDa): New nomenclature for the peripheral-type benzodiazepine receptor based on its structure and molecular function. Trends Pharmacol Sci 2006;27:402–409.

18. Gremeau-Richard C, Woda A, Navez ML, et al. Topical clonazepam in stomatodynia: A randomised placebo- controlled study. Pain 2004;108:51–57.

19. Verleye M, Akwa Y, Liere P, et al. The anxiolytic etifoxine activates the peripheral benzodiazepine receptor and increases the neurosteroid levels in rat brain. Pharmacol Biochem Behav 2005;82:712–720.

20. Girard C, Liu S, Cadepond F, et al. Etifoxine improves peripheral nerve regeneration and functional recovery. Proc Natl Acad Sci USA 2008;105:20505–20510.