Asian expert recommendation on management of skin and mucosal effects of radiation, with or without the addition of cetuximab or chemotherapy, in treatment of head and neck squamous cell carcinoma

Table 5 Management of oral mucositis

Systemic	Topical
1. Pain management	Diluting agents^b: Saline, bicarbonate rinses, frequent water rinses, dilute hydrogen peroxide rinses
• Analgesics: WHO ladder	Topical anaesthetics^b: Dyclonine HCl, xylocaine HCl, benzocaine HCl, diphenhydramine HCl
• Adjuncts: Relaxation, imagery, biofeedback, hypnosis and transcutaneous electrical nerve stimulation
	Analgesic agents^b: Benzydamine HCl
• Beta-carotene	Analgesic agents^b: Benzydamine HCl
• Beta-carotene	Coating agents^c: Kaolin-pectin, aluminium chloride, aluminium hydroxide, magnesium hydroxide, hydroxypropyl cellulose, sucralfate
2. Radioprotectors^a
2. Radioprotectors^a	Lip Lubricants^c: Water-based lubricants, lanolin
• Amifostine: Scavenge free radicals
3. Biologic Response Modifiers^a
• G-CSF, GM-CSF, Keratinocyte Growth Factor

^aMore relevant in Bone Marrow Transplant cases and not crucial in radiotherapy patients
^bMost practiced and accepted form of topical therapy
^cThough mentioned in-frequently in literature and case discussions, they have failed to generate sufficient impact in routine practice

ISSN: 1471-2407