dear colleague

as i can see this does not look like typical mucositis, it looks like whitish lesions which can be due to the viral activation (HPV, EBV) in immunosupressed patients. The best thing is to take biopsy with immunohistochemistry or in situ hybridization for these viruses. Ofcourse it can be lichen and all other lesions presenting as white ones.

usually mucositis can be treated with topical hyaluronian acid such as Gelclair or Caphosol (kind of electrolyte solution)

hope this will help you

Paracetamol liquid PO 1g QDS 1 hour prior food, Oxetacaine/Antacid PO 10-20ml 1 hour prior food (after Paracetamol), Sucrlfate suspension PO 1 g QDS 2 hours after food, increase intake of proteins. Sometime you need to add morphics if the patient is not improving in 3-4 days. Or even you need to use NG tube to keep the intake if the patient has a very low intake. But even in this situation use the medication PO. Furthermore rule out thrush to add nistatine 100000U QDS during 7 days. Also you may use oral rinses with benzidamide and Gelclair sachets TDS/QDS topical.

I can recomend you to read about oral cryotherapy during infusion of chemotherapy. Oral cryotherapy is one of the recomended preventive treatment in guidelines for oral mucositis by Suportive Care in Cancer and ASCO. My research on cryotherapy showed significant lower duration and grade of oral mucositis (WHO grading) om patinets receiving high dose chemotherapy in connection with stem cell transplantation.

Dear Dr Shabana

Oral mucosa directly absorb short -medium chain fatty asid for own nutrition.We use goat milk ice-cream for preventing or treatment.Goat milk contains 8 and 10 chain fatty asids.