Response to letter Re: Extensive oral mucosal hyperkeratosis caused by over-the-counter long lasting snoring relief agent.

In most patients, the product would probably not have caused this particular side-effect, but in ours, the lesion was likely to have been caused by excessive use as we stated, this patient had used both the strips and the spray, which is not advisable. The lesion was on the right side of the hard palate and, according to her detailed medical history, she had applied Snoreeze strips on that side only, for years. We did not see any similar lesions on the uvula, which would have been the first sign of problems caused by snoring alone. They refer to a medical paper published in China, 3 but this does not give strong enough evidence for a diagnosis of hyperkeratosis caused by snoring. Had snoring been the cause, the lesions would have been bilateral, as snoring is not a one-sided occurence. We also stated in our original letter that our patient’s medical records were unremarkable regarding other possible causes of this hyperkeratosis, and she was examined by several different specialists. Several studies have described various over- the-counter agents, which might induce unwanted side- effects, although for most people, they are safe to use.4–6 To the best of our knowledge, no clinical studies show a correlation or connection between snoring and unilateral hyperkeratosis of the mucosa.