Aphthous Ulcer

Canker sore or ulcerative stomatitis

Large or persistent areas of ulcerative stomatitis may be secondary to

• Erythema multiforme or drug allergies

• Acute herpes simplex

• Pemphigus

• Pemphigoid

• Epidermolysis bullosa acquisita

• Bullous lichen planus

• Behçet disease

• Inflammatory bowel disease

Cause remains uncertain, although an association with human herpesvirus 6 has been suggested

Stress seems to be a major predisposing factor

Frequency of viral rhinitis and bedtime after 11 PM were independent predictors of aphthous ulcer frequency and severity in college students

Very common and easy to recognize

Found on freely moving, nonkeratinized mucosa (eg, buccal and labial mucosa and not attached gingiva or palate)

May be single or multiple, are usually recurrent, and appear as small, round painful ulcerations with yellow-gray fibrinoid centers surrounded by red halos

Minor ulcers are < 1 cm and generally heal in 10–14 days

Major ulcers are > 1 cm and can be disabling in their degree of oral pain

Based on clinical appearance

When the diagnosis is not clear, incisional biopsy is indicated

Topical corticosteroids (triamcinolone acetonide, 0.1%, or fluocinonide ointment, 0.05%) in an adhesive base (Orabase-Plain) provide symptomatic relief

Other topical therapies are diclofenac 3% in hyaluronan 2.5%, doxymycine-cyanoacrylate, mouthwashes containing the enzymes amyloglucosidase and glucose oxidase, and amlexanox 5% oral paste

A 1-week tapering course of prednisone (40–60 mg daily orally) can be used

For recurrent ulcers

• Cimetidine maintenance therapy

• Thalidomide has been used selectively in those who are also HIV-positive