Aphthous Ulcer

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• Based on clinical appearance

• When the diagnosis is not clear, incisional biopsy is indicated

Treatment

• Avoiding local irritants, such as certain toothpastes, may decrease symptoms and episodes

• 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