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

• Squamous cell carcinoma may occasionally present in this fashion

CLINICAL FINDINGS

• Very common and easy to recognize

• Found on freely moving, nonkeratinized mucosa eg,

  • Buccal and labial mucosa

  • Not attached gingiva or palate

• May be single or multiple, are usually recurrent

• Appear as

  • Small, round painful ulcerations

  • 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 in an adhesive base (Orabase-Plain) provide symptomatic relief

  • Triamcinolone acetonide 0.1%, or

  • Fluocinonide ointment 0.05%

• Other topical therapies shown to be effective

  • Diclofenac 3% in hyaluronan 2.5%

  • Doxymycine-cyanoacrylate

  • Mouthwashes containing the enzymes

    • Amyloglucosidase

    • Glucose oxidase

  • 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 patients with HIV