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A 58-year-old man presents with a 1-year history of painful sores in his mouth. (Figures 41-1, 41-2, 41-3, and 41-4). He has lost 20 pounds over the past year because it hurts to eat. The ulcers come and go, but are found on his tongue, gums, buccal mucosa, and inner lips. Prior to the onset of these lesions the patient had been in good health and was not on any medications. The physician recognized his condition as recurrent aphthous ulcers with giant ulcers. No underlying systemic diseases were found on work-up. The patient was started on oral prednisone and given dexamethasone oral elixir to swish and swallow. Within 1 week the patient was able to eat and drink liquids comfortably and began regaining his lost weight. Long-term management of his problem required the use of other medications so as to successfully taper him off prednisone without recurrences.

Figure 41-1

Major aphthous ulcer on the buccal mucosa of a 58-year-old man who has been suffering with recurrent aphthous stomatitis for the past year. (Courtesy of Richard P. Usatine, MD.)

Figure 41-2

Two aphthous ulcers on the tongue of a 58-year-old man with recurrent aphthous stomatitis. (Courtesy of Richard P. Usatine, MD.)

Figure 41-3

Minor aphthous ulcer occurring simultaneously with major aphthous ulcers on the buccal mucosa and tongue of a 58-year-old man with recurrent aphthous ulcers. (Courtesy of Richard P. Usatine, MD.)

Figure 41-4

Aphthous ulcer located on unkeratinized (movable) mucosa in a 5-year-old girl. It is slightly raised, round, with a white-yellow necrotic center and surrounding erythema. (Courtesy of Richard P. Usatine, MD.)

Aphthous ulcers are painful ulcerations in the mouth which can be single, multiple, occasional, or recurrent. These ulcers can be small or large but are uniformly painful and may interfere with eating, speaking, and swallowing. Oral trauma, stress, and systemic diseases can contribute to the occurrence of these ulcers but no precise etiology is apparent. Recurrent aphthous stomatitis (RAS) is a frustrating condition that merits aggressive treatment aimed at pain relief and prevention.

Canker sores, recurrent aphthous ulcer (RAU), aphthous stomatitis, RAS.

  • Incidence rates of RAUs of 0.85% among adults and 1.5% among children and adolescents have been reported.1
  • RAS is more common in women, in people younger than age 40 years, in whites, in nonsmokers, and in people of high socioeconomic status.1

  • The precise etiology and pathogenesis of this condition remains unknown, although a variety of host and environmental factors have been implicated.
  • A positive family history is seen in about one-third of RAS ...

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