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Aphthous Stomatitis
What is aphthous stomatitis?
Aphthous stomatitis (minor) is a common disorder marked by small, round,
"punched-out" ulcers of the oral mucosa with a yellow base and
surrounding erythema. They can be quite painful. The buccal (inside the cheek) and labial (inside the lip)
mucosa are the most commonly involved sites. Variations include major
aphthous
ulcers, which are large and slow to heal with areas of necrosis, and herpetiform ulcers,
which are grouped like herpetic lesions. The cause of these ulcers is
unknown, but an autoimmune process is the most prevalent theory. Stress,
infection, and hormonal balance have also been implicated. Recurrence is the
norm.
With what can aphthous stomatitis be confused?
Herpes simplex virus can present as oral ulcers, but these lesions look distinctly different from
those of aphthous stomatitis
(minor). A Tzanck smear and culture can be used to diagnose
herpes simplex virus. In
Behcet's disease,
an autoimmune disorder, the oral lesions cannot be distinguished from those of aphthous stomatitis
(minor). However, in Behcet's disease there are also genital
and ocular ulceration and sometimes other systemic problems.
How is aphthous stomatitis diagnosed?
Aphthous stomatitis is a clinical diagnosis. No biopsy is
required unless the ulcer fails to heal, in which case malignancy must be
excluded.
How is aphthous stomatitis treated?
Treatment is challenging and often unsuccessful. A number
of approaches are used with varying success, including: tetracycline "swish and
swallow", topical steroids in a formulation adherent to the oral mucosa (e.g.
Lidex), intralesional
steroids, occasionally oral
steroids,
and Amlexanox oral paste.
Thalidomide is sometimes used n severely affected
HIV-positive patients. Pain can be
controlled with topical anesthetics, such as viscous
lidocaine.
What is the prognosis for aphthous stomatitis?
The lesions of aphthous stomatitis (minor) usually heal in
several days, but can last up to two weeks. Major aphthous
ulcers last longer, usually one to two months. Recurrence is the norm,
ranging from occasionally to frequently depending on the individual. The
condition often abates after several years.
Date created 05/03/2007
Last updated
01/03/2009
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