Oral aphthous ulcers - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Clinically, three forms of recurrent aphthous ulceration exist: major, minor, and herpetiform.
Recurrent aphthous stomatitis is distinguished from aphthous-like ulceration by exclusion of underlying systemic conditions (e.g., inflammatory bowel disease, Behcet syndrome, HIV/AIDS, or cyclic neutropenia).
Diagnosis is based on the history and clinical examination with exclusion of a systemic etiology; there are no specific laboratory findings.
Topical corticosteroids and anti-inflammatory agents are the mainstay of treatment. Severe or refractory cases may require systemic therapy.

Recurrent aphthous stomatitis (RAS): minor aphthae

From the personal collection of Crispian Scully, MD, PhD, FDSRCS, FRCPath

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Recurrent aphthous stomatitis (RAS): minor aphthae
Recurrent aphthous stomatitis (RAS): major aphthae
Recurrent aphthous stomatitis (RAS): herpetiform ulceration

Citations

Key Articles

Scully C. Clinical practice. Aphthous ulceration. N Engl J Med. 2006 Jul 13;355(2):165-72.[Abstract]
Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003 Feb;134(2):200-7.[Abstract]
Brocklehurst P, Tickle M, Glenny AM, et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev. 2012 Sep 12;(9):CD005411.[Abstract][Full Text]

Referenced Articles

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35. Rehberger A, Puspok A, Stallmeister T, et al. Crohn's disease masquerading as aphthous ulcers. Eur J Dermatol. 1998 Jun;8(4):274-6.[Abstract]
36. Shotts RH, Scully C, Avery CM, et al. Nicorandil-induced severe oral ulceration:a newly recognized drug reaction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Jun;87(6):706-7.[Abstract]
37. Lopez-Jornet P, Camacho-Alonso F, Martos N. Hematological study of patients with aphthous stomatitis. Int J Dermatol. 2014 Feb;53(2):159-63.[Abstract]
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41. Femiano F, Gombos F, Scully C. Sweet's syndrome: recurrent oral ulceration, pyrexia, thrombophlebitis, and cutaneous lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Mar;95(3):324-7.[Abstract]
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50. Liu C, Zhou Z, Liu G, et al. Efficacy and safety of dexamethasone ointment on recurrent aphthous ulceration. Am J Med. 2012 Mar;125(3):292-301.[Abstract]
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55. Graykowski EA, Kingman A. Double-blind trial of tetracycline in recurrent aphthous ulceration. J Oral Pathol. 1978;7(6):376-82.[Abstract]
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58. Brocklehurst P, Tickle M, Glenny AM, et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev. 2012 Sep 12;(9):CD005411.[Abstract][Full Text]
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66. O'Neill ID, Scully C. Biologics in oral medicine: principles of use and practical considerations. Oral Dis. 2012 Sep;18(6):525-36.[Abstract][Full Text]
67. O'Neill ID, Scully C. Biologics in oral medicine: ulcerative disorders. Oral Dis. 2013 Jan;19(1):37-45.[Abstract]
68. Robinson ND, Guitart J. Recalcitrant, recurrent aphthous stomatitis treated with etanercept. Arch Dermatol. 2003 Oct;139(10):1259-62.[Abstract][Full Text]
69. Vujevich J, Zirwas M. Treatment of severe, recalcitrant, major aphthous stomatitis with adalimumab. Cutis. 2005 Aug;76(2):129-32.[Abstract]
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