Recurrent Aphthous Stomatitis Flashcards
What are aphthous ulcers?
- recurrent oral ulcers
- follow a set pattern depending upon ulcer type; minor, major, herpetiform
- GENETICALLY driven with environmental modification
- MULTIFACTORIAL environmental triggers and variable expression
- ulcer experience may change as risk factor changes
4 main forms of Recurrent aphthous stomatitis (RAS)
- minor
- major
- herpetiform
- oro- genital ulcer syndromes, ie: Behcet’s syndrome
How to diagnose?
- full history of all features
- examination, looking for evidence of recurrent ulceration, scarring for past ulceration
- yellow/ grey base with erythematous margins
Major Aphthous Ulcers
- > 10mm
- may get small ulcers too
- diagnose worse site
- can last for months
- can affect ANY part of oral mucosa (keratinised/ non-keratinised/ both)
- may scar when healing
- responds poorly to topical steroids
- responds better to intralesional steroids
- lateral aspect of tongue, soft palate, hard palate
Minor Aphthous Ulcers
- commonest type of recurrent oral ulceration
- <10mm diameter
- last up to 2 weeks
- only affecting non- keratinised mucosa
- heal without scarring
- responds well to topical steroids
Ulcer free period is a good guide to morbidity
- longer ulcer free, less morbidity
** important to ask pt about it
Herpetiform Aphthae
- RAREST form of aphthous ulcers
- multiple small ulcers on non- keratinised mucosa
- heal within 2 weeks
- can coalesce into larger areas of ulceration
No relation with herpes viruses
- early stages: may look like primary herpetic gingivostomatitis (fever)
- in HSV, get keratinised epithelium involved, not in herpetiform aphthae
Oral and Genital ulceration
Behcet’s disease
- common in asia races- 2:1000 turkey
Diagnosis of Oral & genital ulceration
- 3 episodes of mouth ulcers in a year
- at least 2 of the following: genital sores, eye inflammation, skin ulcers, pathergy
Other oro-genital ulcerative conditions?
- vesiculobullous disease: Pemphigoid, pemphigus
- Lichen planus
Behcet’s disease
- primarily a vasculitis
- inflammation of BV
- oral and genital ulceration
- eye disease- leading to loss of vision in 20%
- bowel ulceration - iliocaecal area; pain and cramping
- heart and lungs
- brain
- joints
How to manage Behcet’s disease?
- Treat oral disease/ RAS
Systemic immunodulation where multisystem involvement
- Colchicine used as off label as first tx
- Azathioprine/ Mycophenolate
- Infliximab
Managed with help of rheumatology
- national specialist tx centres
Predisposing factors of RAS
- mechanical injuries- parafunctional clenching; tongue tip
- Microelement deficiencies, ie: iron, B12, folate
- stress
- hormonal level fluctuations
- viral and bacterial infections
- genetic predisposition
- systemic disease
Immunopathology of aphthae
- takes place at basement membrane
- no new epithelial cells to replace them
REMEMBER Aphthous ulcers
- damage happens before ulcer appears
- tx is most effective in ulcer prodrome period
General rule!
- recurrent self- healing ulcers affecting exclusively non- keratinised mucosa are aphthae
