aphthous ulcers

Question 1

most common cause of oral ulcers

Answer 1

30% o otherwise healthy persons

Question 2

assoc w what disease

Answer 2

HIV/AIDSandBehçetdisease

Question 3

etiology
pathogenesis: ___ immunity mediated
age of onset

Answer 3

ETIOLOGY Idiopathic. Can arise at the site o minor mucosal injury, e.g., bite.
PATHOGENESIS Cell-mediated immune reaction pattern.
AGEATONSET Anyage;o enduringsecond decade, persisting into adulthood, and becom- ingless requentwithadvancingage

Question 4

diff simple complex and major AU

Answer 4

Simple: 1 to 3 oral ulcers that recur 1 to 3 times per year.
■ Complex: Continuous ulcers and associated with systemic disease or genital ulcers.
■ Major aphthous ulcers (AU) may persist or ≥ 6 weeks, healing with scarring.
■ Behçet disease should be considered in patients with persistent oropharyngeal AU, with or without anogenital AU, associated with systemic ndings (eye, nervous system). See Section 14.

Question 5

manif

Answer 5

At times, small, pain ul red macule or papule be ore ulceration.
■ More commonly, ulcer(s) < 1 cm
(Figs. 33-10 and 33-11), covered with brin (gray-white), with sharp, discrete, and at times edematous borders.
■ Herpeti orm “or grouped” AU (HAU) and Major AU (MaAU) may heal with white, depressed scars.
■ Number o ulcers: Minor AU (MiAU), 1–5; MaAU, 1–10: HAU, up to 100.
■ Distribution: Oropharyngeal, anogenital, any site in the GI tract. Oral lesions most commonly on the buccal and labial mucosa,

Question 6

dx

Answer 6

clinical

Question 7

tx

Answer 7

INTRALESIONALTRIAMCINOLONE 3 to 10 mg/mL inlidocaineverye ective orimmediaterelie
o pain and resolution o ulcers. Amlexanox 5% can be applied topically our times a day (a er meals and be ore bedtime). Viscous lidocaine 2%shouldonlybeused orbrie,immediate controlo pain.
SystemicTherapy
■ Prednisone: In persons with large, persistent, pain ul AU inter ering with nutrition, a brie courseo prednisoneise ective(70mg, tapered by 10 or 5 mg/d).
■ Tetracycline syrup and minocycline 100 mg po BID, reported with variable success.
■ T alidomide: E ective in HIV/AIDS, Behçet disease, and large pain ul AU. Adverse
e ects:Peripheralsensoryneuropathy. Lenalodomide may be used in these cases.
eratogenesis.
■ umor necrosis factor- α inhibitor:
Adalimumab and inf iximab reported to be e ective. Interleukin-1 inhibition shows promise or PFAPA.