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4.04 Aphthous Ulcer (Canker Sore)


Presentation

The patient complains of a painful lesion in the mouth, and may be worried about having herpes. A pale yellow, flat, even-bordered ulcer surrounded by a red halo may be seen on the buccal or labial mucosa, lingual sulci, soft palate, pharynx, tongue, or gingiva. Lesions are usually solitary, but can be multiple and recurrent. The pain is usually greater than the size of the lesions would suggest, and major aphthae (larger than 1 cm) indicate a severe form of the disease which may last for weeks of months.

What to do:

Discussion

Aphthous stomatitis has been studied for many years by numerous investigators. Although many exacerbating factors have been identified, the cause as yet remains unknown. Lesions can be precipitated by minor trauma, food allergy, stress, and systemic illness. Recurrent aphthous ulcers may accompany malignancy or autoimmune disease. At present, the treatment is only palliative, and may not alter the course of the syndrome. Apthous ulcers may be an immune reaction to damaged mucosa or altered oral bacteria. Herpangina and hand-foot-and-mouth disease can produce ulcers resembling aphthous ulcers, but which are instead part of coxsackie viral exanthems, usually with fever and occurring in clusters among children. Behcet's syndrome is an idiopathic condition characterized by oral ulcers clinically indistinguishable from aphthae but accompanied by genital ulcers, conjunctivitis, retinitis, iritis, leukocytosis, eosinophilia and increased erythrocyte sedimentation rate.

References:


Table of Contents
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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