Aphthous stomatitis: Difference between revisions
ClaireLewis (talk | contribs) |
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==Background== | ==Background== | ||
* | *Common oral ulcers (''canker sores'') affecting ~20% of the population | ||
* | *Recurrent episodes; etiology unclear | ||
* | *Triggers: stress, hormonal changes, local trauma, certain foods (citrus, chocolate, coffee), nutritional deficiencies (B12, folate, iron) | ||
*Self-limited; resolve in 10-14 days without scarring (minor type) | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Aphthous stomatitis.jpg|thumbnail| | [[File:Aphthous stomatitis.jpg|thumbnail|Aphthous ulcer of lip]] | ||
* | *Well-circumscribed, painful ulcers on '''nonkeratinized''' mucosa (labial, buccal mucosa, floor of mouth, ventral tongue) | ||
* | *Central yellow-white fibrinous base with erythematous halo | ||
* | *'''Key distinction from herpes:''' Aphthous ulcers are on non-keratinized mucosa and do NOT involve attached gingiva or hard palate (herpes involves keratinized mucosa) | ||
*Types: | |||
**Minor (<1 cm, most common, heals in 10-14 days) | |||
**Major (>1 cm, deeper, may take weeks to heal, can scar) | |||
**Herpetiform (clusters of tiny ulcers, mimics herpes but on non-keratinized mucosa) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX oral rashes and lesions}} | {{DDX oral rashes and lesions}} | ||
*'''Consider systemic disease if:''' Recurrent severe episodes, genital ulcers ([[Behcet's disease]]), GI symptoms (Crohn's), or systemic symptoms | |||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
*Consider labs (CBC, iron, B12, folate) for recurrent or severe cases | |||
*Biopsy if lesion does not respond to treatment or concern for malignancy | |||
==Management | ==Management== | ||
* | *'''Pain control:''' Viscous lidocaine 2%, benzocaine gel, or ''magic mouthwash'' (equal parts viscous lidocaine, diphenhydramine, and antacid) | ||
*'''Topical corticosteroids:''' | |||
**[[Dexamethasone]] 0.01% elixir as mouth rinse | **[[Dexamethasone]] 0.01% elixir as mouth rinse | ||
**Fluocinonide 0.05% gel applied | **Fluocinonide 0.05% gel applied to isolated lesions | ||
* | **[[Betamethasone]] syrup | ||
*Avoid irritating foods (acidic, spicy) | |||
==Disposition== | ==Disposition== | ||
Discharge | *Discharge with symptomatic treatment | ||
*Refer to oral medicine or ENT if recurrent severe episodes or non-healing ulcers | |||
==See Also== | ==See Also== | ||
[[ | *[[Herpes simplex virus]] | ||
*[[Hand foot and mouth disease]] | |||
*[[Behcet's disease]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
Latest revision as of 01:49, 21 March 2026
Background
- Common oral ulcers (canker sores) affecting ~20% of the population
- Recurrent episodes; etiology unclear
- Triggers: stress, hormonal changes, local trauma, certain foods (citrus, chocolate, coffee), nutritional deficiencies (B12, folate, iron)
- Self-limited; resolve in 10-14 days without scarring (minor type)
Clinical Features
- Well-circumscribed, painful ulcers on nonkeratinized mucosa (labial, buccal mucosa, floor of mouth, ventral tongue)
- Central yellow-white fibrinous base with erythematous halo
- Key distinction from herpes: Aphthous ulcers are on non-keratinized mucosa and do NOT involve attached gingiva or hard palate (herpes involves keratinized mucosa)
- Types:
- Minor (<1 cm, most common, heals in 10-14 days)
- Major (>1 cm, deeper, may take weeks to heal, can scar)
- Herpetiform (clusters of tiny ulcers, mimics herpes but on non-keratinized mucosa)
Differential Diagnosis
Oral rashes and lesions
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Streptococcal pharyngitis
- Tongue diagnoses
- Vincent's angina
- Consider systemic disease if: Recurrent severe episodes, genital ulcers (Behcet's disease), GI symptoms (Crohn's), or systemic symptoms
Evaluation
- Clinical diagnosis
- Consider labs (CBC, iron, B12, folate) for recurrent or severe cases
- Biopsy if lesion does not respond to treatment or concern for malignancy
Management
- Pain control: Viscous lidocaine 2%, benzocaine gel, or magic mouthwash (equal parts viscous lidocaine, diphenhydramine, and antacid)
- Topical corticosteroids:
- Dexamethasone 0.01% elixir as mouth rinse
- Fluocinonide 0.05% gel applied to isolated lesions
- Betamethasone syrup
- Avoid irritating foods (acidic, spicy)
Disposition
- Discharge with symptomatic treatment
- Refer to oral medicine or ENT if recurrent severe episodes or non-healing ulcers