Aphtha / Mucosal disease

Synonyms

Recurrent aphthous stomatitis (RAS), aphthous stomatitis, recurrent oral ulcers (ROU), recurrent bipolar(oral/genital) aphthosis.

Epidemiology

Common disease with 2-10% of people with a 3-month recurrence rate of 50% and a lifetime prevalence of >35%. More common in females. Recurrent genital aphthous ulcers are much less common. Family history in 24-46%.

Definition

Recurrent, multiple, small, round or ovoid ulcers with yellow floor and surrounded by erythematous halo.

Aetiology & Pathogenesis

The aetiology of recurrent benign aphthae is unclear.

Signs & Symptoms

Minor oral aphthae: anterior part of the mouth, superficial, <1 cm, healing within 10-14 days. Major oral aphthae: >1 cm, deep, last for weeks. Herpetiform aphthae: small (1-2 mm), multiple lesions (5-100). Grey-yellow and without a delineating erythematous border inducing pain in eating and speaking. A single crop of ulcers may last for approximately 7-14 days, the period of remission between attacks is variable.

Localisation

Non-keratinized mucosa of the oral cavity or genital mucosa.

Classification

- Minor: Most common form (85%; do not result in scarring)
- Major: Approx. 10-15% (may leave a scar)
- Herpetiform: 5-10%

Laboratory & other workups

None specific.

Dermatopathology

Small focal ulceration above the excretory duct of minor salivary glands, mononuclear cells and neutrophilic acute inflammatory infiltrate surrounding the ulcer.

Course

Obligatory recurrent with varying frequency (2-12x/year up to intervals of few days). Relation to menstrual cycle, pregnancy, and dysmenorrhea in females. Usually improve during pregnancy.

Complications

Occurence at sites of trauma (e.g. from brushing teeth), anesthetic injection and dental treatment. Certain drugs may induce oral aphthae.

Diagnosis

Clinical picture, personal and family history.

Differential diagnosis

High number/in particular Adamantiades-Behçet’s disease, different gastrointestinal inflammatory diseases, viral infections, candidiasis, autoimmune diseases, bullous and lichenoid dermatoses, allergic contact stomatitis, drug-induced ulcerative stomatitis, geographic like stomatitis, traumatic ulcers.

Prevention & Therapy

Registered therapies only include topical corticosteroids, topical antiseptics (reduction of new aphthae) and topical anesthetics (pain relief).

In severe cases, topical treatment can be combined with systemic therapy, e.g. colchicine, pentoxifylline or prednisolone.

Hard, acidic and salty food, alcohol and carbonated beverages should be avoided.

4.3.2 Aphtha / Mucosal disease