Apthous-like Oral ulcers

Other syndromes
1. Reiter's
2. Crohn's disease
3. Coeliac
Recurrent Aphthous Stomatitis
1. Prevalence
  1. 5-25%
2. Onset
  1. Childhood/puberty
3. Presentation
  1. Almost always on non-keratinised epithelium
  2. Seen in healthy individuals
  3. Ulcer with red ring (inflammation)
  4. Painful, recurrent
    1. Should occur every 3-4 weeks
  5. Definition
    1. Recurrant ulceration with no obvious cause
4. Types
  1. Minor
    1. 85%
    2. 2-10mm
    3. Last 7-14 days
    4. 1-5 per crop
    5. No scarring
    6. Non-keratinised mucosa
  2. Major
    1. Scars
    2. Non-keratinised mucosa
    3. 10%
    4. >10mm
    5. 1-2 per crop
    6. Lasts >14 days
  3. Herpetiform
    1. Scars
    2. Can form on keratinised epithelium
    3. 5%
    4. <5mm
    5. >10 per crop
    6. Lasts 7-21 days
5. Unknown aetiology - idiopathic
  1. Possible aetiological factors
    1. B12/Folate
    2. HIV
    3. Genetic
    4. Food allergy
    5. Coeliac
    6. Drugs
      1. Nicorandil
      2. Beta Blockers
      3. NSAIDs
    7. Local
      1. Trauma
6. Diagnosis -> exclude other causes
  1. Bloods
    1. FBC
    2. Ferritin
    3. B12 / folate
  2. Check for Viruses
  3. Biopsy for major apthae
  4. GI investigations
7. Management in practice
  1. Minor RAS
    1. Chx
      1. 0.12% MW
      2. 1% gel
    2. 0.03% Gengigel
      1. Hyaluronic acid
    3. 2nd line
      1. Topical steroid
        Clobetasol in orabase
  2. Exclude related diseases, treat precipitating factors
  3. Major RAS
    1. Topical steroid + Anti-fungal
    2. 2nd line
      1. Systemic steroids
  4. Herpetiform RAS
    1. Systemic steroids
Taking a history of a patient with ulcers
1. How often does it occur?
2. Family history?
3. Nutritional deficiencies?
  1. GI
    1. Coeliac?
4. Onset as a child/teenager?
5. Distributed on non-keratinised mucosa
6. Any problems with genitals or eyes?
  1. Rule out Behcet's
7. Problem with skin?
  1. Lichen planus
8. Drug history
Behcets
1. Gene
  1. HLA-B51
2. Who does it affect?
  1. Adult males
    1. Mediterranean
    2. Japan
  2. Turkey
3. Differential diagnosis
  1. Complex apthosis
    1. Presence of CONSTANT >3 oral/genital apthae but no systemic manifestations
    2. Diagnosis
      1. Vit B12
      2. Red cell folate
      3. Ferritin
      4. FBC
      5. HLA-B27,B51
  2. RAS
  3. Erythema multiform
  4. Reiter's syndrome
  5. Syphilis
4. Management
  1. Oral & Genital ulcers
    1. Topical steroids
  2. Oral & Genital ulcers + skin lesions
    1. Colchicine = systemic immunosuppressant
      1. 0.5-1.5mg/day
5. = oral ulcers + genital ulcers + eye inflammation (vasculitis)
  1. Clinical features
    1. Uveitis
    2. Musculoskeletal disorders
    3. Recurrent aphthous like ulcers
      1. Genital
      2. Oral
        Usually major
        More aggressive & in multiple sites > RAS
    4. Skin lesions
      1. Erythema nodosum
    5. Chronic, good & bad phases
6. MAGIC syndrome = Behcets + Relapsing Polychondritis manifestations
7. Onset = 20-30yrs
Cyclic Neutropenia
1. = periodic decrease in neutrophils
  1. Usually occurs every 3wks, lasts 3-5days
2. Onset = birth
3. Inherited disorder
4. Clinical features
  1. Recurrent fever
  2. Recurrent infections
  3. Aphthous-like ulcers
  4. Abdominal pain
  5. Pharyngitis, gingivitis
PFAPA syndrome
1. Unknown aetiology
2. Clinical features
  1. Recurrent fever
    1. Occurs every 3-6wks, lasting 3-5days
    2. Most common cause in european children
  2. Aphthous-like ulcers
  3. Pharyngitis

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Apthous-like Oral ulcers

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	Created by Zainab Patel about 4 years ago

	Copied by sanna pathy about 4 years ago