Aphthous stomatitis

Background

• Affects 20% of the normal population
• Unclear etiology. Common triggers: stress, hormonal changes, smoking, certain food such as coffee, chocolate.
• Resolve spontaneously in 10-14d

Clinical Features

Apthous ulcer of lip

• Involves the nonkeratinized epithelium (especially labial and buccal mucosa)
• Begins as erythematous macule that ulcerates and forms a central fibropurulent eschar
• Lesions measure from 2-3mm to several cm in diameter

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

Evaluation

• Clinical diagnosis

Management

• Topical corticosteroids
  • Betamethasone syrup OR
  • Dexamethasone 0.01% elixir as mouth rinse OR
  • Fluocinonide 0.05% gel applied topically to isolated lesions
• Biopsy to evaluate for malignancy or immune-mediated disease is recommended if lesion does not respond appropriately to steroids

Disposition

Discharge

See Also

Rash