Aphthous ulcers (AU) are painful mucosal ulcerations of idiopathic etiology occurring commonly in the oropharynx and less commonly in the esophagus, upper and lower GI tract, and anogenital epithelium, characterized clinically by pain and sharply marginated gray-based, red-rimmed ulcer(s). AU occur in otherwise healthy people.
Causes of Aphthous Ulcer
The exact cause of aphthous ulcers is unknown.
- In some cases they are thought to be caused by an overreaction by the body’s own immune system. Factors that appear to provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies.
- A common cause of aphthous ulcers is gluten intolerance in which case consumption of wheat, rye, or barley can result in chronic mouth ulcers.
- Another possible cause of aphthous ulcers may be opportunistic activity by combinations of otherwise normal bacterial flora, such as aerobic streptococci, Neisseria, Actinomyces, spirochetes, and bacteroides
Symptoms of Aphthous Ulcer
Skin lesion on mucous membranes of the mouth
- Begins as a red spot or bump
- Then develops into an open ulcer
- Usually small, 1-2 mm to 1 cm
- Occasionally larger than 1 cm
- Single or clusters, often appears in groups (crops)
- Painful
- Center appears white or yellow with fibrous texture
- Halo border is bright red (a red halo may not always be present)
- May have gray membrane just prior to healing
Diagnosis
A diagnosis is based on the distinctive appearance of the lesion. If canker sores persist or continue to return, a health care provider or dentist should be consulted to rule out other causes of mouth ulcers. (These include erythema multiforme, drug allergies, herpes simplex infection, pemphigus, pemphigoid, bullous lichen planus, and other disorders.)
Treatment
Topical Modalities Topical glucocorticoids in a base suited for mucous membranes. Topical anesthetics (diphenhydramine EMLA, viscous lidocaine).
Intralesional triamcinolone Injection 3 to 10 mg/mL.
Systemic Therapy In persons with large, persistent, painful AU interfering with nutrition, a brief course of oral glucocorticoids is effective. Thalidomide particularly has been used successfully in persons with HIV disease, Behcet’s disease, and large painful AU.
References
- https://www.medicinenet.com/script/main/art.asp?articlekey=43106
- https://www.dermnetnz.org/topics/aphthous-ulcer/
- http://www.jcda.ca/article/d48