Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Raynaud’s Syndrome Recurrent Aphthous Stomatitis 1269

➣1/3 improve

➣1/6 worse

■Secondary Raynaud’s

➣Prognosis highly dependent on course of underlying collagen

vascular disease

RECURRENT APHTHOUS STOMATITIS

SOL SILVERMAN Jr, DDS

history & physical

■usually a history of recurrent oral sores/ulcers

■immunopathic; cause unknown; genetic influence (predisposition)

■aggravated by various irritants, e.g. citrus, nuts, chocolate

■single or multiple shallow ulcers; vary in size up to 6 mm

■last up to 2 weeks; frequency of attacks variable

■covered by pseudomembrane (fibrin) surrounded by red halo

(inflammation)

■occur on unkeratinized mucosa (cheeks, ventral-lateral tongue, floor

of mouth,

■soft palate, oropharynx)

tests

■no tests are indicated; history and clinical appearance usually suffi-

cient

differential diagnosis

■Herpes simplex virus (occur on keratinized mucosa: hard palate,

gingiva, lips)

■erythema multiforme

■Behcet’s

■trauma/injury

management

■self healing

■topical or systemic analgesics

specific therapy

■systemic corticosteroids for severe signs/symptoms

➣high dose, short course

■topical corticosteroids; no contraindications; compliance problem;

➣not reproducibly effective