Recurrent Aphthous Stomatitis

Question 1

What ulcer history questions are relevant to ask?

Answer 1

• What does the patient mean by an ulcer?
• Age of patient
• Prodrome to ulcer? - fizzing/tingling
• Relation to smoking / menstruation?
• Changes in ulcer over time?
• Number / size / shape / duration / any ulcer free periods? / site / pain
• Extra oral features? - blisters / skin lesions / genital ulcers / eye irritability

Question 2

List any recurrent ulcers

Answer 2

RAS
RAS associated with bechets
Smoking related aphthous ulcers
Atypical recurrent oral ulceration
PFAPA (periodic fever, aphthous stomatitis, pharyngitis, adenitis)
Recurrent erythema multiforme

Question 3

What are the characteristics of minor RAS?

Answer 3

• Small ulcers <1cm
• Ovular shaped ulcers
• Grey base ulcers, erythematous border
• Last 1-2 weeks, heal without scarring
• Site = non-keratinised, buccal mucosa, inner surface of lip in anterior region

Question 4

What are some characteristics of herpetiform RAS?

Answer 4

• 0.5-3mm size
• Round shape
• Tend to coalesce together
• Yellow base, large erythematous border
• 1-2 weeks duration, no scarring
• Site = non keratinised, ventral tongue
• Ulcers in crops of 5-40

Question 5

What are the characteristics of major RAS?

Answer 5

• Ulcers > 1cm
• Irregular, ovular shape
• Duration = 2-3 weeks, will scar on healing due to their depth
• Site = any surface
• Ulcers in crops of 2-10

Question 6

How do we give ulcers a severity score?

Answer 6

1. The average number of ulcers in an attack
2. The average size of ulcers
3. The average duration of ulcers
4. The length of the ulcer free period
5. The oral mucosa sites affected
6. Pain severity as perceived by the patient

Question 7

What are the clinical features of Behcets disease?

Answer 7

• Oral: aphthous like ulcers
• Genital: aphthous like ulcers
• Ocular: uveitis (blurring of vision, pain, floaters – inflammatory cells floating within the eye)
• Skin (papulopustular, acne-like, erythema nodosum)
• Neurological: headache
• Vascular: superficial phlebitis, DVT, PE, aortic aneurysm
• Articular: non-erosive, non-deforming
• Gastroenterological: IBS like symptoms, aphthous ulcers

Question 8

What is erythema multiforme? What are the causes of it?

Answer 8

Acute immune mediated condition.
Immune complex formation and deposition in the microvasculature.
Causes: idiopathic, drugs (sulphonamides), infections
Majority are triggered by infections such as hep virus, epstein barr virus, HIV.

Question 9

What are the names of the two severe forms of erythema multiforme?

Answer 9

1) Stevens-Johnson syndrome
2) Toxic epidermal necrolysis