Recurrent Aphthous Ulcers

Question 1

Different types of RAS

Answer 1

1. Minor
2. Major
3. Herpetiforme

Question 2

Characteristics of minor aphthous ulcers

Answer 2

Less than 10mm
Last up to 2wks
Only affect non keratinised mucosa (cheek)
Heal without scarring

Question 3

Characteristics of major aphthous ulcers

Answer 3

Larger than 10mm
Can last for months
Can affect part of mucosa (keratinised/non keratinised0
May scar
Poorly responsive to topical steroids (intralesional more useful)

Question 4

Characteristics of herpetiform apthae ulcers

Answer 4

Rarest
Multiple small ulcers on non-keratinised mucosa (not extending onto tongue)

Question 5

Compare herpetiform + HSV ulcers

Answer 5

Herpetiform
- Recurrent + non keratinised (tongue not involved)

HSV
- Rarely recurrent + keratinised epithelium (tongue involved)

Question 6

Diagnosis basis of Behcets disease

Answer 6

3 episodes of mouth ulcers in a year
Disabling + frequent
May require systemic meds

Question 7

Predisposing factors to RAS

Answer 7

Genetic
Systemic diseases - crohns + ulcerative colitis
Stress
Mechanical trauma
Hormonal level fluctuation
Deficiency - Iron + folic acid

Question 8

Investigations for Aphthous Ulcers

Answer 8

1. Blood tests haematinics (iron vitb12, folic)
2. Coeliac disease
3. Allergy testing

Question 9

Management of recurrent aphthae

Answer 9

Correct blood deficiency (Iron, folic acid, vitB12)
Refer for investigation for coeliac - endoscopy
Avoid dietary triggers - identified from testing, avoid SLS toothpaste

Question 10

Non steroidal topical therapy or RA

Answer 10

For inconvenient occasional lesions
CHX 0.2% 300ml MW
Benzydamine MW
Benzydamine spray 0.15%

Question 11

Steroid topical therapy for RA

Answer 11

For disabling lesions
Betamethasone tablets 500mg
Hydrocortisone oromucosal tablets 2.5mg