Recurrent Aphthous Ulcers Flashcards
what are aphthous ulcers
immunologically generated recurring oral ulcers
what are the types of recurrent aphthous stomatitis
minor, major, herpetiform, oro-genital ulcer syndromes (behcets)
on examination, what will aphthous ulcers look like
yellow/grey base with erythematous margin
what does a minor aphthous ulcer look like
less than 10mm diameter
non-keratinised mucosa
heal without scarring
last for 2 weeks
what does major aphthous ulcers look like
lasts for months
affect any part of mucosa
may scar when healing
larger than 10mm
what type of ulcers respond well to topical steroids
minor aphthous ulcers
what type of ulcers require intralesional steroids
major aphthous ulcers
what do herpetiform ulcers look like
multiple small ulcers on non-keratinised mucosa which can coalesce into larger areas of ulceration
heal within 2 weeks
what is the diagnosis for behcets disease
three episodes of mouth ulcers in a year
at least 2 of genital sores/eye inflammation/skin ulcers/pathergy
what causes behcets disease
inflammation of blood vessels (vasculitis)
what is the management of behcets disease
treat local ulcers
systemic immunomodulation where multisystem
what are the predisposing factors for recurrent aphthous stomatitis
genetic predisposition
systemic diseases
stress
mechanical injuries
hormonal level fluctuations
microelement deficiencies
viral and bacterial infections
what is the immunology of aphthous ulcers
damage to basal cells at basement membrane so they cannot produce epithelial replacement cells so as existing cells are lost the ulceration appears as there are no new cells to replace them
when does the damage occur with aphthous ulcers
before the ulcer appears (3-4 days after immunological process started)
when is treatment most effective with aphthous ulcers
in prodromal period
what are the blood tests for aphthous ulcers
haematinic deficiencies (ferritin, folate, vitamin B)
coeliac disease
FBC
how do you manage recurrent aphthae
correct blood deficiencies
refer for investigation if coeliac positive
avoid dietary triggers (SLS containing toothpaste)
what drugs can we prescribe for aphthous ulcers
non-steroid topical therapy for inconvenient lesions
steroid topical therapy for disabling lesions
when do children get ulcers
when growing rapidly
what is given to children who get ulcers during growth periods
3 months of iron supplements
what do we give patients if their haematinics come back deficient or borderline
3/12 ferritin replacement
when do we refer for ulcers
if iron supplements, non-steroid and steroid therapy has not worked
if children under 12
