| • | aphthae = ancient greek word for ulcer (therefore aphthous ulcers = redundant) |
| • | nicotine in cigarettes seems to decrease recurrence |
| • | well circumscribed, erythematous rim, fibrin covered base |
| 1. | minor aphthous ulcers (80%) <1cm |
| 2. | major aphthous ulcers (10%) >2cm (may respond to thalidomide) |
| 3. | herpetiform aphthae 10-100, 1-2mm ulcers |
Treatment:
(reference: Cutis 9/01 p. 201):
| • | variety of OTC’s including anesthetics, antimicrobials, wound cleansers, and coating agents |
| • | Amlexanox (Aphthasol) – an anti-inflammatory that inhibits leukotrienes and histamines (although exact mechanism unknown); apply QID (after meals and at bedtime) |
| • | Colchicine 1.2 or 1.8 mg/day X 4 months |
| • | OTC Kank-a (benzocaine 20% and benzoin tincture) |
| • | apply silver nitrate (in office) and styptic pencil (at home) |
| • | intralesional kenalog 5mg/cc (diluted with lidocaine instead of saline) |
| • | Vit b12 1000mcg sublingual qd |
| • | AAD 2015 pearl - Aphthous ulcers apply honey qid x 5 days |
ddx:
| • | aphthous ulcerations are common in patients with IBD, are thought to represent an autoimmune reaction |
| • | in IBD patients, the lesions occur only on mucosa not bound to periosteum |
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