A 50-year-old woman presents with a painful lesion on the inside of her upper lip. She has had similar lesions on an intermittent basis over the past several years in this location and on her tongue and buccal mucosa. The lesions heal without scarring. Medical history is negative for systemic disease, and the patient reports no antecedent fever or arthralgia.
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Aphthous stomatitis is a recurrent condition that affects the oral cavity. Lesions may be found on the buccal and labial mucosa, lateral and ventral tongue, soft palate, or oropharynx. The disorder is characterized by discrete ovoid to round superficial ulcers with erythematous borders and sallow to grey bases. Lesions are painful and may interfere with chewing and swallowing.
Females have a higher incidence of aphthous ulcers than males, and approximately 40% of affected individuals have a positive family history.1 Predisposing factors include trauma from dental procedures and tooth brushing.2 The condition has also been linked to medications such as nonsteroidal anti-inflammatory drugs and captopril.3 Tobacco appears to have a protective effect, and smokers may have flare when attempting to quit smoking.4
Those with aphthous ulcers should be advised to minimize oral trauma (ie, use a soft toothbrush and avoid eating sharp foods such as potato chips). Viscous lidocaine may minimize discomfort, and strong topical steroid medications may hasten resolution of ulcers.5 The use of colchicine has been reported to decrease recurrence.6
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
- Scully C, Porter S. Oral mucosal disease: recurrent aphthous stomatitis. Br J Oral Maxillofac Surg. 2008;46:198-206.
- Jurge S, Kuffer R, Scully C, Porter SR. Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Dis. 2006;12:1-21.
- Natah SS, Konttinen YT, Enattah NS, Ashammakhi N, Sharkey KA, Häyrinen-Immonen R. Recurrent aphthous ulcers today: a review of growing knowledge. Int J Oral Maxillofac Surg. 2004;33:221-234.
- Shapiro S, Olson DL, Chellemi SJ. The association between smoking and aphthous ulcers. Oral Surg Oral Med Oral Pathol. 1970;30:624-630.
- Lo Muzio L, della Valle A, Mignogna MD, et al. The treatment of oral aphthous ulceration or erosive lichen planus with topical clobetasol propionate in three preparations: a clinical and pilot study on 54 patients. J Oral Pathol Med. 2001;30:611-617.
- Altenburg A, Zouboulis CC. Current concepts in the treatment of recurrent aphthous stomatitis. Skin Therapy Lett. 2008;13:1-4.