Recurrent Aphthous StomatitisCurrent Perspective
Dr. Prabhakar M Sangolli
Dept of Dermatology
Dr.B.R.AMBEDKAR MEDICAL COLLEGE
Bangalore
Canker Sore
 Recurring
ulcers in the oral mucous
membrane with no signs of systemic
disease.
 Common manifestation of
haematological, immunological and
psychological disorders.
Aetiopathogenesis
 Genetic
( HLA)-40% cases
 Nutritional-Iron,folic acid,B1,B2,B3, B12,C
 Endocrinal-Premenstrual,pregnancy
 Infective-Strep.sanguis(Hsp), HIV
 Stress
 Smoking cessation
 Trauma
 Immunological(ADCC)
Clinical Features
 -20%
of general population
 -Precipitated by trauma,menses
 -Prodrome 2-48 hrs
 Pre ulcerative
 Ulcerative
 Resolving
TYPES
Minor (Mikulicz) Major (Sutton)
No.
Size
1-10
2-4mm
Herpetic
1-10
numerous
>1cm
2mm
Site
Non keratinized
Keratinized+
nonkeratinized
Nonkeratinized
Healing
Time
10 days
>6 weeks
10 days
Scar
-
+
-
DISEASES SIMULATING RAS
Behcet’s: oral, genital, neuro-ocular
 Sweet’s syndrome
 Blood dyscrasias
 GIT malabsorption (Coeliac disease,IBD)
 Collagen vascular diseases
 Cyclic neutropenia
 Reiter’s Disease
 Recurrent Intra oral Herpes

MANAGEMENT
 History
: Stress
Trauma
Smoking
Premenstrual flare
 Clinical examination: Eye
Genital
Rectal
CNS
Investigations
MaRAS,onset >25yrs age,pt with syst.symptoms
 CBC
 Serum
 ANA
iron,B12,RBC folate levels,ferritin
GENERAL MEASURES
 Stress
avoidance
 Nicotine patches
 Soft tooth brush
 B12 supplements:1000mcg twice wkly-6wks
1000mcg once a month-1 yr (low serum B12 level)
 Folic
acid, Iron, B-complex, C supplements
 Pre & Probiotics
TOPICAL THERAPY
 Mild
cases - To promote healing, use
 0.1% Triamcinolone with orabase, qid
 2% xylocaine viscous to relieve pain
 Severe cases :Clobetasol, Flucinolone
 Tetracycline in 30 ml water q.i.d
&
 5% Amlexanox paste-Accelerate healing .
SEVERE CASES
 Prednisolone
1mg/kg/day, taper over 2
weeks
 Azathioprine
 Watch
- 50mg b.i.d
for Candidiasis
PREVENTION OF RECURRENCE
 Oral
Pentoxyfylline : 400mg t.i.d-3mths
 Colchicine
0.5mg t. i. d
S/E: Myopathy, neuropathy, nausea,diarrhoa,
blood dyscrasias.Potent teratogen
 DDS+Colchcine
Prevention of recurrence (contd..)
 Thalidomide
100mg t.i.d, tapering to
50mg /d as maintenance.
 Teratogenic, neurotoxic
 STEPS-(System for Thalidomide
Education Prescribing Safety)
 Other measures:
 Topical tacrolimus
 Levamisole
Points to ponder
 H.Pylori
 CMV,EBV
 Handedness
 Glutein
free diet
 Non enzymatic AOs
 Iontophoresis
 Detergents in toothpaste
SUMMARY
 Stress
avoidance
 Soft tooth brush
 Supplements-B12,folic acid,B3,C,iron
 Steroids with orabase
 Local anaesthetic, tetracycline
mouthwash
 Systemic steroids-severe cases
Summary (contd..)
 Pentoxyfylline,Colchicine
& Dapsone-
severe relapsing patients
 STEPS
Assisted Thalidomide