mouth ulcers

see also:

• dermatology

• DermNetNZ
• also known as aphthous stomatitis
• oval or round ulcers usually on the inside of lips, cheeks or under the tongue where the mucosa is not tightly bound to underlying bone.
• may also appear on genitals if associated with Behcet disease or HIV.
• 40% have a FH
• often triggered by stress, menses or mechanical trauma (eg. accidental self bite of mucosa)
• perhaps one of the few conditions LESS prevalent in smokers!
• 80% are of the minor recurrent type
• higher incidence in those with coeliac disease

• primary herpetic gingivostomatitis
  • first exposure to Herpes simplex virus (HSV) may result in a widespread very painful ulcerated inflammation of oral mucosa, gums and tongue which usually lasts 10-14 days
  • often occurs in pre-school children
• secondary recurrent HSV “cold sores”:
  • the common “cold sore”

• Coxsackie virus A infection resulting in ulceration of the posterior pharynx - usually on the soft palate.
• mainly children in Summer

• Coxsackie A virus infection - mainly an infection of pre-school children; may also be caused by Enterovirus 71.
• helpful diagnostic findings include:
  • purple blistering of medial borders of feet/great toe and hands
  • maculopapular rash over buttocks in infants
• NSW fact sheet
• wikipedia

• see Vincent's gingivitis - fusospirochaetal necrotising gingivitis

• recurrent febrile illness with aphthous stomatitis and adenitis starting in children aged 2-5yrs and becoming rare after age 10yrs
• sporadic and familial cases are rare
• periodicity of 3-6wks resembles cyclic neutropenia suggesting some common biologic clock mechanism
• fevers up to 41degC for 3-6 days, then suddenly fall to normal
• 40-70% develop aphthous ulcers
• most have tender cervical adenopathy and pharyngitis
• most have moderate neutrophilia and raised ESR
• striking response to single dose of corticosteroids

• autosomal recessive periodic fever syndrome
• episodic attacks of fever lasting 3-7 days, usually accompanied by chills, cervical lymphadenopathy, abdominal pain, and vomiting or diarrhoea
• some experience headache, arthralgias or arthritis, aphthous ulceration, a pleomorphic rash, and, occasionally, splenomegaly
• 2/3rds begin in 1st year of life
• most have IgD >100 international units/mL
• 80% have elevated IgA
• raised ESR, CRP occur during attacks and may remain high between attacks

• characterised by a 14-35 day periodic cycle of neutropenia which may cause aphthous ulcers and gingivitis during attacks

• vesicles present on only the left or the right side of the tongue with minimal crossing of the midline
• may be associated with features of Ramsay Hunt Syndrome:
  • facial palsy, often mild
  • otalgia
  • vesicles in ear canal
  • occasionally, hearing loss

• life threatening, widespread blistering condition of the whole body with ulceration of oro-genital mucosa
• see Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

• mouth ulcers may be a sign of severe neutropenia

• chronic ulcerated lesions in the elderly should raise the suspicion of carcinoma of the oropharynx, or chronic irritation from poorly fitting dentures

• white plaques rather than ulceration, often due to chronic inflammation due to dentures
• hairy leukoplakia is associated with EBV / glandular fever / infectious mononucleosis and occurs primarily in HIV-positive individuals.

• painful mouth ulcers are usually the first outward sign of Behcet disease and occur in about 70% of patients.
• ulcers can occur anywhere in the mouth including on the tongue and inside the lips and cheeks.
• usually last for 1-2 weeks but can remain for as long as 3 weeks.
• onset is usually between 30 and 40 years of age
• 1 in 10,000 from “Silk Road” ethnicities, 1 in 20,000 in Western ethnicities
• may be associated with genital ulcers, uveitis, erythema nodosum, tonsillitis, general constitutional symptoms
• see DermNetNZ

• mouth is involved in half of patients with lichen planus
• painless white streaks or fern-like pattern on buccal mucosa
• painful and persistent mouth ulcers (erosive lichen planus)
• desquamative gingivitis
• some cases are due to contact allergy to mercury amalgam dental fillings
• see dermnetnz

• usually mainly affects cheeks, nose, ears and sometimes light exposed areas (upper back, V neck, back of hands)
• it can cause mouth and lip ulcers, and these lesions may predispose to SCC

• see systemic lupus erythematosus (SLE)

• white plaques rather than ulcers, but in the acute pseudomembranous form, these white patches can be peeled off to leave a raw area.
• DermNetNZ

• see DermNetNZ

• red, painful fissuring of the angle of the mouth
• may be due to:
  • candida - eg. dentures, diabetes, steroids, antibiotic use
  • Staph aureus
  • HSV cold sores
  • contact dermatitis from saliva due to constant dribbling or licking
  • dry chapped lips from sun/wind/cold exposure
  • poor nutrition - coeliac disease, iron deficiency, riboflavin deficiency
  • inflammatory bowel disease
  • sensitive skin - eg. atopic skin
  • retinoid use - eg. isotretoin for acne, acitretin for psoriasis
• see DermNetNZ