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Apthous Ulcer

Apthous ulcers are painful small ulcerations that usually occur on the inner lips, gums, and oral mucosa. When in context of other physical findings or associated with eye changes and genital ulcerations, they may be indicative of other conditions such as Behcet's disease, systemic lupus, or discoid lupus. Most commonly, these oral ulcerations occur in all age groups in both sexes. There is no known cause for these oral ulcerations.

The classic appearance of these oral lesions is a small oval red tender ulceration with a white, yellow moist surface. Often seen during times of stress and only experienced several times per year, they may appear in numbers and may affect some individuals chronically. The most common symptom is pain when the area is traumatized or when eating. Many people have difficulty brushing their teeth or drinking acidic fluids such as orange juice.

Apthous ulcerations tend to resolve spontaneously without treatment over the course of 7-14 days without scarring. Some may last 6 weeks or longer and result in a small white scar. Treatment of apthous ulcers include tetracycline washes, oral lidocaine wash mixtures, topical triamcinolone in orabase, potent topical steroids, and topical anesthetics. Intralesional steroid injections may also be helpful. For refractory cases, oral thalidomide therapy may be started by your physician.

The differential diagnosis of this condition includes many oral ulcerative conditions. Should you have any question in the diagnosis of one or more apthous ulcerations, go to your dermatologist immediately for immediate and proper management.

Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California

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