You have been logged out of VisualDx or your session has expired.

Please reload this page and sign into VisualDx to continue.

..
  VisualDx Mobile   Select Language

Get VisualDx Mobile

There are VisualDx mobile apps available for iOS and Android devices.

You will need a VisualDx account to use the mobile apps.



Already have an account? Sign In or
sign up for a free trial.

Users with VisualDx accounts earn CME credits for using VisualDx.

Already have an account? Sign In or
sign up for a free trial.

Create a Personal Account

E-mail (username)
Password
Verify Password
First Name
Last Name

Personal Account Created

Mobile Access

You can now download VisualDx for your iOS and Android devices. Launch the VisualDx app from your device and sign in using your VisualDx personal account username and password.

CME Certification

Sign in with your personal account to earn and claim CME credits through VisualDx. Credits can be earned by building a differential or looking up a diagnosis.

Version: 7.09.1401   (build 62b8f0e)
Select Language


Select Region

Send us your feedback

E-mail
Message
This field is required

Oops! There was an issue during submission. Please try again. If the problem persists, email feedback@visualdx.com with your feedback.

Thank You!

We appreciate your feedback and you will be hearing from us soon.

OK

Share This Page

Thank You!

We have sent an e-mail with a link to the current page.

OK

E-mail This Patient Information Sheet

Thank You!

We have sent an e-mail with this patient information.

OK

Image Contributors

Individuals

  • Christine Ahn MD
    Carl Allen DDS, MSD
    Brandon Ayres MD
    Howard P. Baden MD
    Robert Baran MD
    Keira Barr MD
    Gregory J. Basura MD, Ph.D
    Donald Belsito MD
    Jeffrey D. Bernhard MD
    Jesse Berry MD
    Victor Blanco MD
    Benjamin R. Bohaty MD
    William Bonnez MD
    Sarah Brenner MD
    Robert A. Briggaman MD
    Robert Brodell MD
    Roman Bronfenbrener MD
    Walter Brooks MD
    William Buckley MD
    Philip Bulterys MD, PhD (candidate)
    Susan Burgin MD
    Sonya Burton MD
    Sean P. Bush MD, FACEP
    Jeffrey Callen MD
    Scott Camazine MD
    Michael Cardwell
    Shelley D. Cathcart MD
    Robert Chalmers MD, MRCP, FRCP
    Chia-Yu Chu MD, PhD
    Flavio Ciferri MD
    Maria Rosa Cordisco MD
    Noah Craft MD, PhD
    John T. Crissey MD
    Harold E. Cross MD, PhD
    Charles Crutchfield III MD
    Adriana Cruz MD
    Donna Culton MD, PhD
    Bart J. Currie MBBS, FRACP, DTM&H
    Chicky Dadlani MD
    Alexander Dane DO
    C. Ralph Daniel III MD
    Thomas Darling MD, PhD
    William Delaney MD
    Damian P. DiCostanzo MD
    Ncoza Dlova MD
    James Earls MD
    Libby Edwards MD
    Melissa K. Egge MD
    Charles N. Ellis MD
    Rachel Ellis MD
    David Elpern MD
    Nancy Esterly MD
    Stephen Estes MD
    E. Dale Everett MD
    Janet Fairley MD
    David Feingold MD
    Benjamin Fisher MD
    Henry Foong MBBS, FRCP
    David Foster MD, MPH
    Brian D. Foy PhD
    Michael Franzblau MD
    Vincent Fulginiti MD
    Sunir J. Garg MD, FACS
    Kevin J. Geary MD
    Lowell Goldsmith MD, MPH
    Sethuraman Gomathy MD
    Bernardo Gontijo MD, PhD
    Kenneth Greer MD
    Kenneth G. Gross MD
    Alan Gruber MD
    Nathan D. Gundacker MD
    Akshya Gupta MD
    Vidal Haddad MSC, PhD, MD
    Edward Halperin MD, MA
    Ronald Hansen MD
    John Harvey
    Rizwan Hassan MD
    Michael Hawke MD
    Jason E. Hawkes MD
    Peter W. Heald MD
    David G. Hicks MD
    Sarah Hocker DO
    Ryan J. Hoefen MD, PhD
    Li-Yang Hsu MD
    William Huang MD
    Sanjana Iyengar MD
    Alvin H. Jacobs MD
    Shahbaz A. Janjua MD
    Joshua J. Jarvis MD
    Kit Johnson
    Robert Kalb MD
    A. Paul Kelly MD
    Henry Kempe MD
    Loren Ketai MD
    Sidney Klaus MD
    Ashwin Kosambia MD
    Jessica A. Kozel MD
    Carl Krucke
    Mario E. Lacouture MD
    Joseph Lam MD
    Alfred T. Lane MD
    Edith Lederman MD
    Nahyoung Grace Lee MD
    Pedro Legua MD, PhD
    Robert Levin MD
    Bethany Lewis MD
    Sue Lewis-Jones FRCP, FRCPCH
    Taisheng Li MD
    Christine Liang MD
    Shari Lipner MD, PhD
    Jason Maguire MD
    Mark Malek MD, MPH
    Jere Mammino DO
    Ricardo Mandojana MD
    Lynne Margesson MD
    Thomas J. Marrie MD
    Maydel Martinez MD
    Ralph Massey MD
    Patrick McCleskey MD
    Karen McKoy MD
    Thomas McMeekin MD
    Josette McMichael MD
    Somchai Meesiri MD
    Joseph F. Merola MD
    Mary Gail Mercurio MD
    Anis Miladi MD
    Larry E. Millikan MD
    Dan Milner Jr. MD
    Zaw Min MD
    Stephanie Montero
    Alastair Moore MD
    Keith Morley MD
    Dean Morrell MD
    Samuel Moschella MD
    Taimor Nawaz MD
    Vic Newcomer MD
    John Nguyen MD
    Matilda Nicholas MD
    Thomas P. Nigra MD
    Steven Oberlender MD, PhD
    Maria Teresa Ochoa MD
    Art Papier MD
    Lawrence Parish MD
    Tanner Parrent MD
    Mukesh Patel MD
    Lauren Patty-Daskivich MD
    David Peng MD, MPH
    Robert Penne MD
    Nitipong Permpalung MD
    Doug Powell MD
    Harold S. Rabinovitz MD
    Christopher J. Rapuano MD
    Sireesha Reddy MD
    Angela Restrepo MD, PhD
    Bertrand Richert MD, PhD
    J. Martin Rodriguez, MD, FACP
    Theodore Rosen MD
    Misha Rosenbach MD
    Scott Schiffman MD
    Robert H. Schosser MD
    Glynis A. Scott MD
    Carlos Seas MD, MSc
    Deniz Seçkin MD
    Daniel Sexton MD
    Paul K. Shitabata MD
    Tor Shwayder MD, FAAP, FAAD
    Elaine Siegfried MD
    Gene Sienkiewicz MD
    Christye Sisson
    Mary J. Spencer MD, FAAP
    Sarah Stein MD
    William Van Stoecker MD
    Frances J. Storrs MD
    Erik J. Stratman MD
    Lindsay C. Strowd MD
    Erika Summers MD
    Belinda Tan MD, PhD
    Robert Tomsick MD
    Jenny Valverde MD
    Vishalakshi Viswanath MD
    Susan Voci MD
    Lisa Wallin ANP, FCCWS
    Douglas Walsh MD
    Ryan R. Walsh MD
    George Watt MD
    Clayton E. Wheeler MD
    Sally-Ann Whelan MS, NP, CWOCN
    Jan Willems MD, PhD
    James Henry Willig MD, MPH
    Karen Wiss MD
    Vivian Wong MD, PhD
    Sook-Bin Woo MS, DMD, MMSc
    Jamie Woodcock MD
    Stephen J. Xenias MD
    Lisa Zaba MD
    Vijay Zawar MD
    Bonnnie Zhang MD
    Carolyn Ziemer MD


Organizations

  • Am. Journal of Trop. Med & Hygiene
  • Armed Forces Pest Management Board
  • Blackwell Publishing
  • Bugwood Network
  • Centers For Disease Control and Prevention
  • Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
  • Dermatology Online Journal
  • East Carolina University (ECU), Division of Dermatology
  • International Atomic Energy Agency
  • Massachusetts Medical Society
  • Oxford University Press
  • Radiological Society of North America
  • Washington Hospital Center
  • Wikipedia
  • World Health Organization
ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyAssociated MedicationsReferencesInformation for PatientsView all Images (27)
Aphthous stomatitis - Oral Mucosal Lesion
See also in: Overview,Anogenital
Print
Other Resources UpToDate PubMed

Aphthous stomatitis - Oral Mucosal Lesion

See also in: Overview,Anogenital
Print Patient Handout Images (27)
Contributors: Vivian Wong MD, PhD, Susan Burgin MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed

Synopsis

Aphthous ulcers, or aphthae (canker sores), are the most common cause of recurring ulcers of the mucous membranes. They affect approximately 25% of the general population (estimates range from 20% up to 50%). The mouth is the most common site. The precise cause of aphthous ulceration is unknown, but studies point to a defect in regulation of cellular immunity that results in increased T-cell reactivity to either mucous membrane keratinocytes or microorganisms on the mucosal surface.

There are 3 morphologic types:
  • Minor aphthae (Mikulicz aphthae, representing about 80% of cases) are single or multiple lesions, 1.0 cm or less in diameter, and mildly painful; they heal within 1-2 weeks without scarring. They favor the buccal mucosa, labial mucosa, and the floor of the mouth. Onset is typically around the age of 5 years.
  • Major aphthae (Sutton disease, representing approximately 10%-15% of cases) are deep ulcers that are 1-3 cm in diameter. These lesions are extremely painful, last from 2-6 weeks, and generally heal with scarring. They favor the labial mucosa, soft palate, tongue, or pharynx. Systemic symptoms, such as fever and odynophagia, may be seen. These lesions begin at the onset of puberty.
  • Herpetiform aphthae (representing about 5%-10% of cases) are characterized by multiple oral ulcerations, 1-3 mm in diameter, and have a clinical course similar to minor aphthous ulcers, typically healing in 1-4 weeks without scarring. They can be seen anywhere on the oral mucosa. They have a later onset, usually in adulthood, and are primarily seen in women.
Most patients with aphthous ulcers suffer recurrences, and this is termed recurrent aphthous stomatitis (RAS). RAS is more common in women, in patients younger than 40, in nonsmokers, and in people of higher socioeconomic status. Prevalence seems to be higher in patients of Northern European descent.

There are 2 well-recognized patterns for recurring oral ulcerations:
  • Simple aphthosis is primarily marked by minor aphthae that recur intermittently with disease-free intervals of weeks to months. Patients are generally young and healthy, with lesions limited to the mouth and no underlying systemic disease. Patients frequently report a family history of oral ulceration. In addition to presumed genetic risk, epidemiologic studies (and patient reports) support an association between new lesions and oral trauma, chemical irritation, emotional stress, and smoking cessation. Pregnancy and hormonal changes in menses appear to increase risk. Some studies suggest that those who were breast-fed as infants may be at decreased risk. Most affected individuals experience less severe and fewer episodes after 50 years of age.
  • Complex aphthosis is marked by the near-constant presence of 3 or more oral and/or genital aphthae. When genital ulcers are involved, complex aphthosis is sometimes called Lipschütz disease. Complex aphthosis usually occurs in the presence of an underlying disease such as human immunodeficiency virus (HIV), gluten-sensitive enteropathy, inflammatory bowel disease, or Behçet disease. By definition, Behçet disease is accompanied by other findings, including genital ulcers, uveitis, and other skin and systemic inflammatory processes. Complex aphthosis is also seen in rarer conditions such as MAGIC syndrome (mouth and genital ulcers, inflamed cartilage), PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and lymphadenopathy), and cyclical neutropenia (fever approximately every 3 weeks, oral ulcers, neutropenia).
Both types of RAS have been associated with iron, zinc, folate, and vitamin B1, B2, B6, and B12 deficiencies.

Codes

ICD10CM:
K12.0 – Recurrent oral aphthae

SNOMEDCT:
426965005 – Aphthous ulcer of mouth

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Diseases with oral ulcerations clinically distinguishable from aphthae:

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Associated Medications

Subscription Required

References

Subscription Required

Last Reviewed: 11/07/2016
Last Updated: 01/10/2017
Copyright © 2018 VisualDx®. All rights reserved.
Aphthous stomatitis - Oral Mucosal Lesion
See also in: Overview,Anogenital
Print 27 Images Filter Images
View all Images (27)
(with subscription)
 Reset
Aphthous stomatitis : Mouth pain, Oral mucosa, Oral white plaque, Painful oral ulcers
Clinical image of Aphthous stomatitis
Copyright © 2018 VisualDx®. All rights reserved.