Aphthous ulcers occur mostly in the mouth but can be present as very painful, relapsing, vulvar ulcers of unknown etiology. Recurrent oral and genital aphthae in the absence of Behçet disease is complex aphthosis. Epstein-Barr virus (EBV) may be associated. In the absence of oral ulcers, complex aphthosis is sometimes called Lipschütz disease. The entity of juvenile gangrenous vasculitis of the scrotum is thought by many authors to be the male counterpart of Lipschütz ulcers. Lipschütz disease may be idiopathic in 90% of cases, and 10% of cases are associated with underlying conditions. The age of onset is typically between 9 and 18 years.