Aphthous ulcer physical examination: Difference between revisions
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*Ulcers may be shallow or deep, present in small (1-5) or large (5-100) numbers, may be scarring or not, and these characteristics help physicians to classify the disease. | *Ulcers may be shallow or deep, present in small (1-5) or large (5-100) numbers, may be scarring or not, and these characteristics help physicians to classify the disease. | ||
*Ulcers can be: | *Ulcers can be: | ||
**Major aphthous stomatitis - Most common. Few ulcers or even just a single one, smaller than 1cm. Usually these lesions are self-resolving. Affects the lips, tongue lateral aspects and cheeks. | **Major aphthous [[stomatitis]] - Most common. Few ulcers or even just a single one, smaller than 1cm. Usually these lesions are self-resolving. Affects the lips, tongue lateral aspects and cheeks. | ||
*Minor aphthous stomatitis - Few ulcers of size greater than 1 cm. Often found in the back of the mouth. Painful and deeper than minor aphthous stomatitis, usually leaving a scar as it heals. | *Minor aphthous [[stomatitis]] - Few ulcers of size greater than 1 cm. Often found in the back of the mouth. Painful and deeper than minor aphthous [[stomatitis]], usually leaving a scar as it heals. | ||
**Herpetiform stomatitis - Least common. Wide number of ulcers, usually more than 10, with size varying between 1-3mm and may leave scars as it heals. Ulcers may coalesce and become larger. More common in young adults in the 20s or 30s.<ref name="pmid21925448">{{cite journal| author=Riera Matute G, Riera Alonso E| title=[Recurrent aphthous stomatitis in Rheumatology]. | journal=Reumatol Clin | year= 2011 | volume= 7 | issue= 5 | pages= 323-8 | pmid=21925448 | doi=10.1016/j.reuma.2011.05.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21925448 }} </ref> | **Herpetiform [[stomatitis]] - Least common. Wide number of ulcers, usually more than 10, with size varying between 1-3mm and may leave scars as it heals. [[Ulcers]] may coalesce and become larger. More common in young adults in the 20s or 30s.<ref name="pmid21925448">{{cite journal| author=Riera Matute G, Riera Alonso E| title=[Recurrent aphthous stomatitis in Rheumatology]. | journal=Reumatol Clin | year= 2011 | volume= 7 | issue= 5 | pages= 323-8 | pmid=21925448 | doi=10.1016/j.reuma.2011.05.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21925448 }} </ref> | ||
*Pictures: | *Pictures: | ||
| Line 22: | Line 22: | ||
Some diseases that present with oral ulcers may present with other symptoms as well: | Some diseases that present with oral ulcers may present with other symptoms as well: | ||
====Behçet disease==== | ====Behçet disease==== | ||
*Some symptoms present in Behçet disease, besides oral ulcers that recur usually 3 times per year, are: | *Some symptoms present in [[Behçet disease]], besides oral ulcers that recur usually 3 times per year, are: | ||
**Recurrent genital ulceration or scarring; | **Recurrent genital ulceration or [[scarring]]; | ||
**Anterior or posterior uveitis, retinal vasculitis | **Anterior or [[posterior uveitis]], retinal [[vasculitis]]; | ||
**Erythema nodosum-like skin lesions or pseudofolliculitis, papulopustular lesions or acneiform nodules | **[[Erythema nodosum]]-like skin lesions or [[pseudofolliculitis]], [[papulopustular]] lesions or [[acneiform nodules]]; | ||
**Positive pathergy test: erythematous | **Positive [[pathergy test]]: [[erythematous]] [[papule]] > 2 mm, observed 48 h after the application of sterile needle which penetrated avascular skin to a depth of 5 mm.<ref name="pmid14616160">{{cite journal| author=Field EA, Allan RB| title=Review article: oral ulceration--aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. | journal=Aliment Pharmacol Ther | year= 2003 | volume= 18 | issue= 10 | pages= 949-62 | pmid=14616160 | doi=10.1046/j.1365-2036.2003.01782.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616160 }} </ref> | ||
====Oral Crohn's disease and orofacial granulomatosis==== | ====Oral Crohn's disease and orofacial granulomatosis==== | ||
*Also known as: [[Melkersson–Rosenthal syndrome]] and [[Mieschener's cheilitis granulomatosa]], associated with [[Crohn's disease]], may present with: | *Also known as: [[Melkersson–Rosenthal syndrome]] and [[Mieschener's cheilitis granulomatosa]], associated with [[Crohn's disease]], may present with: | ||
**Swelling of lips and face | **[[Swelling]] of lips and face; | ||
**Mucosal tags or "cobblestoning" | **Mucosal tags or "cobblestoning"; | ||
**Oral ulceration | **Oral ulceration; | ||
**Angular cheilitis | **[[Angular cheilitis]]; | ||
**Lip fissures | **Lip fissures; | ||
**Persistent lymphadenopathy | **Persistent [[lymphadenopathy]]; | ||
** | **Perioral [[erythema]] and [[scaling]] of skin; | ||
**"Full‐width" gingivitis<ref name="pmid14616160">{{cite journal| author=Field EA, Allan RB| title=Review article: oral ulceration--aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. | journal=Aliment Pharmacol Ther | year= 2003 | volume= 18 | issue= 10 | pages= 949-62 | pmid=14616160 | doi=10.1046/j.1365-2036.2003.01782.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616160 }} </ref> | **"Full‐width" [[gingivitis]].<ref name="pmid14616160">{{cite journal| author=Field EA, Allan RB| title=Review article: oral ulceration--aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. | journal=Aliment Pharmacol Ther | year= 2003 | volume= 18 | issue= 10 | pages= 949-62 | pmid=14616160 | doi=10.1046/j.1365-2036.2003.01782.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616160 }} </ref> | ||
==References== | ==References== | ||
Latest revision as of 21:47, 12 January 2021
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Aphthous ulcer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Aphthous ulcer physical examination On the Web |
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American Roentgen Ray Society Images of Aphthous ulcer physical examination |
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Risk calculators and risk factors for Aphthous ulcer physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]
Overview
Patients with aphthous ulcers usually present with ulcers that may be may be shallow or deep, present in small (1-5) or large (5-100) numbers, may be scarring or not. These characteristics help physicians to classify the disease.
Aphthous Ulcer Physical Examination
Aphthous ulcer physical examination findings may be rich depending on the associated medical conditions such as Crohn's disease or Behçet's disease.
Oral Ulcers
- Ulcers may be shallow or deep, present in small (1-5) or large (5-100) numbers, may be scarring or not, and these characteristics help physicians to classify the disease.
- Ulcers can be:
- Major aphthous stomatitis - Most common. Few ulcers or even just a single one, smaller than 1cm. Usually these lesions are self-resolving. Affects the lips, tongue lateral aspects and cheeks.
- Minor aphthous stomatitis - Few ulcers of size greater than 1 cm. Often found in the back of the mouth. Painful and deeper than minor aphthous stomatitis, usually leaving a scar as it heals.
- Herpetiform stomatitis - Least common. Wide number of ulcers, usually more than 10, with size varying between 1-3mm and may leave scars as it heals. Ulcers may coalesce and become larger. More common in young adults in the 20s or 30s.[1]
- Pictures:
- Other causes of oral ulcers: Stevens-Johnson syndrome, Behçet, drug associated oral ulcers:
Associated diseases
Some diseases that present with oral ulcers may present with other symptoms as well:
Behçet disease
- Some symptoms present in Behçet disease, besides oral ulcers that recur usually 3 times per year, are:
- Recurrent genital ulceration or scarring;
- Anterior or posterior uveitis, retinal vasculitis;
- Erythema nodosum-like skin lesions or pseudofolliculitis, papulopustular lesions or acneiform nodules;
- Positive pathergy test: erythematous papule > 2 mm, observed 48 h after the application of sterile needle which penetrated avascular skin to a depth of 5 mm.[2]
Oral Crohn's disease and orofacial granulomatosis
- Also known as: Melkersson–Rosenthal syndrome and Mieschener's cheilitis granulomatosa, associated with Crohn's disease, may present with:
- Swelling of lips and face;
- Mucosal tags or "cobblestoning";
- Oral ulceration;
- Angular cheilitis;
- Lip fissures;
- Persistent lymphadenopathy;
- Perioral erythema and scaling of skin;
- "Full‐width" gingivitis.[2]
References
- ↑ Riera Matute G, Riera Alonso E (2011). "[Recurrent aphthous stomatitis in Rheumatology]". Reumatol Clin. 7 (5): 323–8. doi:10.1016/j.reuma.2011.05.003. PMID 21925448.
- ↑ 2.0 2.1 Field EA, Allan RB (2003). "Review article: oral ulceration--aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic". Aliment Pharmacol Ther. 18 (10): 949–62. doi:10.1046/j.1365-2036.2003.01782.x. PMID 14616160.