Aphthous ulcer physical examination

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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.

• 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.

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.