Approach to the aphthous lesions of the oral mucosa

Year 2021, , 1 - 9, 31.03.2021

Deniz Aksu Arıca , Arzu Ferhatosmanoğlu

https://doi.org/10.33204/mucosa.889503

Abstract

Aphthous oral cavity lesions are common in clinical practice that negatively affect the quality of life. It is possible
to reveal the etiological cause in aphthous lesions, with detailed history, physical examination findings, and
appropriate laboratory evaluation. In this article, we aimed to review the differential diagnosis by examining
the conditions that need to be questioned with clinical clues to reveal the correct etiological cause in a patient
presenting with the complaint of oral aphthae.

Keywords

oral ulcer, stomatitis, diagnosis

Oral mukozanın aftöz lezyonlarına yaklaşım

Abstract

Oral kavitenin aftöz lezyonları klinik pratikte sıklıkla karşılaşılan hayat kalitesini olumsuz yönde etkileyen bir
durumdur. Aftöz lezyonlarda etiyolojik nedenin ortaya konulabilmesi ayrıntılı anamnez, fizik muayene bulguları
ve uygun laboratuvar değerlendirme ile mümkündür. Bu derlemede oral aft şikayetiyle başvuran bir hastada
doğru etyolojik nedenin ortaya konulabilmesi için sorgulanması gereken durumlar, klinik ipuçlarıyla irdelenerek
ayırıcı tanının gözden geçirilmesi amaçlanmıştır.

Keywords

oral ülser, stomatit, tanı

References

• Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: a review. J Clin Aesthet Dermatol 2017;10:26-36. Schemel-Suarez M, Lopez-Lopez J, ChimenosKustner E. Oral ulcers: differential diagnosis and treatment. Med Clin (Barc) 2015;145:499-503.
• Tarakji B, Gazal G, Al-Maweri SA, et al. Guideline for the diagnosis and treatment of recurrent aphthous stomatitis for dental practitioners. J Int Oral Health 2015;7:74-80.
• Fitzpatrick SG, Cohen DM, Clark AN. Ulcerated lesions of the oral mucosa: Clinical and histologic review. Head Neck Pathol 2019;13:91-102.
• Uzun S. Erosive, ulcerative, vesicular and bullous lesions of oral mucosa. Turkderm-Turk Arch Dermatol Venereol 2012;46:77-85.
• Scully C. Clinical practice. Aphthous ulceration. N Engl J Med 2006;355:165-72.
• Bratel J, Hakeberg M. Anamnestic findings from patients with recurrent aphthous stomatitis. Swed Dent J 2014;38:143-9.
• Ma R, Chen H, Zhou T, et al. Effect of bedtime on recurrent aphthous stomatitis in college students. Oral Surg Oral Med Oral Pathol Oral Rad 2015;119:196-201.
• Wallace A, Rogers HJ, Hughes SC, et al. Management of recurrent aphthous stomatitis in children. Oral Medicine 2015;42:564-72.
• Sakarya U, Gundogan O, Imre A, Arslan B, Pinar E. Rekurren aftoz stomatitli 112 hastanın demografik ve labaratuvar verileri: Retrospektif inceleme. KBB-Forum 2014;13:19-25.
• Akintoye SO, Greenberg MS. Recurrent aphthous stomatitis. Dent Clin North Am 2014;58:281-97.
• Tappuni AR, Kovacevic T, Shirlaw PJ, et al. Clinical assessment of disease severity in recurrent aphthous stomatitis. J Oral Pathol Med 2013;42:635-41.
• Yasui K, Kurata T, Yashiro M, et al. The effect of ascorbate on minor recurrent aphthous stomatitis. Acta Paediatrica 2010;99:442-5.
• Lodi G, Varoni E, Robledo-Sierra J, et al. Oral ulcerative lesions. In: Contemporary Oral Medicine (Farah C, Balasubramaniam R, McCullough M, eds.), Springer,2017.
• Shah K, Guarderas J, Krishnaswamy G. Aphthous stomatitis. Ann Allergy Asthma Immunol 2016;117:e341-3.
• Topkarci Z. Current treatment options in challenging oral diseases: recurrent oral aphthosis. Turkderm-Turk Arch Dermatol Venereol 2012;46:123-9.
• Slebioda Z, Szponar E, Kowalska A. Recurrent aphthous stomatitis: genetic aspects of etiology. Postepy Dermatol Alergol 2013;30:96-102.
• Slebioda Z, Krawiecka E, Szponar E, et al. Haematinic deficiencies and patient clinical profiles in Polish patients with recurrent aphthous stomatitis (RAS). J Oral Pathol Med 2018;47:531-7.
• Orbak R, Cicek Y, Tezel A, Dogru Y. Effects of zinc treatment in patients with recurrent aphthous stomatitis. Dent Mater J 2003;22:21-9.
• Nolan A, McIntosh WB, Allam BF, Lamey PJ. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991;20:389-91.
• Scully C, Grosky M, Nur FL. Aphthous ulcerations. Dermatol Ther 2002;15:185-205.
• Tuzun B, Wolf R, Tuzun Y, Serdaroglu S. Recurrent aphthous stomatitis and smoking. Int J Dermatol 2000;39:358-60.
• Rajendran K. Relation between smoking and recurrent aphthous stomatitis. Oral Maxillofac Pathol J 2016;7:761-2.
• Miziara ID, Auaujo-Filho BC, Weber R. AIDS and recurrent aphthous stomatitis. Rev Bras Otorhinolaringol 2005;71:517-20.
• Leao JC, Gueiros LA, Porter SR. Oral manifestations of syphilis. Clinics 2006;61:161-6.
• Alam F, Argiriadou AS, Hodgson TA, et al. Primary syphilis remains a cause of oral ulceration. Br Dent J 2000;189:352-4.
• de Andrade RS, de Freitas EM, Rocha BA, et al. Oral findings in secondary syphilis. Med Oral Patol Oral Cir Bucal 2018;23:138-43.
• Krawiecka E, Szponar E. Tuberculosis of the oral cavity: an uncommon but still a live issue. Adv Dermatol Allergol 2015;32:302-6.
• Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex virus. Clin Infect Dis 1998;26:541-55.
• Clarkson E, Mashkoor F, Abdulateef S. Oral viral infections: diagnosis and management. Dent Clin N Am 2017;61:351-63.
• Kolokotronis A, Louloudiadis K, Fotiou G, et al. Oral manifestations of infections due to varicella zoster virus in otherwise healthy children. J Clin Pediatr Dent. 2001;25:107-12.
• Ueda T, Ogata H, Kojima Y, et al. Cytomegalovirus oral ulcers. Infection 2014;42:235.
• Reichart PA. Oral ulcerations in HIV infection. Oral Dis 1997;3:180-2.
• Ramirez-Amador V, Esquivel-Pedraza L, SierraMadero J, et al. The changing clinical spectrum of human immunodeficiency virus (HIV)-related oral lesions in 1000 consecutive patients: a 12-year study in a referral center in mexico. Medicine (Baltimore) 2003;82:39.
• Alegre M, Dalmau J, Domingo P, et al. Successful treatment of major oral aphthous ulcers in HIV-1 infection after highly active antiretroviral therapy. Int J Infect Dis 2007;11:278.
• Dojcinov SD, Venkataraman G, Raffeld M, Pittaluga S, Jaffe ES. EBV positive mucocutaneous ulcer-a study of 26 cases associated with various sources of immunosuppression. Am J Surg Pathol 2010;34:405-17.
• Bunn B, van Heerden W. EBV-positive mucocutaneous ulcer of the oral cavity associated with HIV/AIDS. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;120:725-32.
• Bugshan A, Farag AM, Desai B. Oral complications of systemic bacterial and fungal infections. Atlas Oral Maxillofac Surg Clin North Am 2017;25:209-20.
• Delgado W. Oral cryptococcosis. JSM Trop Med Res 2017;2:1015.
• Celentano A, Tovaru S, Yap T, Adamo D, Aria M, Mignogna MD. Oral erythema multiforme: trends and clinical findings of a large retrospective European case series. Oral Surg Oral Med. Oral Pathol Oral Radiol 2015;120:707-16.
• Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol 2012;51:889.
• MEDSCAPE. Toxic Epidermal Necrolysis (TEN). 2018 Available at: https://emedicine.medscape. com/article/229698-overview (last accessed 20 March 2021).
• Ozkaya E. Oral mucosal fixed drug eruption: characteristics and differential diagnosis. J Am Acad Dermatol 2013;692:51-8.
• Shazib MA, Woo SB, Sroussi H, et al. Oral immune related adverse events associated with PD-1 inhibitor therapy: A case series. Oral Dis 2020;26:325.
• Chambers MS, Rugo HS, Litton JK, Meiller TF. Stomatitis associated with mammalian target of rapamycin inhibition: a review of pathogenesis, prevention, treatment, and clinical implications for oral practice in metastatic breast cancer. J Am Dent Assoc 2018;149:291-8.
• Lee MT, Lin HY, Lee SH, et al. Risk of skin ulcerations associated with oral nicorandil therapy: a population-based study. Br J Dermatol 2015;173:498.
• Black M, Mignogna MD, Scully C. Number II. Pemphigus vulgaris. Oral Dis 2005;11:119-30.
• Joly P, Litrowski N. Pemphigus group (vulgaris, vegetans, foliaceus, herpetiformis, brasiliensis). Clin Dermatol 2011;29:432-6.
• Wieczorek M, Czernik A. Paraneoplastic pemphigus: a short review. Clin Cosmet Investig Dermatol 2016;9:291-5.
• Amber KT, Murrell DF, Schmidt E, Joly P, Borradori L. Autoimmune subepidermal bullous diseases of the skin and mucosae: Clinical features, diagnosis, and management. Clin Rev Allergy Immunol 2018 ;54:26-51.
• Di Zenzo G, DellaTorre R, Zambruno G, Borradori L. Bullous pemphigoid: from the clinic to the bench. Clin Dermatol 2012;30:3-16.
• Bagan J, Jimenez Y, Murillo J, Bagan L. Oral mucous membrane pemphigoid: a clinical study of 100 low-risk cases. Oral Dis 2018;24:132-4.
• Carey B, Setterfield J. Mucous membrane pemphigoid and oral blistering diseases. Clin Exp Dermatol 2019;44:732-9.
• Setterfield J. Clinicopathological associations in mucous membrane pemphigoid. MD thesis, University of London, 2009.
• Kridin K, Kneiber D, Kowalski EH, et al. Epidermolysis bullosa acquisita: a comprehensive review. Autoimmun Rev 2019;18:786-95.
• Chaudhari S, Mobini N. Linear IgA bullous dermatosis: a rare clinicopathologic entity with an unusual presentation. J Clin Aesthet Dermatol 2015;8:43-6.
• Munoz-Corcuera M, Esparza-Gomez G, GonzalezMoles MA, et al. Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers. Clin Exp Dermatol 2009;34:289-94.
• Ellington TD, Henley SJ, Senkomago V, et al. Trends in incidence of cancers of the oral cavity and pharynx - United States 2007-2016. MMWR Morb Mortal Wkly Rep 2020;69:433.
• Kalavrezos N, Scully C. Mouth cancer for clinicians part 6: potentially malignant disorders. Dent Update 2015;42:866-8.
• Yazici Y, Yurdakul S, Yazici H. Behcet’s Syndrome. Curr Rheumatol Rep 2010;12:429-35.
• Lavanya N, Jayanthi P, Rao UK, Ranganathan K. Oral lichen planus: an update on pathogenesis and treatment. J Oral Maxillofac Pathol. 2011;15:127-32.
• Muller S. Oral lichenoid lesions: distinguishing the benign from the deadly. Mod Pathol 2017;30:54-67.