Mouth and Mucous Membranes












CHAPTER 21
MOUTH AND MUCOUS MEMBRANES

 


Aphthous Stomatitis







































Synonyms Aphthae, canker sores, simple or complex aphthosis, recurrent aphthous stomatitis (AS).
Inheritance 20% of population.
Prenatal Diagnosis n/a
Incidence ~1% of children will experience AS; most common onset second decade; most common cause of oral ulceration.
Age at Presentation Onset between 10 and 60 years of age, 1% of young children, highest age of onset second decade, 40% with positive family history.
Pathogenesis Idiopathic; proposed localized immunosuppression secondary to various triggers (trauma, nutritional deficiency, viral or bacterial infections, and hormonal; imbalance, food hypersensitivities, and stress); more common in children with affected parents or affected identical twin.
Key Features

  • Oral mucosa: Well-defined ovoid ulcer with creamy white fibrinous base and erythematous halo; limited to nonkeratinized oral mucosa; often recurrent, heals without scarring, noncontagious; most heal in 10 to 14 days without scarring.
  • Subtypes:

    • Minor: <5 mm shallow, solitary to several.
    • Major: 1 to 3 cm with deeper morphology, solitary to several.
    • Herpetiform: Numerous smaller clustered lesions resembling herpes simplex virus (HSV) infection.
Differential Diagnosis HSV, varicella zoster virus (VZV), cytomegalovirus, Epstein-Barr virus, Coxsackie, syphilis, pemphigus vulgaris, cicatricial pemphigoid; allergic/irritant contact dermatitis, erythema multiforme, and ulcerative lichen planus; chemotherapy medications (eg, sirolimus, methotrexate); trauma.
Laboratory Data For most patients, no testing is necessary; if severe, recurrent or in patients with systemic disorders or nutritional deficiency consider screening for vitamin deficiencies; HSV screening if clinically indicated; biopsy findings are not generally specific but may be necessary to evaluate for pemphigus.
Management Symptomatic treatment; early class 1 topical steroid gel (NPO for 30 min after application); intralesional triamcinolone acetonide (dilute Kenalog 10 with 1% lidocaine without epinephrine for 2.5-5 mg/ml concentration); topical analgesics; “Magic mouthwash” (MMW), many formulations, one example is viscous lidocaine 2%/Maalox (do not substitute Kaopectate)/diphenhydramine (12.5 mg/5 ml) in a 1:1:1 suspension, “swish-and-spit” 3 or 4 times daily.
Prognosis Spontaneous remission in 5-15 years for most patients.

image PEARL/WHAT PARENTS ASK


Given morphologic overlap and high incidence, HSV PCR can be reassuring to the patient and the provider. Lab workup only if indicated by H&P and should be reserved for more severe, persistent, or recurrent disease. If recurrences are infrequent (no more than 2-3 times a year) and debilitating would consider 2-week tapering course of oral steroids started early in the course. Possible systemic disease associations: systemic lupus erythematosus, inflammatory bowel disease (Crohn), Behcet disease, cyclic neutropenia, Sweet syndrome, reactive arthritis, HIV, PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis), and MAGIC (Mouth And Genital ulcers with Inflamed Cartilage).











Skin | Associated Findings
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21.1. Recurrent aphthous ulcers in 15 year-old boy.


Gingivostomatitis




















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Aug 17, 2025 | Posted by in PEDIATRICS | Comments Off on Mouth and Mucous Membranes

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Synonyms Herpetic gingivostomatitis, orolabial herpes, and HSV-1 infection.
Inheritance n/a
Prenatal Diagnosis n/a
Incidence Common; M = F.
Age at Presentation