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Aphthous Ulcers (Recurrent Aphthous Stomatitis, Canker Sore)

Clinical Case

Case 1

  • 20-year-old healthy man
  • No significant past medical history
  • Review of systems is noncontributory, notably negative for fever, joint pains, diarrhea, or weight changes
  • Social history is notable for monogamous relationship with one partner, no history of sexually transmitted diseases; does not smoke or drink alcohol
  • Presents for management of 7-year history of intermittent painful ulcers in the mouth

Initial evaluation

  • Healthy appearing male
  • Four small 4 mm ulcers on the buccal mucosa with a rounded appearance and red border
  • No genital ulcerations or other skin lesions
  • Diagnosis: aphthous ulceration
  • Recommend topical analgesia with 2% lidocaine gel and 1% triamcinolone paste used four times daily
  • Gentle oral care recommended: avoiding hygiene products containing sodium lauryl sulfate, avoiding sharp/traumatic foods, avoiding acidic foods
  • Follow-up if fails to respond

Follow-up evaluation

  • Patient notes symptomatic relief and feels the ulcers resolved faster than in the past
  • Antimicrobial mouthwash rinses with 0.2% chlorhexidine gluconate mouthwash three times daily
  • Follow-up as needed; report any nonhealing ulcers