Recurrent aphthous stomatitis

Recurrent aphthous stomatitis is the most common ulcerative disease of the oral mucosa. The lesions of aphthous stomatitis are mucosal manifestations of a variety of conditions, 30 per cent of which may be discerned by history, physical examination, and appropriate laboratory testing. Correction of underlying conditions or deficiencies results in improvement or remission in aphthous disease activity. Treatment of lesions for which an underlying cause cannot be discerned is discussed.     

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis remains a commonly occurring cause of oral pain and ulceration. Although the ulcerations of RAS are multifactorial and of unknown cause, recognition of the role of patient and environmental factors may be helpful in developing recommendations for treatment and prevention of future ulcers.     

Recurrent aphthous stomatitis and smoking

BACKGROUND: Several studies have reported cigarette smoking to have a beneficial protective effect on recurrent aphthous stomatitis (RAS). In this study, we evaluated once again the incidence of smoking in RAS patients compared with controls. This study differs from most previous ones in that the patients were diagnosed by direct observation of active lesions by a dermatologist. METHODS: Thirty-four patients with RAS who were seen at the dermatology clinic during a period of 2 years were compared with 115 outpatients with other skin diseases and 20 healthy hospital personnel who had no history of aphthae, with regard to their smoking habits. RESULTS: Among the 34 patients with RAS, 8.8% were active smokers compared with a significantly higher percentage (25.2%) among the control subjects. CONCLUSIONS: In agreement with others, we found a negative epidemiologic association between smoking and RAS. This finding can be used to clarify the cause and pathogenesis of the disease, and possibly to identify better treatment or preventive options than those currently available.     

Recurrent aphthous stomatitis: clinical characteristics and evidence for an immunopathogenesis.

Recurrent aphthous stomatitis is one of the most common diseases affecting the oral mucosa, and one of its variants is the most painful affliction of the oral mucosa. The lesions of recurrent aphthous stomatitis can be manifested as part of a broad spectrum of clinical disease ranging from the common minor aphthous ulcers to Beh?et's syndrome. Differential diagnosis, although not often difficult, must include many conditions capable of producing erosive and ulcerative oral mucosal lesions. The salient features of recurrent aphthous stomatitis suggest that it is a heterogeneous entity. Recent immunologic investigations have focused attention on a possible immunopathogenesis and the evidence for this is reviewed.     

Practical therapy for aphthous stomatitis

The differential diagnosis, incidence, causes, and previous therapies of aphthous stomatitis are discussed. The treatment includes no intake of nuts or foods or medications known to cause new lesions, and the topical use of triamcinolone acetonide dental base before and after meals and at bedtime.     

Recurrent aphthous stomatitis: treatment with colchicine. An open trial of 54 cases

INTRODUCTION: Colchicine is a treatment used for aphthous stomatitis but its efficacy has never been proved. We report the results of an open trial of 54 patients treated with colchicine for aphthous stomatitis. The aim of our study was to assess the long and short term efficacy and tolerance of this molecule in this disease. PATIENTS AND METHODS: The case reports of 64 patients presenting with severe, recurrent aphthous stomatitis treated with colchicine between 1986 and 2000 were analyzed retrospectively. Only immunocompetent patients exhibiting idiopathic aphthous stomatitis or Beh?et's disease were included. Ten patients were excluded: 4 cases of Beh?et's disease treated with colchicine and systemic corticosteroids, 4 cases of aphthous stomatitis secondary to a hematological cause and 2 patients who were lost to follow-up after 3 month's treatment. Colchicine was prescribed at a dose of 1 to 1.5 mg/d for at least 3 months. All the patients were assessed after 3 month's treatment and all were contacted by phone in May 2000. Our end-point criteria were: the frequency and duration of the episodes, intensity of pain and impact on the quality of life of the patients. RESULTS: Fifty-four patients were included: 39 women (mean age=44 +/- 16.8) and 15 men (mean age=49 +/- 13.5). The disease had progressed for a mean of 11.6 +/- 13.5 years. After 3 month's treatment, 12 patients (22 p. 100) no longer had aphta and were in complete remission, 22 patients (41 p. 100) were significantly improved, since the frequency and duration of the lesions had decreased by at least 50 p. 100 and the latter were no longer painful. Treatment failed or tolerance was poor in 20 patients (37 p. 100). Patients were monitored and assessed for a mean of 4.7 years (range: 6 months to 13 years). Six patients were lost to follow-up. Three patients (6 p. 100) were considered as cured, since they were still in complete remission after suspension of colchicine respectively 6, 24 and 72 months later. Fifteen patients (31 p. 100) had still improved. Among the latter, 10 continued colchicine for a mean of 27 months, and 5 patients stopped treatment, which they considered tedious, after a mean of 16 months. These 15 patients noted a significant reduction in the frequency and duration of the lesions. Moreover, the subjective end-point criteria had improved significantly for them not to wish to change treatment. Thirty patients (63 p. 100) were not improved by the treatment. Some benign adverse events were noted in 10 patients (18.5 p. 100) and led to suspension of treatment in 4 cases. DISCUSSION: This study, which is the first in size (n=54) and duration of follow-up (4.7 years), showed that colchicine is an efficient preventive treatment of severe aphthous stomatitis for 63 p. 100 of patients after 3 month's treatment and that this improvement was lasting in 37 p. 100 of them. Colchicine should therefore be proposed in first intention in severe recurrent aphthous stomatitis, since it is effective, well tolerated and easy to use.     

Thyroid autoimmunity associated with recurrent aphthous stomatitis

Background Recurrent aphthous stomatitis (RAS) is an autoimmune disorder characterized by the periodic appearance of aphthous lesions on the oral mucosa. TH1 cytokines plays a key role in the aetiopathogenesis. Autoimmune thyroid disease (ATD) is the most common autoimmune disease and is frequently accompanied by various other autoimmune diseases. Objective To investigate the frequency of ATD which has not been studied in the patients with RAS. Methods Ninety patients and 30 healthy volunteers were included into the study. The serum samples were assayed for thyroid stimulant hormone (TSH), free and total triiodothyronine (fT3, TT3), free and total thyroxine (fT4, TT4), thyroglobuline, anti‐thyroid peroxidase antibody (anti‐TPO) and anti‐thyroglobuline antibody (anti‐TG) levels. Thyroid ultrasonography was performed as well. Results In RAS patients, the fT3, TT3 levels were higher; whereas the fT4 levels were lower that the control group (P < 0.05). The anti‐thyroid antibody was positive in 31.11% of the patients with RAS, and in only 10% of the individuals in the control group (P < 0.05). The mean anti‐TG level was also higher in the RAS group. Ultrasonography revealed nodules in 28.8% of the patients with RAS and in 16.7% of the individuals in the control group (P < 0.05). The sT4 levels were lower and the TSH, anti‐TPO and anti‐TG levels were significantly higher in the RAS patients with thyroid nodules than the RAS patients without nodules (P < 0.05). Discussion These results may be related to either the advance age of the patients or the increased duration of the autoimmune activation which may affect the thyroid. Conclusions The frequency of thyroid autoimmune‐related problems was higher in patients with RAS. It would be worthy of searching autoimmune thyroid disorders in patients with RAS.     

Selecting topical and systemic agents for recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is one of the most common oral diseases worldwide. Although the exact etiology of RAS remains unknown, a variety of topical and systemic preparations may be used for palliation or prevention. In most patients with RAS, topical agents, including over-the-counter preparations such as amlexanox, prescribed corticosteroids, or antimicrobial agents, are sufficient to control the disease. Patients with frequent exacerbations or those with a severe form of RAS that is unresponsive to topical treatments often require systemic agents to control their disease. These include corticosteroids, colchicine, dapsone, pentoxifylline, and thalidomide. All therapies are palliative, and none result in permanent remission.