Aphthous ulceration is classified into three types.
Recurrent minor aphthous ulcer (80%). This is less than 5 mm in diameter and heals within 1–2 weeks.
Major aphthous ulcer, which is large (often more than 10 mm) and takes weeks or months to heal and leaves a scar.
Herpetiform ulcers, which are multiple pinpoint ulcers that heal within a month. These are most commonly on the tongue.
Recurrent aphthous ulcer usually begins as a round yellowish elevated spot surrounded by a red halo. This then breaks down into a punched-out ulcer, which is covered with a loosely attached white, yellow or greyish membrane.
Factors that seem to trigger outbreaks of ulcers include:
Emotional stress and lack of sleep
Mechanical trauma, for example, self-inflicted bite
Nutritional deficiency, particularly of vitamin B, iron, and folic acid
Certain foods, including chocolate
Certain toothpastes; this may relate to sodium laureth sulfate (the foaming component of toothpaste)
Menstruation
Certain medications, including nicorandil, given for angina
Viral infections.
GENERAL MEASURES
Protective pastes that form a barrier over the ulcer so that exposure to irritating substances is reduced.
Local anaesthetics benzocaine and lignocaine (lidocaine) to reduce pain
Medicated toothpaste without sodium laureth sulfate
Antibacterial mouthwashes to reduce secondary infection.
Avoidance of foods that trigger or exacerbate the ulcers.
Dietary supplements of vitamins or minerals, if the diet is deficient.
Reduction in stress
Prescribed medicines for aphthous ulcer
Topical prescription medicines include:
Tetracycline suspension as a mouthwash
Topical corticosteroids as lotions, creams or paste, often triamcinolone in dental paste
Calcineurin inhibitors: topical pimecrolimus or tacrolimus.
In severe cases, particularly if there are systemic symptoms, anti-inflammatory oral medications may be considered (off-label use):
Tetracycline, e.g. doxycycline 50-100mg daily for 3-6 months or longer.
Dapsone
Colchicine
Systemic steroids
Immunosuppressive agents such as azathioprine, methotrexate, ciclosporin
Apremilast, which has been approved in the USA to treat oral ulcers in Behçet disease
Tumour necrosis factor (TNF) antagonists (adalimumab, etanercept, infliximab)
Thalidomide.
Non-sexually acquired genital ulceration (NSGU) refers to an aphthous ulcer in genital sites. A genital aphthous ulcer is also called a Lipschutz ulcer.
A genital aphthous ulcer is more common in females than in males.
It may be accompanied by considerable pain and swelling.
Reactive genital ulcer follows an infection.
NSGU is more likely than simple oral aphthosis to be associated with systemic illness, such as:
Behcet syndrome
Gluten-sensitive enteropathy (celiac disease)
Inflammatory bowel disease
Human immunodeficiency virus (HIV) infection.