Aphthous Ulcers (Canker Sores)
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Evaluation
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General—common, painful lesions are present on the labial mucosa or mucous membranes of the oral cavity.
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Description—usually red, sometimes have a white coating; not contagious.
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Clinical—if benign, the patient should NOT have fever, adenopathy, gastrointestinal (GI) symptoms, or skin manifestations.
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Etiology—unclear; consequently treatments focus on symptoms rather than a specific cause.
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Epidemiology—they are more common in young adults (teens-20s).
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Classification
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Minor aphthae—can be singular or multiple, <A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<1 cm in diameter, and shallow
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Major aphthae—diameter is ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1ba9d8a14f7f3e720cd1aa9bce2b39adf7}/ID(AB1-M10)”>>1 cm and ulceration is deeper; more likely to scar
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Herpetiform aphthae—very numerous and vesicular in nature
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Differential diagnosis (with diagnostic discriminators noted)
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Infectious
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Viral
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Herpes simplex virus (HSV)—vesicular; Tzank stain reveals inclusion-bearing giant cells
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Cytomegalovirus (CMV)—biopsy reveals multinucleated giant cells
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Varicella (chicken pox/zoster)
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Coxsackie virus—may also have hand and foot lesions
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Treponemal
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Example: syphilis—rapid plasma reagin (RPR) positive
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Psychiatric correlate—neurosyphilis most frequently presents with personality change
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