Tetracycline solution 5 mL rinse in mouth for 1 minute q.i.d., toothpaste b.i.d.Ģ.5% tetracycline solution: increase (over 40%) in ulcer-free or pain-free days compared to placebo (p<0.05) toothpaste no significant differences from placebo toothpaste with amyloglucosidase and glucose oxidase Triclosan 0.15% in propylene glycolĢ.5% tetracycline solution vs.
controls (p<0.0001)Ĭommercially available fluoride mouth wash. Reduction of number of ulcers in 43%, of pain by 45%, increase in ulcer-free days vs. Triclosan 0.15% in 7.8% w/w ethanol/0.4% w/w zinc sulfate, triclosan 0.15% in 15.6% w/w ethanol/0.4% w/w zinc sulfate In order to make the diagnosis, clinical diagnostic criteria are applied, such as those of the International Study Group for Behçet’s Disease ( e12), or the new International Criteria for Behçet’s Disease ( 9) ( eBox) which are based on epidemiological data.
About 10% of the patients with complex aphthosis in Western Europe and North America develop ABD the likelihood is higher in the eastern Mediterranean region, Middle East and Asia ( 9). In 84.5% of patients, the first manifestation is oral ulcers, while 3.5% start with genital ulcers, which are the second most frequent symptom ( 8). Recurrent genital aphthous ulcers are seen in 64.7% ( 8). In ABD, 98.5% of patients have recurrent oral aphthous ulcers this is the most common manifestation of the disorder ( 8). Some include ABD among the autoinflammatory diseases. Hautarzt 2012 63: 693–703 with kind permission from Springer Verlag, Heidelberg)Īdamantiades-Behçet disease (ABD) is a chronic recurrent systemic vasculitis ( e11) in which oral and genital ulcers are major diagnostic criteria. (from Altenburg A, et al.: Klinik und Therapie chronisch rezidivierender Aphthen. PFAPA syndrome (periodic fever, aphthous ulcers, pharyngitis, cervical adenitis) Complex aphthosis features frequently appearing ulcers with either short lesion-free periods or even repeatedly recurrent ulcers, severe pain and even systemic effects such as interference with eating and the resultant problems of inadequate nutrition ( 3). The latter may also be perigenital, affecting the scrotum, vulva, anus, perineum and inguinal region. In complex aphthosis, there are a few or many slowly healing intensely painful ulcers on the oral and perhaps genital mucosa ( 3). The simple chronic recurrent oral aphthous ulcers present with a limited number of small, quickly healing, minimally painful ulcers limited to the oral mucosa and recurring with 3–6 episodes annually. Figures 1a and c used with kind permission from Springer-Verlag, HeidelbergĪnother classification is based on the time course. Klinik und Therapie chronic rezidivierender Aphthen. Figure 1c modified from Altenberg A, et al. (Figure 1a modified from Altenburg A, Mahr A, Maldini C, et al.: Epidemiologie und Klinik des Morbus Adamantiades-Behçet in Deutschland: Aktuelle Daten. (a) Minor-type oral aphthous ulcers, (b) major-type oral aphthous ulcer, (c) herpetiform oral aphthous ulcers The three morphologic variants can occasionally appear simultaneously ( 2). As many as a 100 ulcers can be present they may coalesce into larger erosive plagues and about 32% heal with scarring. They account for around 5% of recurrent oral aphthous ulcers, are extremely painful and persist for 7–10 days. Herpetiform aphthous ulcers are very small (1–2 mm) grouped lesions ( 1, e4) ( Figure 1c). About 64% of Sutton ulcers heal with scarring. They account for around 10% of recurrent benign oral ulcers. Large ulcers of the major-type (Sutton ulcers) are usually 1–3 cm in diameter, deeply indurated and can last for 10 days to 6 weeks or occasionally even longer ( 1, e3) ( Figure 1b). Scarring occurs in around 8% of cases ( 1, e2) ( Figure 1a).
They account for 80–90% of all recurrent oral aphthous ulcers ( 1, e1). Small ulcers of the minor-type (Mikulicz) are less than 1 cm in diameter (usually 2–5 mm) and heal spontaneously in 4–14 days. Oral aphthous ulcers typically present as painful, sharply circumscribed fibrin-covered mucosal defects with a hyperemic border.Ĭhronic recurrent oral aphthous ulcers occur in three different clinical morphological variants and with two different time courses.
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