Recurrent aphthous stomatitis is a common disorder of unknown aetiology in the form round to oval, painful Mundschleimhautulzera over again. The etiology is unclear. The diagnosis is made clinically. Is treated symptomatically, mostly with local corticosteroids.
See also stomatitis.)
Recurrent aphthous stomatitis is a common disorder of unknown aetiology in the form round to oval, painful Mundschleimhautulzera over again. The etiology is unclear. The diagnosis is made clinically. Is treated symptomatically, mostly with local corticosteroids. See also stomatitis.) In 20-30% of adults and even a higher percentage of children recurrent aphthous stomatitis (RSA) developed sometime in the course of life. Etiology The etiology is unclear, but it seems to be a family history of this predominantly cell-mediated oral mucosal injury. Play cytokines such as IL-2, IL-10, and particularly tumor necrosis factor-alpha (TNF-alpha) plays a role. Predisposing factors may be oral trauma stress foods, especially chocolate, coffee, peanuts, eggs, cereals, almonds, strawberries, cheese and tomato allergy seems to spieln not matter. For unknown reasons, oral contraceptives, pregnancy and tobacco act (incl. Snuff or chewing tobacco, even Nicotintabletten) apparently as protective factors. Symptoms and signs The symptoms usually begin in childhood (80% of patients are <30 years) and with age leave their frequency and severity deteriorates over time. The clinical spectrum ranges from individual ulcers (2 to 4 times / year) to an almost uninterrupted disease in which constantly form new ulcers, once the old heal. Prodrome burning or pain can have 1-2 days in advance occur, but it will show neither bubbles (vesicles) or blisters (bullae). The strong, about 4-7 days lasting pain out of proportion to the size of the lesion. The flat, well-defined, aphthous ulcers are round or oval with a necrotic center with a yellowish-gray pseudo membrane and have slightly raised, red edges with a red atrium (Halo ring). In 85% of cases is small aphthous ulcers (Mikulicz's syndrome), which are large <8 mm (average 2-3 mm), can form the floor of the mouth, side edges and bottom of the tongue in the cheek mucosa and pharynx heal without scarring within 10 days. Large aphthous ulcers (Sutton's disease, recurrent Periadenitis mucosa necrotica) account for 10% of cases. They occur only after puberty and with stronger prodromal symptoms; there are larger (> 1 cm), deeper penetration and longer (weeks to months) sustained ulcers than the Mikulicz aphthous ulcers. They develop on the lips, soft palate and throat. Fever, dysphagia, malaise and scarring can be added. Herpetiform aphthous ulcers (which are not related to herpes lesions despite morphological similarity) provide a proportion of 5% of the RSA cases. You begin as a multiple (up to 100) small herd of 1-3 mm, grouped standing, painful ulcers on an erythematous base and then merge into larger area Ulkusherden that last about 2 weeks. Women are affected more often, and compared with other forms of RSA, the lesions occur only at a later age. Diagnosis Clinical evaluation diagnosis as described above with stomatitis, proceed. Because there is no clearly defined histological features or laboratory tests (exclusion) diagnosis is made on the basis of appearance. Primary herpes (HSV) infection in the mouth can look remarkably like an RSA. but he is more likely in younger children, always includes the gums with one, and all keratinized mucosal sites can (hard palate, gingiva in the cervical area, back of the tongue) attacked and accompanied by systemic symptoms. For HSV detection cultures can be created. Herpes recurrences are usually located on one side. Episodic recurrences can occur both malnutrition even with Behcet’s disease), inflammatory bowel disease celiac disease, HIV infection, phthous stomatitisperiodisches fever with aphthous stomatitis, pharyngitis and adenitis (PFAPA) -Syndromphthous stomatitis. These states have systemic symptoms and discomfort normally. While these states are also expressed in general with systemic symptoms, but in herpes, HIV infection and – rarely – malnutrition and only isolated oral ulcers may occur. Differential diagnosis help virus tests and serum / blood tests on. Although drug reactions can mimic a RSA, can be produced in a temporal relation to the taking of adequate resources mostly. Difficult allergic reactions to foods or dental products are observed, so that a gradual elimination in the case may be necessary. Topical therapy chlorhexidine and corticosteroids The general treatment above recommendations for stomatitis can also help with a RSA. As the cornerstone of therapy possible should already be applied in the prodromal phase mouthwashes with chlorhexidine gluconate and local corticosteroids. Suitable dexamethasone (the mouth 3 times a day with 0.5 mg rinse / 5 ml and then spit out) or Clobetasol or fluocinonide (0.05% ointment, for mucosa protection 3 times a day in the ratio 1: 1 with a carboxymethylcellulose paste apply). Under a local corticosteroid application is to pay attention to the development of candidiasis. If local corticosteroids remain ineffective, a prednisone may be required (eg. B. p.o. for ? 5 Days 1 times 40 mg / day). Patients with chronic or severe RSA are best treated by a specialist in stomatology. In the case of systemic long-term treatment with corticosteroids, azathioprine or other immunosuppressive agents, pentoxiphylline or thalidomide could be necessary. Betamethasone, dexamethasone or triamcinolone can also be injected directly into the lesions. In some patients, the RSA improved by intake of vitamin B1, B2, B6, B12, folate or iron.