• Vol. 41 No. 10, 463–470
  • 15 October 2012

Oral Aphthosis: Management Gaps and Recent Advances



Introduction: Though oral aphthosis is common, it has a significant impact on the quality of life in the patients. It is the most common oral ulcerative condition encountered in clinical practice. This study describes the characteristics and patterns of oral aphthosis seen at a tertiary dermatological centre in Singapore, with emphasis in evaluating the management gaps and in identifying underlying systemic diseases and nutritional deficiencies.

Materials and Methods: This is a retrospective review of medical records over a 10-year period between June 2000 and June 2010. Two hundred and thirteen patients were identified using the search terms ‘oral ulcers’, ‘aphthous ulcers’, ‘oral aphthosis’, and ‘Behcet’s disease’. Patients with Behcet’s disease without oral ulcers and other diagnoses such as pemphigus vulgaris, lichen planus and herpes simplex were excluded. The remaining patients were evaluated with regard to demographic characteristics, characteristics of oral ulcers, associated connective tissue disorders and nutritional deficiencies, diagnostic tests results, treatment response as well as follow-up duration.

Results: One hundred and seventy-five patients were included in this study. One hundred and one patients had recurrent oral aphthosis, with 77 having simple aphthosis and 24 having complex aphthosis. Fourteen patients (8%) fulfilled the International Study Criteria (ISG) for Behcet’s disease, of which, 85.71% had complex aphthosis. The therapeutic ladder for such patients ranged from topical steroids and colchicine through to oral corticosteroids and/or dapsone therapy.

Conclusion: Recurrent oral aphthosis is a niche condition in which dermatologists are well-poised to manage. This study demonstrates that a more definitive management and therapeutic algorithm for oral aphthosis are needed for better management patients in the future. In particular, complex aphthosis needs to be monitored for progression onto Behcet’s disease.

Oral aphthous ulcers are a common condition which has significant impact on the patients’ quality of life, causing much pain and interference with mastication and speech. It is the most common oral ulcerative condition encountered in clinical practice. Recurrent aphthous ulceration or recurrent aphthous stomatitis (RAS) is often an “orphan” disease. Patients are often seen by a variety of medical specialties including dermatologists, dental physicians and otolaryngologists, with no definite medical speciality assuming particular interest in the management of these patients. Dermatologists are often faced with referrals for patients suffering from oral aphthosis, many of whose care has been transferred from one speciality to another. It is therefore important that we are able to treat such patients with the specialised care that they require. Given the fact that some oral aphthosis may present concomitantly with skin lesions or as manifestation of a systemic disease may require various systemic therapies that require monitoring, dermatologists are in a good position to offer care for these patients.

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