Recurrent Aphthous Stomatitis- Current Perspective Dr. Prabhakar M Sangolli Dept of Dermatology Dept...
-
Upload
melvin-rodgers -
Category
Documents
-
view
225 -
download
3
Transcript of Recurrent Aphthous Stomatitis- Current Perspective Dr. Prabhakar M Sangolli Dept of Dermatology Dept...
Recurrent Aphthous Stomatitis-Current Perspective
Dr. Prabhakar M Sangolli Dr. Prabhakar M Sangolli
Dept of DermatologyDept of Dermatology
Dr.B.R.AMBEDKAR MEDICAL COLLEGEDr.B.R.AMBEDKAR MEDICAL COLLEGE
BangaloreBangalore
Canker SoreCanker Sore
Recurring ulcers in the oral Recurring ulcers in the oral mucous membrane with no signs mucous membrane with no signs of systemic disease.of systemic disease.
Common manifestation of Common manifestation of haematological, immunological haematological, immunological and psychological disorders.and psychological disorders.
AetiopathogenesisAetiopathogenesis
Genetic ( HLA)-40% casesGenetic ( HLA)-40% cases NutritionalNutritional-Iron-Iron,,folicfolic acidacid,B,B11,B,B22,B,B33, , BB1212,C,C Endocrinal-Premenstrual,pregnancyEndocrinal-Premenstrual,pregnancy Infective-Strep.sanguis(Hsp), HIVInfective-Strep.sanguis(Hsp), HIV StressStress Smoking cessationSmoking cessation TraumaTrauma Immunological(ADCC)Immunological(ADCC)
Clinical FeaturesClinical Features
-20% of general population-20% of general population -Precipitated by trauma,menses-Precipitated by trauma,menses -Prodrome 2-48 hrs-Prodrome 2-48 hrs Pre ulcerativePre ulcerative UlcerativeUlcerative ResolvingResolving
TYPESTYPES
Minor (Mikulicz) Major (Sutton) Herpetic
No. 1-10 1-10 numerous
Size 2-4mm >1cm 2mm
Site Non keratinized Keratinized+ non-
keratinized
Non-keratinized
Healing
Time
10 days
>6 weeks
10 days
Scar - + -
DISEASES SIMULATING DISEASES SIMULATING RASRAS
Behcet’s: oral, genital, neuro-ocularBehcet’s: oral, genital, neuro-ocular Sweet’s syndromeSweet’s syndrome Blood dyscrasiasBlood dyscrasias GIT malabsorption (GIT malabsorption (Coeliac disease,IBDCoeliac disease,IBD)) Collagen vascular diseasesCollagen vascular diseases Cyclic neutropeniaCyclic neutropenia Reiter’s DiseaseReiter’s Disease Recurrent Intra oral HerpesRecurrent Intra oral Herpes
MANAGEMENTMANAGEMENT
History :History : Stress Stress
TraumaTrauma
SmokingSmoking
Premenstrual flarePremenstrual flare Clinical examination: EyeClinical examination: Eye
GenitalGenital
RectalRectal
CNSCNS
InvestigationsInvestigations
MaRAS,onset >25yrs age,pt with MaRAS,onset >25yrs age,pt with syst.symptomssyst.symptoms
CBCCBC Serum iron,BSerum iron,B1212,RBC folate
levels,ferritin ANA
GENERAL MEASURESGENERAL MEASURES
Stress avoidanceStress avoidance Nicotine patchesNicotine patches Soft tooth brushSoft tooth brush BB1212 supplements:1000mcg twice wkly-6wks supplements:1000mcg twice wkly-6wks
1000mcg once a month-1 1000mcg once a month-1 yr (low serum Byr (low serum B12 12 level)level)
Folic acid, Iron, B-complex, C supplementsFolic acid, Iron, B-complex, C supplements Pre & Probiotics Pre & Probiotics
TOPICAL THERAPYTOPICAL THERAPY
Mild cases - To promote healing, useMild cases - To promote healing, use 0.1% Triamcinolone with orabase, qid0.1% Triamcinolone with orabase, qid 2% xylocaine viscous to relieve pain2% xylocaine viscous to relieve pain Severe cases :Clobetasol, FlucinoloneSevere cases :Clobetasol, Flucinolone Tetracycline in 30 ml water q.i.d &Tetracycline in 30 ml water q.i.d & 5% Amlexanox paste-Accelerate healing .5% Amlexanox paste-Accelerate healing .
SEVERE CASESSEVERE CASES
Prednisolone 1mg/kg/day, taper Prednisolone 1mg/kg/day, taper over 2 weeksover 2 weeks
Azathioprine - 50mg b.i.dAzathioprine - 50mg b.i.d
Watch for CandidiasisWatch for Candidiasis
PREVENTION OF PREVENTION OF RECURRENCERECURRENCE
Oral Pentoxyfylline : 400mg t.i.d-3mthsOral Pentoxyfylline : 400mg t.i.d-3mths
Colchicine- 0.5mg t. i. dColchicine- 0.5mg t. i. d S/ES/E: Myopathy, neuropathy, nausea,diarrhoa, : Myopathy, neuropathy, nausea,diarrhoa,
blood dyscrasias.Potent teratogenblood dyscrasias.Potent teratogen
DDS+ColchcineDDS+Colchcine
Prevention of recurrence Prevention of recurrence (contd..)(contd..)
Thalidomide 100mg t.i.d, tapering to Thalidomide 100mg t.i.d, tapering to 50mg /d as maintenance.50mg /d as maintenance.
Teratogenic, neurotoxicTeratogenic, neurotoxic STEPS-(System for Thalidomide STEPS-(System for Thalidomide
Education Prescribing Safety)Education Prescribing Safety) Other measuresOther measures: : Topical tacrolimusTopical tacrolimus Levamisole Levamisole
Points to ponderPoints to ponder
H.PyloriH.Pylori CMV,EBVCMV,EBV HandednessHandedness Glutein free dietGlutein free diet Non enzymatic AOsNon enzymatic AOs IontophoresisIontophoresis Detergents in toothpasteDetergents in toothpaste
SUMMARY
Stress avoidanceStress avoidance Soft tooth brushSoft tooth brush Supplements-BSupplements-B1212,folic acid,B,folic acid,B33,C,iron,C,iron Steroids with orabaseSteroids with orabase Local anaesthetic, tetracycline Local anaesthetic, tetracycline
mouthwashmouthwash Systemic steroids-severe casesSystemic steroids-severe cases
Summary (contd..)Summary (contd..)
Pentoxyfylline,Colchicine & Pentoxyfylline,Colchicine & Dapsone-severe relapsing patientsDapsone-severe relapsing patients
STEPS Assisted ThalidomideSTEPS Assisted Thalidomide