Aphthous ulcer differential diagnosis: Difference between revisions

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__NOTOC__
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{{Aphthous ulcer}}
{{Aphthous ulcer}}
{{CMG}}; {{AE}} {{SaraM}}
{{CMG}}; {{AE}} {{SaraM}} <br>
 
For more differentials of other oral lesions look [[Oral lesions|here]]
==Overview===
==Overview==
Aphthous ulcer must be differentiated from malignant ulcers, Infections, rheumatic and cutaneous disease.
[[Aphthous ulcer]] must be differentiated from malignant ulcers, infections, [[rheumatic]] and cutaneous disease.


==Differential Diagnosis==
==Differential Diagnosis==
Aphthous ulcer must be differentiated from:
Aphthous ulcer must be differentiated from:


* '''Infections'''
*'''Infections'''
**Recurrent infection with [[herpesvirus]]
**Recurrent infection with [[herpesvirus]]
**[[HIV infection]]
**[[HIV infection]]
**[[Intraoral infections]]  
**[[Intraoral infections]]
**[[Candidiasis]]
**[[Oral candidiasis]]
**[[Hand-foot-and-mouth disease]]
**[[Hand-foot-and-mouth disease]]
**[[infectious mononucleosis|Epstein-Barr virus (EBV) infection (infectious mononucleosis)]]
**[[infectious mononucleosis|Epstein-Barr virus (EBV) infection (infectious mononucleosis)]]


*'''Neoplasms'''
*'''Neoplasms'''
**[[Kaposi’s sarcoma]]  
**[[Kaposi’s sarcoma]]
**[[Lymphoma]]
**[[Lymphoma]]
**[[Leukemia]]s  
**[[Leukemia]]s


*'''Rheumatic diseases'''
*'''Rheumatic diseases'''
** [[Behçet’s syndrome]]
**[[Behçet's disease|Behçet’s syndrome]]
**[[Reiter’s syndrome|Reactive arthritis (Reiter’s syndrome)]]
**[[Reiter’s syndrome|Reactive arthritis (Reiter’s syndrome)]]
**[[Sweet’s syndrome]]  
**[[Sweet’s syndrome]]
**MAGIC syndrome (mouth and genital ulcers with inflamed cartilage)  
**MAGIC syndrome (mouth and genital ulcers with inflamed cartilage)


*'''Cutaneous diseases'''
*'''Cutaneous diseases'''
**[[Erythema multiforme]]  
**[[Erythema multiforme]]
**[[Pemphigus]]
**[[Pemphigus]]


*'''Hematologic diseases'''
*'''Hematologic diseases'''
**[[Cyclic neutropenia]]  
**[[Cyclic neutropenia]]


*'''[[Nutritional deficiency]]'''
*'''Nutritional deficiency'''
**[[Iron deficiency]]  
**[[Iron deficiency]]
**[[Folate deficiency]]
**[[Folate deficiency]]
**[[Vitamin B12 deficiency]]
**[[Vitamin B12 deficiency]]


*'''Gastro-Intestinal diseases'''
*'''Gastro-Intestinal diseases'''
** [[Gluten-sensitive enteropathy]]  
**[[Gluten-sensitive enteropathy]]
** [[Inflammatory bowel disease]] ([[ulcerative colitis]], [[Crohn’s disease]])
**[[Inflammatory bowel disease]] ([[ulcerative colitis]], [[Crohn’s disease]])


* '''Drugs'''  
*'''Drugs'''  
**[[Nonsteroidal antiinflammatory drugs]]
**[[Nonsteroidal antiinflammatory drugs]]
**[[Beta-blockers]]
**[[Beta-blockers]]
** [[Nicorandil]] (Ikorel)
**[[Nicorandil]] (Ikorel)
**[[Alendronate]] (Fosamax)
**[[Alendronate]] (Fosamax)
Aphthous ulcer must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.
<div style="width: 70%;">
<small><small>
{| class="wikitable"
!Disease
!Presentation
!Risk Factors
!Diagnosis
!Affected Organ Systems
!Important features
!Picture
|-
! colspan="3" |Diseases predominantly affecting the oral cavity
!
!
!
!
|-
|[[Oral candidiasis|Oral Candidiasis]]
|
*[[Dysphagia]] or [[odynophagia]]
*White patches on the mouth and tongue
|
*[[Newborn]] babies
*Denture users
*Poorly controlled [[diabetes]]
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]].
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment).
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]].
*[[Organ transplantation]] patients
|
*Clinical diagnosis
*Confirmatory tests rarely needed
|'''Localized candidiasis'''
*[[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
*[[Candida vulvovaginitis]]
*[[Chronic mucocutaneous candidiasis]]
'''Invasive candidasis'''
*[[Candidiasis|Candidaemia]]
*[[Endocarditis|Candida endocarditis]]
*[[Osteoarthritis|Candida osteoarticular disease]]
|
*[[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]].
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
|-
|[[Herpes simplex|Herpes simplex oral lesions]]
|
*[[Fever]]
*[[Sore throat]]
*Painful [[ulcer]]s
|
*Stress
*Recent [[URTI]]
*Female sex
|
*Physical examination
*[[Viral culture]]
*[[Tzanck smear]]
|
*Orofacial Infection
*[[Herpes simplex anogenital infection|Anogenital Infection]]
*[[Herpes simplex ocular infection|Ocular Infection]]
*[[Herpes simplex encephalitis|Herpes Encephalitis]]
*[[Herpes simplex neonatorum|Neonatal Herpes]]
*[[Herpetic whitlow|Herpetic Whitlow]]
*[[Herpes gladiatorum|Herpes Gladiatorum]]
|
*The symptoms of primary [[HSV]] infection generally resolve within two weeks
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]]
|-
|[[Aphthous ulcer|Aphthous ulcers]]
|
*Painful, red spot or bump that develops into an open [[ulcer]]
|
*Being a female
*Between the ages of 10-40
*Family history of [[Aphthous ulcer|aphthous ulcers]]
|
*Physical examination
*Diagnosis of exclusion
|
*Oral cavity
|
*Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]]
|-
|[[Squamous cell carcinoma]]
|
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
|
*Chronic sun or [[Ultraviolet|UV exposure]]
*Fair [[skin]]
*[[Elderly]] age (>45 yrs)
*[[Male sex]]
*[[Smoking]]
|
*[[Physical exam]]
*[[Biopsy]]
|
*[[Oral Cavity]]
**Floor of [[mouth]]
**Lateral [[tongue]]
*[[Throat]]
*[[Esophagus]]
|
*[[Malignant]]
*Can spread to [[TMJ]]
*Some times associated with [[leukoplakia]]
|[[File:PLoS oral cancer.png|thumb|400x400px|Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]]
|-
|[[Leukoplakia]]
|
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]]
*Lateral borders of [[tongue]]
|
*Atypical [[Tobacco]] use
*Chronic [[irritation]]
*[[Immunodeficiency]]
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]])
|
*[[Physical exam]]
*Diagnosis of exclusion
*[[Biopsy]]
|
*[[Vulva|Vulvar]] lesions occur independent of oral lesions
|
*Associated with [[HIV]]
*Persistant white spots
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]]
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!
| journal = [[Advances in anatomic pathology]]
| volume = 20
| issue = 6
| pages = 416–423
| year = 2013
| month = November
| doi = 10.1097/PAP.0b013e3182a92df1
| pmid = 24113312
}}</ref>
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]]
|-
|[[Melanoma]]
|
*A lesion with [[ABCD]]
**[[Asymmetry]]
**Border irregularity
**Color variation
**[[Diamete]]r changes
*[[Bleeding]] from the lesion
|
*[[Ultraviolet|UV radiations]]
*[[Genetic predisposition]]
*[[Old age]]
*[[Male gender]]
*Family or personal history of [[melanoma]]
*Multiple benign or atypical [[Nevus|nevi]]
|
*[[ABCD]] characteristics
*[[Bleeding]] or [[ulceration]] may show [[malignancy]]
*Serum [[LDH]] may be elevated in case of [[malignancy]]
*[[Biopsy]]
|
*Can [[metastasize]]
*All [[UV radiation]] or sun exposed areas can be effected independently
*1-2 to hundreds of [[granules]]
|
*[[Neural crest cell]] derivative
*Development begins with disruption of [[nevus]] growth control
*Progression involves [[MAPK/ERK pathway]]
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]]
|-
|[[Fordyce spots]]
|
*Rice-like [[granules]] or [[spots]]
*Small, [[painless]], [[raised]], [[pale]], red or white
*1 to 3 mm in [[diameter]]
|
*Greasy skin types
*Some [[Rheumatic|rheumatic disorders]]
*[[Hereditary nonpolyposis colorectal cancer]]
**Lower [[gingiva]] (gums)
**[[Vestibular system|Vestibular mucosa]]
|
*[[Physical exam]]
*Small [[keratin]]-filled [[pseudocysts]]
*May be seen on [[incidental]] [[mucosal]] [[biopsy]]
**[[Biopsy]] not done for them primarily
|
*[[Oral cavity]]
**[[Vermillion border|Vermilion border]] of the lips
**[[Oral mucosa]] of the upper lip
*[[Buccal mucosa]] in the commissural region often bilaterally
*[[Genitals]]
|
*[[Benign neoplasms]] with [[sebaceous]] features
*Visible [[sebaceous glands]]
*No surrounding [[mucosal]] change
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]]
|-
|[[Burning mouth syndrome]]
|
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]]
|
*[[Nutritional deficiencies]]
*Chronic [[anxiety]] or [[depression]]
*[[Diabetes type 2]]
*[[Menopause]]
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste
*[[Female gender ]]
*[[Menopause]]
|
*[[Presentation]]
*[[Physical exam]]
|
*[[Oral cavity]]
|
*Pain typically is low in the morning and builds up over the day
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective
|
|-
|[[Torus palatinus]]
|
*Bony growth on midline of the [[hard palate]]
*[[Nodular]] mass covered with normal [[mucosa]]
|
*[[Genetic predisposition]]
**[[Autosomal dominant]]
|
*[[Physical exam]]
*Types
**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Nodular tori]]
**[[Torus palatinus|Lobular tori]]
|
*[[Hard palate]]
|
*More common in [[Asian]] and Inuit populations
*Twice more common in [[females]]
*Repeated [[trauma]] can cause [[bleeding]]
*[[Surgery]] may be required in symptomatic
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]]
|-
| colspan="4" |'''Diseases involving oral cavity and other organ systems'''
|
|
|
|-
|[[Behçet's disease|Behcet's disease]]
|
*Painful [[mouth sores]]
*[[Acne]] like skin lesions
*Headache, [[fever]], poor [[balance]], [[disorientation]]
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]]
*[[Uveitis]]
*Joint [[swelling]] and joint [[pain]]
*Genital [[sores]] wit [[pain]] and [[scaring]]
*[[Aneurysms]]
|
*Over active [[immune system]]
|
*[[Physical examination]]
|
*[[Mouth]]
*[[Genitals]]
*[[GIT]]
*[[Eye]]
*[[Joints]]
*[[Skin]]
*[[Vascular system]]
*[[Brain]]
|
*[[Outbreaks]] of exaggerated [[inflammation]]
*Affects smaller [[blood vessels]]
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]]
|-
|[[Crohn's disease]]
|
*Chronic, episodic [[diarrhea]] or [[constipation]]
*[[Abdominal pain]]
*[[Vomiting]]
*[[Weight loss]] or [[weight gain]]
|
*[[Smoking]]
*[[Whites]] and [[European]] [[Jews]]
*[[Hormonal contraception]]
*Diets high in microparticles, sweet, fatty or refined foods
*Industrialized country
|
*Typical [[history]] and [[symptoms]]
*[[Skip lesions]] on [[biopsy]]
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]]
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]])
|
*[[Eyes]]
*[[Joints]]
*[[Skin]]
|
*May lead to
**[[Obstruction]]s
**[[Abscess]]es
**Free [[perforation]]
**[[Hemorrhage]]
|
|-
|[[Agranulocytosis]]
|
*[[Fever]] or [[chills]]
*Frequent [[infections]]
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound
*Mouth [[ulcers]]
*[[Abdominal pain]]
*[[Burning sensation when urinating]]
*[[Sore throat]]
|
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref>
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]]
*[[Hematological malignancy|Hematologic malignancies]]
*[[Autoimmune disorders]]
|
*[[Neutropenia]] <100 cells per micro litre
*[[Eosinopenia]]
*[[Basopenia]]
|
*[[Oral cavity]]
*[[Skin]]
*[[GIT]]
*[[Urinary system]]
*[[Conjunctiva]]
|
*[[Immunocompromised|Immunocompromization]]
*Types
**[[Drug-induced]]
**[[Malignant]]
**[[Autoimmune]]
|
|-
|[[Syphilis]]<ref> title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref>
|
*[[Chancre]]
*Regional [[lymphadenopathy]]
|
*[[Multiple sexual partners]]
*Illicit [[drug use]]
*[[Unprotected sex]]
*[[Homosexual men|Men who have sex with men]]
*Residence in highly prevalent areas
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection
*Presence of other [[STI]]s
*Previous history of [[Sexually transmitted disease|STIs]]
*[[Intravenous drug use]]
|
*[[Darkfield microscope|Darkfield microscopy]]
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]])
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]])
|
*[[Oral cavity]]
*[[Penis]]
*[[Cervix]]
*[[Labia]]
*[[Anal canal]]
*[[Rectum ]]
*[[CNS]]
*[[Cardiovascular|CVS]]
|
*[[Primary syphilis]]
**[[Chancre]]
*[[Secondary syphilis]]
**[[Condyloma latum|Condylomata lata]]
*[[Latent syphilis]]
**[[Asymptomatic]]
*[[Tertiary syphilis]]
**[[Gumma|Gummas]]
**[[Neurosyphilis]]
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]]
|-
|[[Coxsackie virus]]
|
*[[Fever]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Aches]]
|
*[[Pregnancy]]
*[[immunodeficiency]]
|
*[[History]] and [[Physical exam]]
*[[Swabbing|Throat swabs]]
*Swabs from the lesion
*[[Tzanck test]]
|
*[[Oral cavity]]
*[[Skin]]
|
*Symptomatic treatment
|[[File:Hand foot mouth disease 07a.jpg|thumb|400x400px|Coxsackie virus stomatitis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>]]
|-
|[[Chickenpox|Chicken pox]]
|
*[[Conjunctival]] symptoms
*[[Catarrhal]] symptoms
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
|
*[[Pregnancy]]
*[[Premature infants]] born to susceptible mothers
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh ≤1000 grams
*[[Immunocompromised]]
|
*[[History]] and [[physical exam]]
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]])
|
*[[Oral cavity]]
*[[Skin]]
|
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
*[[Prednisolone]] is [[contraindicated]]
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]]
|-
|[[Measles]]
|
*[[Fever]]
*[[Rash]]
*[[Cough]]
*[[Coryza]] (runny nose)
*[[Conjunctivitis]] (pink eye)
*[[Malaise]]
*[[Koplick spots]] in mouth
|
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778  }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
*Crowded and/or unsanitary conditions
*Traveling to less developed and developing countries
*Immunocompromized
*Winter and [[spring]] seasons
*Born after 1956 and never fully vaccinated
*Health care workers
|
*[[History]] and [[examination]]
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]]
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]]
|}</small></small>
</div>


==References==
==References==
{{reflist|2}}
{{reflist|2}}


{{WH}}
{{WS}}
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Immunology]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
{{WH}}
{{WS}}

Latest revision as of 00:59, 17 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
For more differentials of other oral lesions look here

Overview

Aphthous ulcer must be differentiated from malignant ulcers, infections, rheumatic and cutaneous disease.

Differential Diagnosis

Aphthous ulcer must be differentiated from:

Aphthous ulcer must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.

Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture
Diseases predominantly affecting the oral cavity
Oral Candidiasis
  • Denture users
  • As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for the treatment of lung conditions (e.g, asthma or COPD) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
  • Clinical diagnosis
  • Confirmatory tests rarely needed
Localized candidiasis

Invasive candidasis

Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg
Herpes simplex oral lesions
  • Stress
  • Recent URTI
  • Female sex
  • The symptoms of primary HSV infection generally resolve within two weeks
Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg
Aphthous ulcers
  • Painful, red spot or bump that develops into an open ulcer
  • Physical examination
  • Diagnosis of exclusion
  • Oral cavity
  • Self-limiting , Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358
Squamous cell carcinoma
Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632
Leukoplakia
  • Vulvar lesions occur independent of oral lesions
Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087
Melanoma
Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811
Fordyce spots
Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899
Burning mouth syndrome
Torus palatinus
Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591
Diseases involving oral cavity and other organ systems
Behcet's disease
Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021
Crohn's disease
Agranulocytosis
Syphilis[3]
oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349
Coxsackie virus
  • Symptomatic treatment
Coxsackie virus stomatitis - Adapted from Dermatology Atlas.[4]
Chicken pox
Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565
Measles
  • Unvaccinated individuals[5][6]
  • Crowded and/or unsanitary conditions
  • Traveling to less developed and developing countries
  • Immunocompromized
  • Winter and spring seasons
  • Born after 1956 and never fully vaccinated
  • Health care workers
Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483

References

  1. Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter |month= ignored (help)
  2. Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
  3. title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
  4. "Dermatology Atlas".
  5. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). "Individual and community risks of measles and pertussis associated with personal exemptions to immunization". JAMA. 284 (24): 3145–50. PMID 11135778.
  6. Ratnam S, West R, Gadag V, Williams B, Oates E (1996). "Immunity against measles in school-aged children: implications for measles revaccination strategies". Can J Public Health. 87 (6): 407–10. PMID 9009400.

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