Aphthous ulcer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{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]]
**[[Oral candidiasis]]
**[[Oral candidiasis]]
**[[Hand-foot-and-mouth disease]]
**[[Hand-foot-and-mouth disease]]
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*'''Neoplasms'''
*'''Neoplasms'''
**[[Kaposi’s sarcoma]]  
**[[Kaposi’s sarcoma]]
**[[Lymphoma]]
**[[Lymphoma]]
**[[Leukemia]]s  
**[[Leukemia]]s


*'''Rheumatic diseases'''
*'''Rheumatic diseases'''
**[[Behçet's disease|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)


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|[[Oral candidiasis|Oral Candidiasis]]
|[[Oral candidiasis|Oral Candidiasis]]
|
|
* [[Dysphagia]] or [[odynophagia]]
*[[Dysphagia]] or [[odynophagia]]
* White patches on the mouth and tongue
*White patches on the mouth and tongue
|
|
*[[Newborn]] babies
*[[Newborn]] babies
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*[[Organ transplantation]] patients
*[[Organ transplantation]] patients
|
|
* Clinical diagnosis
*Clinical diagnosis
* Confirmatory tests rarely needed
*Confirmatory tests rarely needed
|'''Localized candidiasis'''
|'''Localized candidiasis'''
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
*[[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
* [[Candida vulvovaginitis]]
*[[Candida vulvovaginitis]]
* [[Chronic mucocutaneous candidiasis]]
*[[Chronic mucocutaneous candidiasis]]


'''Invasive candidasis'''
'''Invasive candidasis'''
* [[Candidiasis|Candidaemia]]
 
* [[Endocarditis|Candida endocarditis]]
*[[Candidiasis|Candidaemia]]
* [[Osteoarthritis|Candida osteoarticular disease]]
*[[Endocarditis|Candida endocarditis]]
*[[Osteoarthritis|Candida osteoarticular disease]]
|
|
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]].
*[[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]]
|[[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]]
|[[Herpes simplex|Herpes simplex oral lesions]]
|
|
* [[Fever]]
*[[Fever]]
* [[Sore throat]]
*[[Sore throat]]
* Painful [[ulcer]]s
*Painful [[ulcer]]s
|
|
* Stress
*Stress
* Recent [[URTI]]
*Recent [[URTI]]
* Female sex
*Female sex
|
|
* Physical examination
*Physical examination
* [[Viral culture]]
*[[Viral culture]]
* [[Tzanck smear]]
*[[Tzanck smear]]
|
|
* Orofacial Infection
*Orofacial Infection
* [[Herpes simplex anogenital infection|Anogenital Infection]]
*[[Herpes simplex anogenital infection|Anogenital Infection]]
* [[Herpes simplex ocular infection|Ocular Infection]]
*[[Herpes simplex ocular infection|Ocular Infection]]
* [[Herpes simplex encephalitis|Herpes Encephalitis]]
*[[Herpes simplex encephalitis|Herpes Encephalitis]]
* [[Herpes simplex neonatorum|Neonatal Herpes]]
*[[Herpes simplex neonatorum|Neonatal Herpes]]
* [[Herpetic whitlow|Herpetic Whitlow]]
*[[Herpetic whitlow|Herpetic Whitlow]]
* [[Herpes gladiatorum|Herpes Gladiatorum]]
*[[Herpes gladiatorum|Herpes Gladiatorum]]
|
|
* The symptoms of primary [[HSV]] infection generally resolve within two weeks
*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]]
|[[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]]
|[[Aphthous ulcer|Aphthous ulcers]]
|
|
* Painful, red spot or bump that develops into an open [[ulcer]]
*Painful, red spot or bump that develops into an open [[ulcer]]
|
|
* Being a female
*Being a female
* Between the ages of 10-40
*Between the ages of 10-40
* Family history of [[Aphthous ulcer|aphthous ulcers]]
*Family history of [[Aphthous ulcer|aphthous ulcers]]
|
|
* Physical examination
*Physical examination
* Diagnosis of exclusion
*Diagnosis of exclusion
|
|
* Oral cavity
*Oral cavity
|
|
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
*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]]
|[[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]]
|-
|-
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*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
|
|
* Chronic sun or [[Ultraviolet|UV exposure]]
*Chronic sun or [[Ultraviolet|UV exposure]]
* Fair [[skin]]
*Fair [[skin]]
* [[Elderly]] age (>45 yrs)
*[[Elderly]] age (>45 yrs)
* [[Male sex]]
*[[Male sex]]
* [[Smoking]]
*[[Smoking]]
|
|
*[[Physical exam]]
*[[Physical exam]]
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*Can spread to [[TMJ]]
*Can spread to [[TMJ]]
*Some times associated with [[leukoplakia]]
*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]]  
|[[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]]
|[[Leukoplakia]]
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*Some [[Rheumatic|rheumatic disorders]]
*Some [[Rheumatic|rheumatic disorders]]
*[[Hereditary nonpolyposis colorectal cancer]]
*[[Hereditary nonpolyposis colorectal cancer]]
**Lower [[gingiva]] (gums)  
**Lower [[gingiva]] (gums)
**[[Vestibular system|Vestibular mucosa]]
**[[Vestibular system|Vestibular mucosa]]
|
|
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**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Nodular tori]]  
**[[Torus palatinus|Nodular tori]]
**[[Torus palatinus|Lobular tori]]  
**[[Torus palatinus|Lobular tori]]
|
|
*[[Hard palate]]
*[[Hard palate]]
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|
|
*[[Darkfield microscope|Darkfield microscopy]]
*[[Darkfield microscope|Darkfield microscopy]]
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]])  
*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]])
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]])
|
|
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|[[Coxsackie virus]]
|[[Coxsackie virus]]
|
|
*[[Fever]]  
*[[Fever]]
*[[Sores]] in the [[mouth]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Rash]] with [[blisters]]
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*[[History]] and [[Physical exam]]
*[[History]] and [[Physical exam]]
*[[Swabbing|Throat swabs]]
*[[Swabbing|Throat swabs]]
*Swabs from the lesion  
*Swabs from the lesion
*[[Tzanck test]]
*[[Tzanck test]]
|
|
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|
|
*Symptomatic treatment
*Symptomatic treatment
|[[File:Hand foot mouth disease 07a.jpg|thumb|400x400px|Hand-foot-and-mouth disease - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>]]
|[[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]]
|[[Chickenpox|Chicken pox]]
|
|
*[[Conjunctival]] symptoms
*[[Conjunctival]] symptoms
*[[Catarrhal]] symptoms  
*[[Catarrhal]] symptoms
*Characteristic [[spots]] on the trunk appearing in two or three waves
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
*[[Itching]]
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*Immunocompromized
*Immunocompromized
*Winter and [[spring]] seasons
*Winter and [[spring]] seasons
*Born after 1956 and never fully vaccinated  
*Born after 1956 and never fully vaccinated
*Health care workers
*Health care workers
|
|
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{{reflist|2}}
{{reflist|2}}


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

Latest revision as of 00:59, 17 February 2021

Aphthous ulcer Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aphthous ulcer from other Diseases

Epidemiology and Demographics

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Diagnostic Study of Choice

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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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