Aphthous ulcers affect nearly 20% of the population.
Yet in a busy practice, family physicians can miss 3 conditions,
which may mimic aphthous ulcers. Here, I am not discussing the
causes of ulcers in the mouth, but the patients, who get recurrent
attacks of ulcers in the mouth, where in the intervening period,
the mucous membrane of the oral cavity is absolutely normal.
Patients having aphthous ulcers are otherwise absolutely healthy,
with normal body weight and normal blood count. However, I have
noticed that the following three conditions can be easily missed,
if one is not careful. These are:
- Behcet’s Syndrome : It is a connective
tissue disorder. There is no special test to confirm the diagnosis,
which can be diagnosed only on clinical grounds. If a patient
has ulcers, which appear like aphthous ulcers, along with
ulcers on the genitals, it is a case of Behcet’s disease.
These patients should be referred to rheumatologists, who
can give them specific drugs for this connective tissue disorder.
Patients with this illness can develop multiple complications
involving the eyes, brain and other vital organs.
- Skin conditions like lichen planus and
pemphigus can start off in the mucous membrane
of the mouth or oral cavity. One should remember that in any
patient (who otherwise seems to be having aphthous ulcers),
if the ulcer does not heal within 2-3 weeks, a biopsy of the
ulcer must be done to exclude the above mentioned two skin
conditions.
- Herpes Simplex virus can cause ulcers,
which look like aphthous ulcers. Herpes Simplex should be
specially thought of in a patient, who is having the attack
for the first time.
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