Number VI Recurrent aphthous stomatitis

Abstract

Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is a common condition which is characterized by multiple recurrent small, round or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors typically presenting first in childhood or adolescence. RAS occurs worldwide although it appears most common in the developed world. The aetiology of RAS is not entirely clear. Despite many studies trying to identify a causal microorganism, RAS does not appear to be infectious. A genetic predisposition is present, as shown by strong associations with genotypes of IL-1beta; IL-6 in RAS patients, and a positive family history in about one-third of patients with RAS. Haematinic deficiency is found in up to 20% of patients. Cessation of smoking may precipitate or exacerbate RAS in some cases. Ulcers similar to RAS may be seen in human immunodeficiency virus disease and some other immune defects, and drugs, especially non-steroidal anti-inflammatory drugs and nicorandil may produce lesions clinically similar to RAS. Topical corticosteroids can often control RAS. However, the treatment of RAS remains unsatisfactory, as most therapies only reduce the severity of the ulceration and do not stop recurrence.

Recurrent aphthous stomatitis

“…The presence of extravasated erythrocytes around the ulcer margin, subepithelial extravascular neutrophils, numerous macrophages loaded with phagolysosomes, and the non-specific binding of stratum spinosum cells to immunoglobulins and complements may be a result of vascular leakage and passive diffusion of serum proteins. These findings suggest that pathogenesis of RAS may be mediated by immune complex vasculitis 74 . The onset of a RAS lesion is associated with cell-mediated immune response, generation of T cells and production of TNF-α.…”

“…The onset of a RAS lesion is associated with cell-mediated immune response, generation of T cells and production of TNF-α. Peripheral blood mononuclear cells of RAS patients has been shown to secrete high amounts of TNF-α, an indication that TNF-α plays a key role in RAS pathogenesis 54,[74][75][76] . Consequently, TNF-α-mediated endothelial cell adhesion and neutrophil chemotaxis initiate the cascade of inflammatory processes that lead to ulceration 77 .…”

Maladie de Sutton : difficultés thérapeutiques. A propos d’une observation clinique

“…Les corticoïdes, en application locale ou en aérosols, représentent le traitement de base de la maladie de Sutton [10,12] . Parmi les molécules utilisées localement, on trouve la triamcinolone acétonide, la béthamé-thasone, la fluocinomide.…”

Oral manifestations of systemic disease

“…Recurrent aphthous stomatitis is the most common cause of multiple superficial ovoid ulcers of the oral mucosa, 19 but this is 20 The uncommon autoinflammatory syndrome of periodic fever, aphthous ulceration, pharyngitis and adenitis (PFAPA) that usually arises in pre-pubertal children gives rise to episodes of superficial aphthous-like ulceration. Unlike RAS this disorder tends to spontaneously remit in the teenage years.…”