Mayo Patients With Complex Aphthosis

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The records of 244 patients with complex aphthosis who had been seen personally by the author were evaluated. There were 152 females (62.3%) and 92 males (37.7%). The ages ranged from 15 months to 81 years of age. The peak decade was 20-29 years of age. Patients who suffered oral aphthous ulcerations approximately 50% of the time or had continuous oral ulcerations or had oral and genital ulcerations or suffered major disability from aphthosis were included. Causes for aphthosis were sought for each patient. The response to therapy was assessed. Twenty-five patients with complex aphthosis and BD were excluded. More than 60% of patients were 10-39 years of age.

Presentation as simple aphthosis converting to complex aphthosis occurred in 125 (51.3%) while the disease of 119 (48.7%) presented as complex aphthosis. Genital lesions were present in 34 (13.9%) of patients. Females suffered from genital lesions more often than males (16.4% versus 9.8%). Almost % of patients had MiAU (73.4%) while 22.5% had MjAU and 4.1% had HU type of RAS lesions.

A substantial number (almost 60%) of patients had associated conditions relevant to their complex aphthosis problem (Table 2). Anemia and/or hematinic deficiencies were present in 61 (25.0%), gastrointestinal disease in 41 (16.8%), and hematopoietic and immunodeficiency conditions in 12 (4.9%) of patients. The onset was associated with smoking cessation in 10 (4.1%), drug reactions in 8 (3.3%), and chronic trauma in 6 (2.5%) of patients. Twelve patients (4.9%) had pseudo-Behget's disease, 8 patients (3.3%) had cicatrizing oropharyngeal disease, while 4 (1.6%) had erythema multiforme associated with complex aphthosis. It is notable that 25 patients with complex aphthosis and BD were seen during this same period.

Table 2. Conditions Associated with Complex Aphthosis




Anemia and/or hematinic deficiencies



GI diseases



Hematopoietic and /or immunodeficiency



Smoking cessation



Drug reactions (NSAIDs, Captopril)



Chronic trauma



Treatment of patients with complex aphthosis was successful in many patients with replacement of hematinic deficiencies, treating primary diseases such as Crohn's disease and GSE, modifying provocative factors such as drug reactions and trauma, and utilizing drugs such as systemic corticosteroids and nonsteroidal anti-inflammatory drugs such as colchicine, dapsone, pentoxifylline, and antibiotics.

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