Mixed diagnoses – 10 cases (3 of 11)

The causes of mouth ulcers include:

• Trauma: injury, dentures, adornments in pierced tongue or lip
• Infection: candidiasis, herpes simplex, hand foot and mouth disease, syphilis
• Contact stomatitis: irritant or allergic
• Gastrointestinal disease: gluten sensitive enteropathy, inflammatory bowel disease
• Haematological disease: cyclic neutropaenia, leukaemia
• Nutritional deficiency: iron, folic acid, B1, B6 or B12 deficiency
• Immunodeficiency: HIV infection
• Bullous diseases: erythema multiforme major, pemphigus
• Lichenoid diseases: lichen planus, drug eruptions, lupus erythematosus
• Drugs: NSAIDs, chemotherapy, methotrexate, fixed drug eruption
• Behçet's disease: multisystem disorder with orogenital aphthous ulceration and iritis
• Neoplasia: primary squamous cell carcinoma.

Treatment of course depends on the cause of the ulceration. It may be necessary to adhere to soft foods and to avoid salt, spices and acidic fruit.

Aphthous ulceration is treated by a variety of agents without substantial research demonstrating therapeutic results. These gels, pastes, ointments, sprays and rinses contain various corticosteroids, antiseptics, analgesics and bland coating agents.

Systemic agents prescribed for severe disease include systemic steroids, ciclosporin, colchicine, cimetidine, azathioprine, and thalidomide.

In the absence of specific deficiency, multivitamins and minerals do not appear to be of benefit.