aphthous stomatitis current perspective复发性阿弗他口炎流视角课件

Recurrent Aphthous Stomatitis- Current Perspective Dr. Prabhakar M Sangolli Dept of Dermatology Dr.B.R.AMBEDKAR MEDICAL COLLEGE Bangalore,Canker Sore,Recurring ulcers in the oral mucous membrane with no signs of systemic disease. Common manifestation of haematological, immunological and psychological disorders.,Aetiopathogenesis,Genetic ( HLA)-40% cases Nutritional-Iron,folic acid,B1,B2,B3, B12,C Endocrinal-Premenstrual,pregnancy Infective-Strep.sanguis(Hsp), HIV Stress Smoking cessation Trauma Immunological(ADCC),Clinical Features,-20% of general population -Precipitated by trauma,menses -Prodrome 2-48 hrs Pre ulcerative Ulcerative Resolving,TYPES,DISEASES SIMULATING RAS,Behcets: oral, genital, neuro-ocular Sweets syndrome Blood dyscrasias GIT malabsorption (Coeliac disease,IBD) Collagen vascular diseases Cyclic neutropenia Reiters Disease Recurrent Intra oral Herpes,MANAGEMENT,History : Stress Trauma Smoking Premenstrual flare Clinical examination: Eye Genital Rectal CNS,Investigations,MaRAS,onset 25yrs age,pt with syst.symptoms CBC Serum iron,B12,RBC folate levels,ferritin ANA,GENERAL MEASURES,Stress avoidance Nicotine patches Soft tooth brush B12 supplements:1000mcg twice wkly-6wks 1000mcg once a month-1 yr (low serum B12 level) Folic acid, Iron, B-complex, C supplements Pre & Probiotics,TOPICAL THERAPY,Mild cases - To promote healing, use 0.1% Triamcinolone with orabase, qid 2% xylocaine viscous to relieve pain Severe cases :Clobetasol, Flucinolone Tetracycline in 30 ml water q.i.d & 5% Amlexanox paste-Accelerate healing .,SEVERE CASES,Prednisolone 1mg/kg/day, taper over 2 weeks Azathioprine - 50mg b.i.d Watch for Candidiasis,PREVENTION OF RECURRENCE,Oral Pentoxyfylline : 400mg t.i.d-3mths Colchicine- 0.5mg t. i. d S/E: Myopathy, neuropathy, nausea,diarrhoa, blood dyscrasias.Potent teratogen DDS+Colchcine,Prevention of recurrence (contd),Thalidomide 100mg t.i.d, tapering to 50mg /d as maintenance. Teratogenic, neurotoxic STEPS-(System for Thalidomide Education Prescribing Safety) Other measures: Topical tacrolimus Levamisole,Points to ponder,H.Pylori CMV,EBV Handedness Glutein free diet Non enzymatic AOs Iontophoresis Detergents in toothpaste,SUMMARY,Stress avoidance Soft tooth brush Supplements-B12,folic acid,B3,C,iron Steroids with orabase Local anaesthetic, tetracycline mouthwash Systemic steroids-sever