Aphthous ulcers

Author: Vanessa Ngan, staff writer. Updated by A/Prof Amanda Oakley, Chief Editor, January 2016.

What are aphthous ulcers?

Aphthous ulcers are ulcers that form on the mucous membranes. They are also called aphthae, aphthosis, aphthous stomatitis and canker sores.

Aphthous ulcers are typically recurrent round or oval sores or ulcers inside the mouth on areas where the skin is not tightly bound to the underlying bone, such as on the inside of the lips and cheeks or underneath the tongue. They can also affect the genitalia in males and females.

Recurrent aphthous ulcers are mostly a minor nuisance, but they are associated with significant health problems in some people.

Who is at risk of aphthous ulcers?

Anyone can get aphthous ulcers; 20% of the population have them at least occasionally. They usually first appear in childhood or adolescence, and more commonly in females than males.

Interestingly, smoking may be protective against aphthae, even though smoking make many oral and skin conditions worse.

Non-sexually acquired genital ulceration

Non-sexually acquired genital ulceration (NSGU) re fers to aphthous ulcers in genital sites.

Images of vulval ulcers

Aphthous ulcers in genital sites are also called non-sexually acquired genital ulcers or Lipschutz ulcers. They are more common in females than in males. They may be accompanied by considerable pain and swelling. Reactive genital ulcers follow an infection.

NSGU is more likely than simple oral aphthosis to be associated with systemic illness, such as:

What causes aphthous ulcers?

The exact reason why aphthous ulcers develop is not yet clearly defined. Approximately 40% of people who get aphthous ulcers have a family history of the same. Current thinking is that the immune system is disturbed by some external factor and reacts abnormally against a protein in mucosal tissue.

Factors that seem to trigger outbreaks of ulcers include:

Other causes of mouth ulcers should be considered, including herpes simplex or infection with Vincents organisms, herpangina, recurrent erythema multiforme, and fixed drug eruption.

What are the signs and symptoms of aphthous ulcers?

Recurrent aphthous ulcers usually begin as a round yellowish elevated spot surrounded by a red halo. This then breaks down into a punched-out ulcer, which is covered with a loosely attached white, yellow or greyish membrane. Surrounding tissue is healthy and unaffected. Sometimes these ulcers can be painful, particularly if they are irritated by movement or from eating certain types of food.

People may experience a single ulcer or multiple ulcers. Multiple ulcers tend to be widely distributed throughout a person's mouth.

There are basically 3 types of aphthous ulcers:

What tests should be done in aphthous ulceration?

Most people affected by occasional minor aphthous ulceration do not require tests. They are undertaken if there are recurrent attacks of multiple or severe oral ulcers, or complex aphthosis.

Blood tests may include:

Swabs for microbiology evaluate the presence of Candida albicans, Herpes simplex virus and Vincent's organisms.

What is the treatment for aphthous ulcers?

There is no cure for aphthous ulcers. Most recurrent minor aphthous ulcers heal within 1-2 weeks without any treatment. The main goal of treatment is to lessen the pain and discomfort, and promote healing.

General measures

Prescribed medicines for aphthous ulceration

Topical prescription medicines include:

In severe cases, particularly if there are systemic symptoms, anti-inflammatory oral medications may be considered (off-label use):

Related information

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