EDWARD W.COWENMD, MHSc
A 46-year-old white woman presented with recurrent aphthous stomatitis (RAS) since childhood and an otherwise unremarkable medical history. Physical examination revealed 4 major ulcers with circumscribed margins, erythematous haloes, and gray floors at the oral mucosa (Figure, A). The severely painful oral lesions interfered with eating, swallowing, and speaking. The patient reported having multiple recurrences per year (>15), each lasting for approximately 5 to 10 days, as documented by her dentist. Previous symptomatic treatments included short-term use of topical corticosteroids, chlorhexidine, triclosan, and systemic corticosteroids. Other underlying medical problems such as Behçet disease, cyclic neutropenia, periodic fever with aphthae pharyngitis and adenitis, Sweet syndrome, nutritional deficiencies, gastrointestinal disorders, human immunodeficiency virus, Herpes simplex, and other viral infections could be ruled out.1,2 Interestingly, a detailed family history revealed that both parents had RAS as well.
Guenova E, Hoetzenecker W. Treatment of Recurrent Aphthous Stomatitis With Fumaric Acid Esters. Arch Dermatol. 2011;147(3):282-284. doi:10.1001/archdermatol.2011.27