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1、RecurrentAphthousStomatitis- CurrentPerspectiveDr.PrabhakarMSangolliDeptofDermatologyDr.B.R.AMBEDKARMEDICALCOLLEGEBangaloreCankerSoreRecurringulcersintheoralmucousmembranewithnosignsofsystemicdisease.Commonmanifestationofhaematological,immunologicalandpsychologicaldisorders.Aetiopat
2、hogenesisGenetic(HLA)-40%casesNutritional-Iron,folicacid,B1,B2,B3,B12,CEndocrinal-Premenstrual,pregnancyInfective-Strep.sanguis(Hsp),HIVStressSmokingcessationTraumaImmunological(ADCC)ClinicalFeatures-20%ofgeneralpopulation-Precipitatedbytrauma,menses-Prodrome2-48hrsPreulcerativeUlce
3、rativeResolvingTYPESDISEASESSIMULATINGRASBehcet’s:oral,genital,neuro-ocularSweet’ssyndromeBlooddyscrasiasGITmalabsorption(Coeliacdisease,IBD)CollagenvasculardiseasesCyclicneutropeniaReiter’sDiseaseRecurrentIntraoralHerpesMANAGEMENTHistory:StressTraumaSmokingPremenstrualflareClinical
4、examination:EyeGenitalRectalCNSInvestigationsMaRAS,onset>25yrsage,ptwithsyst.symptomsCBCSerumiron,B12,RBCfolatelevels,ferritinANAGENERALMEASURESStressavoidanceNicotinepatchesSofttoothbrushB12supplements:1000mcgtwicewkly-6wks1000mcgonceamonth-1yr(lowserumB12level)Folicacid,Iron,B-com
5、plex,CsupplementsPre&ProbioticsTOPICALTHERAPYMildcases-Topromotehealing,use0.1%Triamcinolonewithorabase,qid2%xylocaineviscoustorelievepainSeverecases:Clobetasol,FlucinoloneTetracyclinein30mlwaterq.i.d&5%Amlexanoxpaste-Acceleratehealing.SEVERECASESPrednisolone1mg/kg/day,taperover2wee
6、ksAzathioprine-50mgb.i.dWatchforCandidiasisPREVENTIONOFRECURRENCEOralPentoxyfylline:400mgt.i.d-3mthsColchicine-0.5mgt.i.dS/E:Myopathy,neuropathy,nausea,diarrhoa,blooddyscrasias.PotentteratogenDDS+ColchcinePreventionofrecurrence(contd..)Thalidomide100mgt.i.d,taperingto50mg/dasmainten
7、ance.Teratogenic,neurotoxicSTEPS-(SystemforThalidomideEducationPrescribingSafety)Othermeasures:TopicaltacrolimusLevamisolePointstoponderH.PyloriCMV,EBVHandednessGluteinfreedietNonenzymaticAOsIontophoresisDetergentsintoothpasteSUMMARYStressavoidanceSofttoothbrushSupplements-B12,folic
8、acid,B3,C,ironStero
