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[Stomatitis in childhood, not always benign]
1St. Lucas Andreas Ziekenhuis, afd. Kindergeneeskunde, AE Amsterdam.
Insights
Pediatric stomatitis, often viral, causes painful mouth sores. Prompt symptomatic treatment and parent reassurance are key to managing this common childhood condition and preventing dehydration.
Area of Science:
- Pediatric Medicine
- Infectious Diseases
- Dermatology
Background:
- Stomatitis is a frequent condition in childhood, presenting with painful buccal lesions.
- Viral infections are the predominant etiology, including herpes simplex virus, Coxsackie virus, varicella-zoster virus, and Epstein-Barr virus.
Observation:
- Two boys presented with severe symptoms including dehydration, blisters, conjunctivitis, and urethritis, responding well to symptomatic treatment.
- A recurrent case of painful buccal ulcers in a young girl highlights the varied presentations of stomatitis.
Findings:
- While viral infections are common, bacterial infections and oral candidiasis (thrush) in infants are also noted causes.
- Non-infectious differential diagnoses include recurrent aphthous stomatitis, Stevens-Johnson syndrome, Behçet's disease, and hematologic/autoimmune disorders.
Implications:
- Most childhood stomatitis cases are self-limiting, emphasizing the importance of parental reassurance.
- Effective management focuses on symptomatic relief with analgesics to prevent complications like dehydration, often avoiding extensive investigations.
Abstract:
Two boys of 1 and 16 year had painful buccal lesions and were admitted for dehydration. The younger had finger and toe blisters; the older, severely ill, had conjunctivitis, urethritis and skin lesions. Only symptomatic treatment with lidocaine gel and paracetamol gave good recovery. A 5-year-old Turkish girl had recurrent painful buccal ulcers which each time cleared up spontaneously. Stomatitis is common in childhood. Viral infections are the most common causes of stomatitis, in particular infections with herpes simplex virus (herpes gingivostomatitis), Coxsackie virus (herpangina, hand-foot-mouth-disease), chickenpox and infectious mononucleosis. Bacterial infections are rare and mostly secondary to the viral infections. In infants oral candidiasis (thrush) is a common cause of stomatitis. Most infections are self-limiting and reassurance of parents is important. Dehydration is a common complication and admission to hospital can be prevented by analgesics. The most important non-infectious conditions that cause stomatitis in children are recurrent aphthous stomatitis, erythema multiforme major (Stevens-Johnson syndrome), Behçet's disease, malignancy (leukaemia), immune-mediated disorders (agranulocytosis, cyclic neutropenia), traumata, blistering disorders of the skin and lichen planus. A complete history and a thorough physical examination usually give the correct diagnosis and further investigations are seldom necessary.