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Complex aphthosis: a large case series with evaluation algorithm and therapeutic ladder from topicals to thalidomide
Julie Anne Letsinger1, Martha Ann McCarty, Joseph L Jorizzo
1Department of Dermatology at University of California, San Fransico, CA 94118, USA. letsingerj@derm.ucsf.edu
Journal of the American Academy of Dermatology
|March 12, 2005
Summary
Complex aphthosis, distinct from Behcet's disease, affects many patients. This study proposes evaluation and treatment strategies for complex aphthosis, differentiating it from Behcet's disease.
Area of Science:
- Dermatology
- Oral Medicine
Background:
- Recurrent aphthous stomatitis affects 20-50% of the population.
- Complex aphthosis involves persistent oral aphthae or recurrent oral/genital aphthae without Behcet's disease.
Purpose of the Study:
- To evaluate and propose diagnostic and treatment algorithms for complex aphthosis.
- To differentiate complex aphthosis from Behcet's disease.
Main Methods:
- Retrospective review of 81 patients with presumptive Behcet's disease from 1995-2001.
- Exclusion of simple aphthous stomatitis and non-aphthous oral disease, leaving 64 patients.
- Diagnosis of complex aphthosis in 54 patients after excluding 10 with Behcet's disease.
Main Results:
- Of 54 complex aphthosis patients, 12 had secondary aphthosis (10 with inflammatory bowel disease) and 42 had primary idiopathic aphthosis.
- Treatment ranged from topical therapies to oral colchicine, dapsone, and thalidomide.
- Complex aphthosis requires distinct evaluation and management.
Conclusions:
- Complex aphthosis is a distinct clinical entity requiring differentiation from Behcet's disease.
- Proposed evaluation algorithms and treatment ladders can guide patient management.
- Effective management strategies are crucial for patients with complex aphthosis.