Complex aphthosis: A large case series with evaluation algorithm and therapeutic ladder from topicals to thalidomide

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Complex aphthosis: A large case series with evaluation algorithm and therapeutic ladder from topicals to thalidomide

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Journal of the American Academy of Dermatology
Volume 52, Issue 3, March 2005, Pages 500-508

Julie Anne Letsinger MD a, Martha Ann McCarty PA-C b, and Joseph L. Jorizzo MD b
a From the Departments of Dermatology at University of California, San Fransico
b Wake Forest University School of Medicine San Francisco, California, and Winston-Salem, North Carolina. Available online 2 March 2005.

mailto:letsingerj@derm.ucsf.edu

Background
Recurrent aphthous stomatitis is a common problem with 20% to 50% of the population having experienced simple aphthous lesions (ie, canker sores). Complex aphthosis is the diagnosis given to patients with almost constant >3 oral aphthae or recurrent oral and genital aphthae in the absence of Behˇet's disease.

Methods
Eighty-one patients were referred to the Wake Forest University School of Medicine, Department of Dermatology from 1995 to 2001 with the diagnosis of presumptive Behˇet's disease. After exclusion of patients with simple recurrent aphthous stomatitis or non-aphthous oral disease, 64 patients remained. Ten of the patients met criteria for Behˇet's disease. The remaining 54 patients were evaluated and treated as patients with the diagnosis of complex aphthosis.

Results
The 54 patients with complex aphthosis became the subject of this study. Twelve patients had secondary complex aphthosis with 10/12 having inflammatory bowel disease. The remaining 42 patients had primary (ie, idiopathic) complex aphthosis. The therapeutic ladder for these patients ranged from topical therapy through oral colchicine and combination oral colchicine and oral dapsone therapy to oral thalidomide therapy.

Conclusion
Complex aphthosis is an important condition to distinguish from Behˇet's disease. Appropriate patient evaluation algorithms and treatment therapeutic ladders are proposed.

Abbreviation used: CBC, complete blood count; FAPA, fever, aphthous stomatitis, pharyngitis, adenitis; G6PD, glucose-6-phosphate dehydrogenase; HLA, human leukocyte antigen; ISG, international study group; MAGIC, mouth and genital ulcers with inflamed cartilage; PCR, polymerase chain reaction; RAS, recurrent aphthous stomatitis; STEPS, system for thalidomide education and prescribing safety

Supported by a Women's Dermatologic Society Mentorship grant (J. A. L.).Conflicts of interest: None identified.Presented in Part at the 10th International Conference on Behˇet's Disease, Berlin, June 27-29, 2002.
Reprint requests: Julie Letsinger, MD, UCSF Department of Dermatology, 515 Spruce Street, San Francisco, CA 94118.

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