A 65 yr old female non DM non HTN with no known addictions, came to me with h/o painful ulcerations over the tongue,soft palate and buccal mucosa since 1yr...on and off...she received multiple treatments...including multivitamins, short courses of steroids twice in this one year..subsided in between.But this time she is having it since 1 month,not subsiding with treatment and severe pain along with difficulty in swallowing. I diagnosed it as recurrent aphthous stomatitis and adv workup. HIV negative,RBS normal,UGI endoscopy-Normal.ANA sent report awaited. There are no other signs and symptoms suggestive of malignancy or autoimmune or behcets disease. I suspected HSV stomatitis and so started her on acyclovir, but did not send tzanck smear...also put her on triamcinolone 0.1% buccal paste, amlexanox and lignocaine ointment and also started pentoxyfylline 400 tid...she came after 3 days with no improvement and so i added defcort 6 mg bid. what is the next course of action,should i get a biopsy. Need expert opinion pls

26 year old male with no known co-morbidites presents with oral ulcers of 8 days duration.no history of trauma,no history of fever no h/o ulcers anywhere else in body foriegn body h/o spicy foods (+) gives past history of mouth ulcers 3 months back. took candid cream and dolo gel for L/A O/E reddish ulcers on palate does nt bleed on touch please help with the diagnosis is it simple aphthous ulcer and what is the reason for the recurrence

Patient complains of frquent ulcer with history of 8years..no sharp cusp..no gastritis..no systemic disease..age 17years..no habits..patient had vit B Complex from long time..no changes seen..kenacort or mucopain? Is it recurrent apthous ulcer..its frequent..he is suffering from 8long years..what should be done..i just wrote some blood test.. suggestion are welcome

57 year old male known case of HTN and DM. Complaints of soreness of mouth and tongue. Recurrent about 4 times per year. It was improved before on miconazole gel. No GI symptoms, not a smoker What do you think? It could be herps ?? Or aphthous ulcers? Underlying disease??

*APTHOUS ULCERS* Introduction Recurrent aphthous stomatitis (RAS) is a common condition, restricted to the mouth, that leads to ulcerative inflammatory condition of oral cavity . Typically starts in childhood or adolescence as recurrent small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or gray floors having a positive family history of similar ulcers is common. *Types;* Minor; Minor RAS is mild apthous ulcer also known as Miculiz’s Apthae. It constitute about 80% cases of RAS. Size of ulcer ; 8 to 10 mm. Heals within; 10-14 days without scaring Major; Major RAS is also known as sutton’s disease or Periadenitis Mucosa necrotica recurrens. It constitute about 10-15% cases of RAS. Size of ulcer ; 1cm. Heals in; 6 week with scaring Herpetiform; Reccurent crops of multiple ulcers;100-120 in numbers. It constitute about 5-10 % cases of RAS. Size of ulcer ; 2mm. Heals in; 10-14 days *Causes* Familial history and genetic history of RAS in 40 % of cases. Hematinic deficiencies like; (e.g. iron, folic acid, vitamin B-12) in as many as 20% of patients with recurrent ulcers. Deficiencies of vitamins B-1, B-2, and B-6 also responsible for recurrent apthous ulcer. Tobacco use Drug induced Celiac diseases IBD Stress induced. Decrease water intake. *Symptoms* Significant pain while chewing food Painful Single or multiple,shallow surrounded by erythematous mucosa anywhere in the oral cavity. Small ulcers heal without scar, while larger and deep ulcers leave a scar. • Fever, adenopathy, gastrointestinal sympyoms are typically absent. *NOTE : –Repeated ulcers at the same site or slow healing ulcers with systemic symptoms eg, uveitis, arthritis, fever adenopathy are worrisome.Malignancy should be excluded.* *HOMOEOPATHIC MEDICINE FOR RECURRENT APTHOUS ULCER :*  Arum Triphyllum; Apthae with profuse acrid saliva.  Borax ; apthous ulcer whitish coated which bleed on touch.  Capsicum Annum; Flat,painful vesicular apthae.  Kalium Muriaticum; White ulcer in mouth with grayish- white coating of tongue.  Mercuris Sol. : Apthae with increased saliva associated with bad(Mettalic) taste in mouth.  Sulphuricum Acidum; Apthae with offensive breath. *DrSaurabh Suman Prasad* *Intern* Dr.yadubir sinha homoeopathic medical college and hospital laheriasarai, Darbhanga. Bihar.