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

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herpetic stomatitis,start giving inj.vitcofol 2ml.one od.alternate days,with tab.rebagen one tab.thrice for 7 days with mucopain oral gel.Tab.acyclovir and start doing one unique thing.Break two capsules of becosule inside oral cavity and the resultant powder should be revolved all around the mouth with tounge so as to evenly apply the capsule powder over the ulcers.Do it twice a day keep

the powder in mouth for 3 mins.every time.Also advise patient to take tab.sumoflam thrice to reduce the inflammatory process.This will give a soothing healing experience.

Sir as I can see there is halo around the ulcer. So it looks like Aphthous ulcer , I understand there is a long history but also to be considerd is itbis on off, so may be just recurrent aphthous ulcer

sir we strongly support ur advise
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Give him mouth wash, tab turmix twice a day for 15 days.i think it is benficial for her.

This is surely a chronic case of aphthous stomatitis. U have already done the relevant tests but probably serum iron and related tests with B12 and vitamin A and D3 should also be done along with bone marrow for malignant cells if not already done. Chronic constipation or worm infestation should be ruled out. l have treated a number of such cases with the following regime. Zocon50 --1 tab daily Supradyn --1 daily, Astimin MForte -1 tab Dail, BIFILAC cap 1BD, Medrol 4 --1BD Cetzine -1 daily, dilosyn tab 1 - bedtime and oral application of Metrogyl Gel +Tess Gel + Zytee Gel (all mixed in the ratio of 1:1:1 and apply 3 to 4 times a day orally and keeping mouth shut for 5 minutes each time

I agree to Dr Ashok.... chronic constipation n worm infestation.
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Check GI tract upper and lower for any ulceration

upper gi endoscopy is normal
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I too think its apthous and not herpetic , continue triamcinolone , multivitamins and give short course of oral steroids

Herpetic stomatitis

looks like herpetic what about lymph nodes dr.

No significant lymphadenopathy madam.
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Advised biopsy.

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