A30 year male smoker gets these lip lesions in form of ulcers ..frequently relapse for the last 1year some time healing without treatment .!! Plz suggest management .!!

42 y/o male with no significant medical history presented with oral ulcerations x 1.5 weeks. Ulcerations initially scattered in only 3 to 5 mm, increasing in size until they coalesce together into one large ulcer (as seen on the hard palate) + submandibular lymphadenopathy, no fever, no other sx. Has had recurrent episodes, always unilateral, sometimes only on the lateral aspect of the tongue, subsequent episodes always with increased pain and ulcer size. Any ideas? Apthalmous ulcer? Oral shingles (doesn't cross midline)? Vitamin B-12/folate deficiency?

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

c/o lesion in angle of mouth since 3days..pain during opening of mouth..diagnosis and treatment?

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??