Friends today I am discussing about Nail Abnormalities. What are nail abnormalities? Healthy nails appear smooth and have consistent coloring. As you age, you may develop vertical ridges, or your nails may be a bit more brittle. This is harmless. Spots due to injury should grow out with the nail. Abnormalities — such as spots, discoloration, and nail separation — can result from injuries to the fingers and hands, viral warts (periungual warts), infections (onychomycosis), and some medications, such as those used for chemotherapy. Certain medical conditions can also change the appearance of your fingernails. However, these changes can be difficult to interpret. Your fingernails’ appearance alone isn’t enough to diagnose a specific illness. A doctor will use this information, along with your other symptoms and a physical exam, to make a diagnosis. Abnormalities of the fingernail Some changes in your nails are due to medical conditions that need attention. See your doctor if you have any of these symptoms: discoloration (dark streaks, white streaks, or changes in nail color) changes in nail shape (curling or clubbing) changes in nail thickness (thickening or thinning) nails that become brittle nails that are pitted bleeding around nails swelling or redness around nails pain around nails a nail separating from the skin These nail changes can be caused by a variety of different conditions, including ones we describe below. Beau’s lines Depressions that run across your fingernail are called Beau’s lines. These can be a sign of malnourishment. Other conditions that cause Beau’s lines are: diseases that cause a high fever such as measles, mumps, and scarlet fever peripheral vascular disease pneumonia uncontrolled diabetes zinc deficiency Clubbing Clubbing is when your nails thicken and curve around your fingertips, a process that generally takes years. This can be the result of low oxygen in the blood and is associated with: cardiovascular diseases inflammatory bowel disease liver diseases pulmonary diseases AIDS Koilonychia (spooning) Koilonychia is when your fingernails have raised ridges and scoop outward, like spoons. It’s also called “spooning.” Sometimes the nail is curved enough to hold a drop of liquid. Spooning can be a sign that you have: iron deficiency anemia heart disease hemochromatosis, a liver disorder that causes too much iron to be absorbed from food lupus erythematosus, an autoimmune disorder that causes inflammation hypothyroidism Raynaud’s disease, a condition that limits your blood circulation Leukonychia (white spots) Nonuniform white spots or lines on the nail are called leukonychia. They’re usually the result of a minor trauma and are harmless in healthy individuals. Sometimes leukonychia is associated with poor health or nutritional deficiencies. Factors can include infectious, metabolic, or systemic diseases as well as certain drugs. Mees’ lines Mees’ lines are transverse white lines. This can be a sign of arsenic poisoning. If you have this symptom, your doctor will take hair or tissue samples to check for arsenic in your body. Onycholysis When the nail plate separates from the nail bed, it causes a white discoloration. This is called onycholysis. This can be due to infection, trauma, or products used on the nails. Other causes for onycholysis include: psoriasis thyroid disease Pitting Pitting refers to small depressions, or little pits, in the nail. It’s common in people who have psoriasis, a skin condition that causes the skin to be dry, red, and irritated. Some systemic diseases can also cause pitting. Terry’s nails When the tip of each nail has a dark band, it’s called Terry’s nails. This is often due to aging, but it can also be caused by: congestive heart failure diabetes liver disease Yellow nail syndrome Yellow nail syndrome is when the nails get thicker and don’t grow as fast as normal. Sometimes the nail lacks a cuticle and may even pull away from the nail bed. This can be the result of: internal malignancies lymphedema, swelling of the hands pleural effusions, fluid buildup between the lungs and chest cavity respiratory illnesses such as chronic bronchitis or sinusitis rheumatoid arthritis These are just some of the signs of abnormal fingernails. Having any of these signs isn’t proof of any medical condition. You’ll need to visit your doctor to determine if your condition is serious. In many cases, proper care of your nails is enough to correct their appearance. How to care for your nails You can prevent many nail abnormalities by taking good care of your nails. Follow these general guidelines to keep your nails healthy: Tips Don’t bite or tear at your nails, or pull on hangnails. Always use nails clippers and trim them after you bathe, when nails are still soft. Keep your nails dry and clean. Using sharp manicure scissors, trim your nails straight across, rounding the tips gently. If you have a problem with brittle or weak nails, keep them short to avoid breakage. Use lotion on your nails and cuticles to keep the nail and nail beds moisturized. Homoeopathic medicines for nail abnormalities Medicines according to Cause1 Cause Medicines From a hurt Ledum pal. Prick with a needle under the nail Allium cepa, Bovista, Sulphur; Hard work Rhus tox, Sepia; Prick near the nail Iodum; Splinters Baryta carb., Hepar sulph., Iodum, Lachesis, Nitricum acidum, Petroleum, Silicea, Sulphur; Splits of the skin adhering to the nails Allium cepa, Natrum mur. TABLE 2 Medicines according to the Sensation Sensations Medicines Irritable feeling under finger nails, relieved by biting them Ammonium brom. Itching-about roof of Upas tiente Pains-Burning under Sarsarparilla Pains, gnawing, beneath finger nails Alumina; Sarsaparilla.; Sepia Pains, neuralgic, beneath finger nails Berberis vulgaris Pains, neuralgic Alumina; Allium cepa; Colchicum Pains, smarting at roots Sulphur Pains, splinter-like, beneath toe nails Fluoric acidum Pains, ulcerative, beneath toe nails Antimonium crudum; Graphites; Teucrium Medicines according to Location1 Fig. Medicines according to location pastedGraphic.png TABLE 3 Medicines according to Pathology Pathology Medicines Atrophy Silicea Blueness Digitalis; Oxalicum Acidum Deformed-brittle, thickened (onchogryposis) Alumina; Anatherium; Antimonium crudum; Arsenicum album; Causticum; Dioscorea; Fluoricum acidum; Graphites; Merc. Sol.; Natrum muriaticum; Sabadilla; Secal cor..; Senecio aureus; Sepia; Silicea; Thuja.; X-ray. Falling off Brassica napus; Butyric acid; Helleborus faetidus; Helleborus Hangnails Lycopodium; Natrum muriaticum; Sulphur; Upas tiente Hypertrophy (onychauxis) Graphites Inflammation of pulp (onychia) Arnica; Calendula; Fluoricum acidum.; Graphites; Phosphorus; Psorinum; Sarsaparilla; Silicea; Upas tiente Inflammation, under toe nails Sabadilla Ingrowing toe nails Causticum; Magnetis polus austral.; Nitricum acidum; Silicea; Staphysagria; Teucrium; Tetrodymite Softening Plumbum met; Thuja Spots, white on Alumina; Nitricum acidum Trophic changes Radium brom Ulceration Alumina; Garphites; Merc. Sol.; Phosphorus; Sanguinaria; Sarsaparilla; Silicea; Teucrium; Tetrodymite Yellow color Conium maculatum

12 Amazing Health Benefits Of Manganese stylecraze.com Oct 17, 2017 11:20 AM Manganese is an essential mineral that is needed by our body in little amounts, and hence, it is often referred to as one of the trace minerals. Our body contains, at most, 20 mg of manganese. It is mainly concentrated in the liver, pancreas, kidneys, and bones. This mineral is needed for the proper functioning of our brain and nervous system. There are several other important benefits of manganese that have been included in this article. Keep reading to know more about them. Manganese – A Brief  Image: Shutterstock Manganese, an active component of the enzyme manganese superoxide dismutase, is necessary for the proper functioning of enzymes, absorption of nutrients, wound healing, and development of bones in the body. The deficiency of manganese can cause joint pains, poor bone health, and fertility problems. Studies have shown that one needs to take almost 12 mg of manganese on a daily basis for optimum health. This trace mineral is a strong antioxidant that scavenges the free radicals in the body. Now, the important question that arises is, what are the sources of manganese? This trace mineral is found in variable quantities in spices, herbs, cloves, saffron, wheat germ, bran, nuts, mussels, oysters, clams, cocoa powder, dark chocolate, roasted pumpkin, squash seeds, flax, sesame seeds, sesame butter, chili powder, roasted soybeans, and sunflower seeds. How Manganese Is Beneficial Strengthens BonesScavenges Free RadicalsControls Sugar LevelsTreats EpilepsyControls Metabolism RateTreats Inflammation And SprainsPrevents OsteoporosisGood For Thyroid HealthAlleviates PMS SyndromeAids Vitamin AbsorptionGood For Brain HealthIncreases Energy And Functional Efficiency In The Body Health Benefits Of Manganese Let’s take a look at the spectrum of health benefits manganese has to offer. 1. Strengthens Bones  Image: Shutterstock Manganese is vital for the normal development of the human bone structure (1). It helps to boost the mineral density of the spine (2). It has also proved to be beneficial for post-menopausal women. Manganese deficiency in women after menopause can increase the amount of trace minerals and cause minor fractures. Research is going on to establish a concrete evidence that manganese can help prevent osteoporosis and many other diseases. 2. Scavenges Free Radicals Manganese has antioxidant properties, which help it to monitor the activity of free radicals in our body (3). These free radicals can damage human cells and lead to cancer and other harmful diseases. Hence, it is vital to add manganese-rich food sources or supplements to your diet to avert the risk of many diseases. 3. Controls Sugar Levels  Image: Shutterstock Manganese can control the blood sugar levels in our body and help prevent diabetes. Manganese can normalize the synthesis and secretion of insulin in the blood to control the level of sugar. This also helps to regulate unpredictable drops in the blood sugar, which makes life easier for diabetics (4). 4. Treats Epilepsy Epilepsy is a troublesome disorder, and the deficiency of manganese can trigger epileptic seizures. Manganese can act as a vasodilator and plays a key in treating seizures due to its anti-epileptic qualities (5). You can use manganese supplements to control minor and major epileptic seizures. Regulating our body’s metabolism is an essential function of manganese. Manganese-activated enzymes are useful to metabolize cholesterol, amino acids, carbohydrates, and vitamins such as vitamin E and vitamin B1. It also helps in proper functioning of the liver. Manganese can help in the metabolism of glutamine (amino acid) and is an integral part of DNA polymerase (6). 6. Treats Inflammation And Sprains  Image: Shutterstock Manganese cures sprains and inflammation by increasing the superoxide dismutase level (7). This happens due to its antioxidant properties. Superoxide dismutase (SOD) deficiency can be observed in patients with arthritis. SOD has anti-inflammatory properties that can alleviate arthritis. Manganese can help to increase the synthesis and functioning of SOD, thus helping reduce the symptoms of the condition. 7. Prevents Osteoporosis Manganese supplements can give you relief from osteoporosis and osteoarthritis since this essential mineral can add to the bone density and mineral density. However, further research is needed to specifically explore the impact of manganese on the bone health (8). 8. Good For Thyroid Health You may not be aware of many other mineral supplements for thyroid disorder other iodine, right? But, manganese is also very much essential for thyroid health. Manganese is an essential co-factor for various enzymes like thyroxine, a vital hormone in the thyroid gland. It is important to maintain proper functioning of the thyroid gland to avoid health issues. This can be useful to maintain proper appetite, metabolism, weight, and organ system efficiency (9). 9. Alleviates PMS Syndrome  Image: Shutterstock Many women can suffer from premenstrual syndrome (PMS). Manganese helps to manage mood swings and reduce headaches, depression, and irritability. Women who suffer from severe PMS symptoms are advised to consume manganese supplements (10). 10. Aids Vitamin Absorption Manganese can be useful in the absorption of essential vitamins such as vitamin B, vitamin E, and minerals. It plays an important role in enzymatic reactions required for the absorption and utilization of vitamins obtained from food (11). 11. Good For Brain Health Manganese is found to be very essential in treating many nervous disorders. This property of manganese is due to the availability of superoxide dismutase, which scavenges free radicals from the neural pathways. Manganese also binds with neurotransmitters, thus regulating the transmission of electrical impulses throughout the body and enhancing the cognitive function (12). 12. Increases Energy And Functional Efficiency In The Body Manganese can also provide instant energy and ensure proper working of the body. It regulates glucose metabolism, thus ensuring proper energy distribution in each and every cell of the body. It also ensures proper absorption of glucose in the muscles and organs (13). A Word Of Caution Though manganese offers a lot of health benefits, you need to limit its consumption and be aware of its side effects. Listed below are a few things you need to keep in mind: Make sure you consume the amount prescribed by your health care provider. Overdose can be fatal.Don’t consume manganese supplements within an hour or two of taking an antacid. This is because antacids are known to lower the absorption of manganese in the body.People who receive nutrition through IV should avoid consuming manganese supplements altogether.Kids under the age of five can be badly affected if they inhale manganese.Using manganese supplements with quinolone antibiotics can be fatal.Manganese makes up the trio of toxic trace minerals in the body, and their deficiency or overuse can cause serious damage. Make sure that you never inhale it over a long period as it may lead to a number of fatal disorders like Parkinson’s.Those with liver disorders should avoid taking manganese supplements as they can lead to tremors or mental disorders.People suffering from iron-deficiency anemia should totally avoid its consumption as their body tries to absorb as much of manganese as possible. Public Health Recommendations The dietary intakes recommended by the National Academy of Sciences for common masses are as follows. Age/Life Stage Adequate Intake (Per day) 0-6 months0.003 mg7-12 months0.6 mg1-3 years1.2 mg4-8 years1.5 mg 9-13 years, female 9-13 years, male 1.6 mg 1.9 mg 14-18 years, female 14-18 years, male 1.6 mg 2.2 mg 19+ years, female 19+ years, male 1.8 mg 2.3 mg Pregnant women2.0 mgLactating women2.6 mg It is evident from the above-mentioned benefits that manganese can contribute to your overall wellness in a variety of ways. We hope you found this information useful. Let us know if you know any other ways of incorporating this essential mineral in your diet. Report a problem 194dislike

LEAD POISONING- A SERIOUS THREAT TO HEALTH Lead poisoning is a type of metal poisoning caused by lead in the body.[2]The brain is the most sensitive.[2]Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, and tingling in the hands and feet.[1] It causes almost 10% of intellectual disability of otherwise unknown cause and can result in behavioral problems.[2] Some of the effects are permanent.[2] In severe cases anemia, seizures, coma, or deathmay occur.[1][2] Lead poisoning Synonyms Plumbism, colica pictorum, saturnism, Devon colic, painter's colic An X ray demonstrating the characteristic finding of lead poisoning in humans—dense metaphyseal lines. Specialty Toxicology Symptoms Intellectual disability, abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, tingling in the hands and feet[1][2] Complications Anemia, seizures, coma[1][2] Causes Exposure to lead via contaminated air, water, dust, food, consumer products[2] Risk factors Being a child[2] Diagnostic method Blood lead level[2] Differential diagnosis Iron deficiency anemia, malabsorption, anxiety disorder, polyneuropathy[3] Prevention Removing lead from the home, improved monitoring in the workplace, laws that ban lead in products[2][4][5][6] Treatment Chelation therapy[4] Medication Dimercaprol, edetate calcium disodium, succimer[7] Deaths 853,000 (2013)[2] Exposure to lead can occur by contaminated air, water, dust, food, or consumer products.[2] Children are at greater risk as they are more likely to put objects in their mouth such as those that contain lead paint and absorb a greater proportion of the lead that they eat.[2] Exposure at work is a common cause of lead poisoning in adults with certain occupations at particular risk.[7]Diagnosis is typically by measurement of the blood lead level.[2] The Centers for Disease Control (US) has set the upper limit for blood lead for adults at 10 µg/dl (10 µg/100 g) and for children at 5 µg/dl.[8][9] Elevated lead may also be detected by changes in red blood cellsor dense lines in the bones of children as seen on X-ray.[4] Lead poisoning is preventable.[2] This includes by individual efforts such as removing lead-containing items from the home,[5] workplace efforts such as improved ventilation and monitoring,[6]and nationwide policies such as laws that ban lead in products such as paint and gasoline, reduce allowable levels in water or soil, and provide for cleanup of contaminated soil.[2][4] The major treatments are removal of the source of lead and the use of medications that bind lead so it can be eliminated from the body, known as chelation therapy.[4]Chelation therapy in children is recommended when blood levels are greater than 40–45 µg/dl.[4][10]Medications used include dimercaprol, edetate calcium disodium, and succimer.[7] In 2013 lead is believed to have resulted in 853,000 deaths.[2] It occurs most commonly in the developing world.[2]Those who are poor are at greater risk.[2]Lead is believed to result in 0.6% of the world's disease burden.[5] People have been mining and using lead for thousands of years.[4] Descriptions of lead poisoning date to at least 2000 BC,[4] while efforts to limit lead's use date back to at least the 16th century.[5]Concerns for low levels of exposure begin in the 1970s with there being no safe threshold for lead exposure.[2][4] Classification Classically, "lead poisoning" or "lead intoxication" has been defined as exposure to high levels of lead typically associated with severe health effects.[11] Poisoning is a pattern of symptoms that occur with toxic effects from mid to high levels of exposure; toxicity is a wider spectrum of effects, including subclinical ones (those that do not cause symptoms).[12] However, professionals often use "lead poisoning" and "lead toxicity" interchangeably, and official sources do not always restrict the use of "lead poisoning" to refer only to symptomatic effects of lead.[12] The amount of lead in the blood and tissues, as well as the time course of exposure, determine toxicity.[13] Lead poisoning may be acute (from intense exposure of short duration) or chronic (from repeat low-level exposure over a prolonged period), but the latter is much more common.[14] Diagnosis and treatment of lead exposure are based on blood lead level (the amount of lead in the blood), measured in micrograms of lead per deciliter of blood (μg/dL). Urine lead levels may be used as well, though less commonly. In cases of chronic exposure lead often sequesters in the highest concentrations first in the bones, then in the kidneys. If a provider is performing a provocative excretion test, or "chelation challenge", a measurement obtained from urine rather than blood is likely to provide a more accurate representation of total lead burden to a skilled interpreter.[15] The US Centers for Disease Control and Prevention and the World Health Organization state that a blood lead level of 10 μg/dL or above is a cause for concern; however, lead may impair development and have harmful health effects even at lower levels, and there is no known safe exposure level.[16][17]Authorities such as the American Academy of Pediatrics define lead poisoning as blood lead levels higher than 10 μg/dL.[18] Lead forms a variety of compounds and exists in the environment in various forms.[19] Features of poisoning differ depending on whether the agent is an organic compound (one that contains carbon), or an inorganic one.[20] Organic lead poisoning is now very rare, because countries across the world have phased out the use of organic lead compounds as gasoline additives, but such compounds are still used in industrial settings.[20] Organic lead compounds, which cross the skin and respiratory tract easily, affect the central nervous system predominantly.[20] Signs and symptoms Symptoms of lead poisoning. Lead poisoning can cause a variety of symptoms and signs which vary depending on the individual and the duration of lead exposure.[21][22]Symptoms are nonspecific and may be subtle, and someone with elevated lead levels may have no symptoms.[23]Symptoms usually develop over weeks to months as lead builds up in the body during a chronic exposure, but acute symptoms from brief, intense exposures also occur.[24] Symptoms from exposure to organic lead, which is probably more toxic than inorganic lead due to its lipid solubility, occur rapidly.[25] Poisoning by organic lead compounds has symptoms predominantly in the central nervous system, such as insomnia, delirium, cognitive deficits, tremor, hallucinations, and convulsions.[20] Symptoms may be different in adults and children; the main symptoms in adults are headache, abdominal pain, memory loss, kidney failure, male reproductive problems, and weakness, pain, or tingling in the extremities.[26] Early symptoms of lead poisoning in adults are commonly nonspecific and include depression, loss of appetite, intermittent abdominal pain, nausea, diarrhea, constipation, and muscle pain.[27] Other early signs in adults include malaise, fatigue, decreased libido, and problems with sleep.[21] An unusual taste in the mouth and personality changes are also early signs.[28] In adults, symptoms can occur at levels above 40 μg/dL, but are more likely to occur only above 50–60 μg/dL.[21]Symptoms begin to appear in children generally at around 60 μg/dL.[5]However, the lead levels at which symptoms appear vary widely depending on unknown characteristics of each individual.[29] At blood lead levels between 25 and 60 μg/dL, neuropsychiatric effects such as delayed reaction times, irritability, and difficulty concentrating, as well as slowed motor nerve conduction and headache can occur.[30] Anemia may appear at blood lead levels higher than 50 μg/dL.[27] In adults, abdominal colic, involving paroxysms of pain, may appear at blood lead levels greater than 80 μg/dL.[22] Signs that occur in adults at blood lead levels exceeding 100 μg/dL include wrist drop and foot drop, and signs of encephalopathy (a condition characterized by brain swelling), such as those that accompany increased pressure within the skull, delirium, coma, seizures, and headache.[31] In children, signs of encephalopathy such as bizarre behavior, discoordination, and apathy occur at lead levels exceeding 70 μg/dL.[31] For both adults and children, it is rare to be asymptomatic if blood lead levels exceed 100 μg/dL.[22] Acute poisoning In acute poisoning, typical neurological signs are pain, muscle weakness, numbness and tingling, and, rarely, symptoms associated with inflammation of the brain.[26] Abdominal pain, nausea, vomiting, diarrhea, and constipation are other acute symptoms.[32] Lead's effects on the mouth include astringency and a metallic taste.[32]Gastrointestinal problems, such as constipation, diarrhea, poor appetite, or weight loss, are common in acute poisoning. Absorption of large amounts of lead over a short time can cause shock (insufficient fluid in the circulatory system) due to loss of water from the gastrointestinal tract.[32] Hemolysis (the rupture of red blood cells) due to acute poisoning can cause anemia and hemoglobin in the urine.[32] Damage to kidneys can cause changes in urination such as decreased urine output.[32]People who survive acute poisoning often go on to display symptoms of chronic poisoning.[32] Chronic poisoning Chronic poisoning usually presents with symptoms affecting multiple systems,[20] but is associated with three main types of symptoms: gastrointestinal, neuromuscular, and neurological.[26]Central nervous system and neuromuscular symptoms usually result from intense exposure, while gastrointestinal symptoms usually result from exposure over longer periods.[32]Signs of chronic exposure include loss of short-term memory or concentration, depression, nausea, abdominal pain, loss of coordination, and numbness and tingling in the extremities.[28][unreliable medical source?] Fatigue, problems with sleep, headaches, stupor, slurred speech, and anemia are also found in chronic lead poisoning.[26] A "lead hue" of the skin with pallor and/or lividity is another feature.[33][34] A blue line along the gum with bluish black edging to the teeth, known as a Burton line, is another indication of chronic lead poisoning.[35]Children with chronic poisoning may refuse to play or may have hyperkineticor aggressive behavior disorders.[26]Visual disturbance may present with gradually progressing blurred vision as a result of central scotoma, caused by toxic optic neuritis.[36] Effects on children As lead safety standards become more stringent, fewer children in the US are found to have elevated lead levels. A woman who has elevated blood lead levels during pregnancy is at greater risk of a prematurely birth or with a low birth weight.[37] Children are more at risk for lead poisoning because their smaller bodies are in a continuous state of growth and development.[38] Lead is absorbed at a faster rate compared to adults, which causes more physical harm than to older people. Furthermore, children, especially as they are learning to crawl and walk, are constantly on the floor and therefore more prone to ingesting and inhaling dust that is contaminated with lead.[39] The classic signs and symptoms in children are loss of appetite, abdominal pain, vomiting, weight loss, constipation, anemia, kidney failure, irritability, lethargy, learning disabilities, and behavioral problems.[40] Slow development of normal childhood behaviors, such as talking and use of words, and permanent intellectual disability are both commonly seen. Although less common, it is possible for fingernails to develop leukonychia striata if exposed to abnormally high lead concentrations.[41] By organ system Lead affects every one of the body's organ systems, especially the nervous system, but also the bones and teeth, the kidneys, and the cardiovascular, immune, and reproductive systems.[42]Hearing loss and tooth decay have been linked to lead exposure,[43] as have cataracts.[44] Intrauterine and neonatal lead exposure promote tooth decay.[45][46][47][48][49][50][51] Aside from the developmental effects unique to young children, the health effects experienced by adults are similar to those in children, although the thresholds are generally higher.[52] Kidneys Kidney damage occurs with exposure to high levels of lead, and evidence suggests that lower levels can damage kidneys as well.[53] The toxic effect of lead causes nephropathy and may cause Fanconi syndrome, in which the proximal tubular function of the kidney is impaired.[54] Long-term exposure at levels lower than those that cause lead nephropathy have also been reported as nephrotoxic in patients from developed countries that had chronic kidney disease or were at risk because of hypertension or diabetes mellitus.[55]Lead poisoning inhibits excretion of the waste product urate and causes a predisposit

A 65 years old female admitted to the ICU with Urosepsis. Past history of anemia and Interstitial Lung Disease. Please describe is there are any pathological changes in the nails ?

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??