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Management Strategies for HIV-Associated Aphthous Stomatitis

  • Therapy in Practice
  • Published:
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Abstract

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disorder found in men and women of all ages, races, and geographic regions. There are three forms of the lesions (minor, major, and herpetiform), with major aphthous ulcers causing significant pain and potential for scarring. In HIV-infected individuals, these ulcers occur more frequently, last longer, and produce more painful symptoms than in immunocompetent persons. In addition, they may be associated with similar ulcerations involving the esophagus, rectum, anus, and genitals. The diagnosis of HIV-induced RAS requires a careful history of the condition, and a thorough extraand intra-oral examination. Oral mucosal biopsies are required for non-healing ulcers in order to exclude the possibility of deep fungal infections, viral infections, and neoplasms. The cause of the ulcers in HIV-positive persons has not been elucidated — local diseases, genetic, immunologic, and infectious factors all probably play a role. The goals of current treatments are to promote ulcer healing, to reduce ulcer duration and pain while maintaining nutritional intake, and to prevent or diminish the frequency of recurrence. Initial therapy for infrequent RAS recurrences includes over-the-counter topical protective and analgesic products. Initial therapy for frequent RAS outbreaks requires topical anesthetics, binding agents, and corticosteroids. Major RAS and non-healing minor or herpetiform RAS may require intralesional corticosteroids and systemic prednisone. Second-line immunomodulators for frequent and non-healing ulcers includes thalidomide and other immunomodulators.

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Notes

  1. Use of the registered name is for identification purposes only and does not imply endorsement.

References

  1. Ship JA. Recurrent aphthous stomatitis: an update. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81: 141–7

    Article  PubMed  CAS  Google Scholar 

  2. Ship JA, Chavez EM, Doerr PA, et al. Recurrent aphthous stomatitis. Quintessence Int 2000; 31: 95–112

    PubMed  CAS  Google Scholar 

  3. Wray D, Graykowski EA, Notkins AL. Role of mucosal injury in initiating recurrent aphthous stomatitis. Br Med J (Clin Res Ed) 1981; 283 (6306): 1569–70

    Article  CAS  Google Scholar 

  4. Natah SS, Hayrinen-Immonen R, Hietanen J, et al. Quantitative assessment of mast cells in recurrent aphthous ulcers (RAU). J Oral Path Med 1998; 27 (3): 124–9

    Article  CAS  Google Scholar 

  5. Hasan A, Childerstone A, Pervin K, et al. Recognition of a unique peptide epitope of the mycobacterial and human heat shock protein 65–60 antigen by T cells of patients with recurrent oral ulcers. Clin Exp Immunol 1995; 99 (3): 392–7

    Article  PubMed  CAS  Google Scholar 

  6. Pedersen A. Recurrent aphthous ulceration: virological and immunological aspects. APMIS Suppl 1993; 101 (37): 1–37

    Article  Google Scholar 

  7. Hayrinen-Immonen R. Immune-activation in recurrent oral ulcers (ROU). Scand J Dent Res 1992; 100 (4): 222–7

    PubMed  CAS  Google Scholar 

  8. Pedersen A, Hougen HP, Kenrad B. T-lymphocyte subsets in oral mucosa of patients with recurrent aphthous ulceration. J Oral Pathol Med 1992; 21 (4): 176–80

    Article  PubMed  CAS  Google Scholar 

  9. Hayrinen-Immonen R, Nordstrom D, Malmstrom M, et al. Immune-inflammatory cells in recurrent oral ulcers (ROU). Scand J Dent Res 1991; 99 (6): 510–8

    PubMed  CAS  Google Scholar 

  10. Pedersen A, Klausen B, Hougen HP, et al. Peripheral lymphocyte subpopulations in recurrent aphthous ulceration. Acta Odontol Scand 1991; 49 (4): 203–6

    Article  PubMed  CAS  Google Scholar 

  11. Landesberg R, Fallon M, Insel R. Alterations of T helper/inducer and T suppressor/inducer cells in patients with recurrent aphthous ulcers. Oral Surg Oral Med Oral Pathol 1990; 69 (2): 205–8

    Article  PubMed  CAS  Google Scholar 

  12. Pedersen A, Klausen B, Hougen HP, et al. T-lymphocyte subsets in recurrent aphthous ulceration. J Oral Pathol Med 1989; 18 (1): 59–60

    Article  PubMed  CAS  Google Scholar 

  13. Buno IJ, Huff JC, Weston WL, et al. Elevated levels of interferon gamma, tumor necrosis factor alpha, interleukins 2, 4, and 5, but not interleukin 10, are present in recurrent aphthous stomatitis. Arch Dermatol 1998; 134 (7): 827–31

    Article  PubMed  CAS  Google Scholar 

  14. Eversole LR. Immunopathogenesis of oral lichen planus and recurrent aphthous stomatitis. Semin Cutan Med Surg 1997; 16 (4): 284–94

    Article  PubMed  CAS  Google Scholar 

  15. Natah SS, Hayrinen-Immonen R, Hietanen J, et al. Factor XIIIa-positive dendrocytes are increased in number and size in recurrent aphthous ulcers (RAU). J Oral Pathol Med 1997; 26 (9): 408–13

    Article  PubMed  CAS  Google Scholar 

  16. Regezi JA, Macphail LA, Richards DW, et al. A study of macrophages, macrophage-related cells, and endothelial adhesion molecules in recurrent aphthous ulcers in HIV-positive patients. J Dent Res 1993; 72 (12): 1549–53

    Article  PubMed  CAS  Google Scholar 

  17. Ship II. Inheritance of aphthous ulcers of the mouth. J Dent Res 1965; 44 (5): 837–44

    Article  PubMed  CAS  Google Scholar 

  18. Pedersen A, Hornsleth A. Recurrent aphthous ulceration: a possible clinical manifestation of reactivation of varicella zoster or cytomegalovirus infection. J Oral Pathol Med 1993; 22 (2): 64–8

    Article  PubMed  CAS  Google Scholar 

  19. Ghodratnama F, Riggio MP, Wray D. Search for human herpesvirus 6, human cytomegalovirus and varicella zoster virus DNA in recurrent aphthous stomatitis tissue. J Oral Pathol Med 1997; 26 (4): 192–7

    Article  PubMed  CAS  Google Scholar 

  20. Scully C. Are viruses associated with aphthae and oral vesiculo-erosive disorders? Br J Oral Maxillofac Surg 1993; 31 (3): 173–7

    Article  PubMed  CAS  Google Scholar 

  21. Pedersen A, Madsen HO, Vestergaard BF, et al. Varicella-zoster virus DNA in recurrent aphthous ulcers. Scand J Dent Res 1993; 101 (5): 311–3

    PubMed  CAS  Google Scholar 

  22. Eglin RP, Lehner T, Subak-Sharpe JH. Detection of RNA complementary to herpes-simplex virus in mononuclear cells from patients with Behcet’s syndrome and recurrent oral ulcers. Lancet 1982; II (8312): 1356–61

    Article  Google Scholar 

  23. Phelan JA, Eisig S, Freedman PD, et al. Major aphthous-like ulcers in patients with AIDS. Oral Surg Oral Med Oral Pathol 1991; 71 (1): 68–72

    Article  PubMed  CAS  Google Scholar 

  24. Jacobson JM, Greenspan JS, Spritzler J, et al. Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection. N Engl J Med 1997; 336 (21): 1487–93

    Article  PubMed  CAS  Google Scholar 

  25. MacPhail LA, Greenspan JS. Oral ulceration in HIV infection: investigation and pathogenesis. Oral Dis 1997; 3 Suppl. 1: S190–3

    Google Scholar 

  26. Delilbasi E, Turan B, Yucel E, et al. Selenium and Behcet’s disease. Biol Trace Elem Res 1991; 28 (1): 21–5

    Article  PubMed  CAS  Google Scholar 

  27. Yazici H, Pazarli H, Barnes CG, et al. A controlled trial of azathioprine in Behcet’s syndrome. N Engl J Med 1990; 322 (5): 281–5

    Article  PubMed  CAS  Google Scholar 

  28. Plotkin GR, Patel BR, Shah VN. Behcet’s syndrome complicated by cutaneous leukocytoclastic vasculitis: response to prednisone and chlorambucil. Arch Intern Med 1985; 145 (10): 1913–5

    Article  PubMed  CAS  Google Scholar 

  29. de la Fuente-Fernandez R, Rubio-Nazabal E, de la Iglesia-Martinez F. Guillain-Barre syndrome as an extraintestinal manifestation of Crohn’s disease. Postgrad Med J 1995; 71 (837): 437–8

    Article  PubMed  Google Scholar 

  30. Hizawa K, Iida M, Kohrogi N, et al. Crohn disease: early recognition and progress of aphthous lesions. Radiology 1994; 190 (2): 451–4

    PubMed  CAS  Google Scholar 

  31. Maeda K, Okada M, Yao T, et al. Intestinal and extraintestinal complications of Crohn’s disease: predictors and cumulative probability of complications. J Gastroenterol 1994; 29 (5): 577–82

    Article  PubMed  CAS  Google Scholar 

  32. Scully C, MacFadyen E, Campbell A. Oral manifestations in cyclic neutropenia. Br J Oral Surg 1982; 20 (2): 96–101

    Article  PubMed  CAS  Google Scholar 

  33. Hammond IV WP, Price TH, Souza LM, et al. Treatment of cyclic neutropenia with granulocyte colony-stimulating factor. N Engl J Med 1989; 320 (20): 1306–11

    Article  PubMed  Google Scholar 

  34. Rodenas JM, Ortego N, Herranz MT, et al. Cyclic neutropenia: a cause of recurrent aphthous stomatitis not to be missed. Dermatology 1992; 184 (3): 205–7

    Article  PubMed  CAS  Google Scholar 

  35. Marshall GS, Edwards KM, Butler J, et al. Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr 1987; 110 (1): 43–6

    Article  PubMed  CAS  Google Scholar 

  36. Porter SR, Scully C, Standen GR. Autoimmune neutropenia manifesting as recurrent oral ulceration. Oral Surg Oral Med Oral Pathol 1994; 78 (2): 178–80

    Article  PubMed  CAS  Google Scholar 

  37. Orme RL, Nordlund JJ, Barich L, et al. The MAGIC syndrome (mouth and genital ulcers with inflamed cartilage). Arch Dermatol 1990; 126 (7): 940–4

    Article  PubMed  CAS  Google Scholar 

  38. Le Thi Huong D, Wechsler B, Piette JC, et al. Aortic insufficiency and recurrent valve prosthesis dehiscence in MAGIC syndrome. J Rheumatol 1993; 20 (2): 397–8

    PubMed  CAS  Google Scholar 

  39. Scimeca PG, James-Herry AG, Weinblatt ME. Atypical PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, adenitis) in a young girl with Fanconi anemia. J Pediatr Hematol Oncol 1996; 18 (2): 159–61

    Article  PubMed  CAS  Google Scholar 

  40. Palopoli J, Waxman J. Recurrent aphthous stomatitis and vitamin B12 deficiency. South Med J 1990; 83 (4): 475–7

    Article  PubMed  CAS  Google Scholar 

  41. Livneh A, Zaks N, Katz J, et al. Increased prevalence of joint manifestations in patients with recurrent aphthous stomatitis (RAS). Clin Exp Rheumatol 1996; 14 (4): 407–12

    PubMed  CAS  Google Scholar 

  42. Butler MJ, Russell AS, Percy JS, et al. A follow-up study of 48 patients with Reiter’s syndrome. Am J Med 1979; 67 (5): 808–10

    Article  PubMed  CAS  Google Scholar 

  43. Kogure T, Fujinaga H, Nozaki K, et al. Systemic lupus erythematosus complicated by disseminated intravascular coagulation: the role of serum soluble cell surface markers. Clin Exp Rheumatol 1997; 15 (6): 671–5

    PubMed  CAS  Google Scholar 

  44. Fakhry-Smith S, Din C, Nathoo SA, et al. Clearance of sodium lauryl sulphate from the oral cavity. J Clin Periodontol 1997; 24 (5): 313–7

    Article  PubMed  CAS  Google Scholar 

  45. Chahine L, Sempson N, Wagoner C. The effect of sodium lauryl sulfate on recurrent aphthous ulcers: a clinical study. Compend Contin Educ Dent 1997; 18 (12): 1238–40

    PubMed  CAS  Google Scholar 

  46. Herlofson BB, Barkvoll P. The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. Acta Odontol Scand 1996; 54 (3): 150–3

    Article  PubMed  CAS  Google Scholar 

  47. Herlofson BB, Barkvoll P. Sodium lauryl sulfate and recurrent aphthous ulcers: a preliminary study. Acta Odontol Scand 1994; 52 (5): 257–9

    Article  PubMed  CAS  Google Scholar 

  48. Veloso FT, Saleiro JV. Small-bowel changes in recurrent ulceration of the mouth. Hepatogastroenterology 1987; 34 (1): 36–7

    PubMed  CAS  Google Scholar 

  49. Nolan A, Lamey PJ, Milligan KA, et al. Recurrent aphthous ulceration and food sensitivity. J Oral Pathol Med 1991; 20 (10): 473–5

    Article  PubMed  CAS  Google Scholar 

  50. Wray D, Vlagopoulos TP, Siraganian RP. Food allergens and basophil histamine release in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1982; 54 (4): 388–95

    Article  PubMed  CAS  Google Scholar 

  51. van Loon LA, Bos JD, Davidson CL. Clinical evaluation of fifty-six patients referred with symptoms tentatively related to allergic contact stomatitis. Oral Surg Oral Med Oral Pathol 1992; 74 (5): 572–5

    Article  PubMed  Google Scholar 

  52. Haisraeli-Shalish M, Livneh A, Katz J, et al. Recurrent aphthous stomatitis and thiamine deficiency. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82 (6): 634–6

    Article  PubMed  CAS  Google Scholar 

  53. Nolan A, McIntosh WB, Allam BF, et al. Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy. J Oral Pathol Med 1991; 20 (8): 389–91

    Article  PubMed  CAS  Google Scholar 

  54. Porter SR, Scully C, Flint S. Hematologic status in recurrent aphthous stomatitis compared with other oral disease. Oral Surg Oral Med Oral Pathol 1988; 66 (1): 41–4

    Article  PubMed  CAS  Google Scholar 

  55. Wray D, Ferguson MM, Hutcheon WA, et al. Nutritional deficiencies in recurrent aphthae. J Oral Pathol 1978; 7 (6): 418–23

    Article  PubMed  CAS  Google Scholar 

  56. Wray D, Ferguson MM, Mason DK, et al. Recurrent aphthae: treatment with vitamin B12, folic acid, and iron. BMJ 1975; 2 (5969): 490–3

    Article  PubMed  CAS  Google Scholar 

  57. Endre L. Recurrent aphthous ulceration with zinc deficiency and cellular immune deficiency. Oral Surg Oral Med Oral Pathol 1991; 72 (5): 559–61

    Article  PubMed  CAS  Google Scholar 

  58. Miller MF, Garfunkel AA, Ram CA, et al. The inheritance of recurrent aphthous stomatitis: observations on susceptibility. Oral Surg Oral Med Oral Pathol 1980; 49 (5): 409–12

    Article  PubMed  CAS  Google Scholar 

  59. Ship II. Epidemiologic aspects of recurrent aphthous ulcerations. Oral Surg Oral Med Oral Pathol 1972; 33 (3): 400–6

    Article  PubMed  CAS  Google Scholar 

  60. Porter SR, Scully C, Pedersen A. Recurrent aphthous stomatitis. Crit Rev Oral Biol Med 1998; 9 (3): 306–21

    Article  PubMed  CAS  Google Scholar 

  61. Malmstrom M, Salo OP, Fyhrquist F. Immunogenetic markers and immune response in patients with recurrent oral ulceration. Int J Oral Surg 1983; 12 (1): 23–30

    Article  PubMed  CAS  Google Scholar 

  62. Gallina G, Cumbo V, Messina P, et al. HLA-A, B, C, DR, MT, and MB antigens in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1985; 59 (4): 364–70

    Article  PubMed  CAS  Google Scholar 

  63. Glick M, Muzyka BC, Lurie D, et al. Oral manifestations associated with HIV-related disease as markers for immune suppression and AIDS. Oral Surg Oral Med Oral Pathol 1994; 77 (4): 344–9

    Article  PubMed  CAS  Google Scholar 

  64. Muzyka BC, Glick M. Major aphthous ulcers in patients with HIV disease. Oral Surg Oral Med Oral Pathol 1994; 77 (2): 116–20

    Article  PubMed  CAS  Google Scholar 

  65. MacPhail LA, Greenspan D, Greenspan JS. Recurrent aphthous ulcers in association with HIV infection: diagnosis and treatment. Oral Surg Oral Med Oral Pathol 1992; 73 (3): 283–8

    Article  PubMed  CAS  Google Scholar 

  66. MacPhail LA, Greenspan D, Feigal DW, et al. Recurrent aphthous ulcers in association with HIV infection: description of ulcer types and analysis of T-lymphocyte subsets. Oral Surg Oral Med Oral Pathol 1991; 71 (6): 678–83

    Article  PubMed  CAS  Google Scholar 

  67. Rogers III RS. Recurrent aphthous stomatitis: clinical characteristics and associated systemic disorders. Semin Cutan Med Surg 1997; 16 (4): 278–83

    Article  PubMed  Google Scholar 

  68. Ficarra G. Oral ulcers in HIV-infected patients: an update on epidemiology and diagnosis. Oral Dis 1997; 3 Suppl. 1: S183–9

    Google Scholar 

  69. Reichart PA. Oral ulcerations in HIV infection. Oral Dis 1997; 3 Suppl. 1: S180–2

    Google Scholar 

  70. Shiboski CH. Epidemiology of HIV-related oral manifestations in women: a review. Oral Dis 1997; 3 Suppl. 1: S18–27

    Google Scholar 

  71. Anderson J, Clark RA, Watts DH, et al. Idiopathic genital ulcers in women infected with human immunodeficiency virus. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 13 (4): 343–7

    Article  PubMed  CAS  Google Scholar 

  72. Bini EJ, Micale PL, Weinshel EH. Natural history of HIV-associated esophageal disease in the era of protease inhibitor therapy. Dig Dis Sci 2000; 45 (7): 1301–7

    Article  PubMed  CAS  Google Scholar 

  73. Patton LL, van der Horst C. Oral infections and other manifestations of HIV disease. Infect Dis Clin North Am 1999; 13 (4): 879–900

    Article  PubMed  CAS  Google Scholar 

  74. Zakrzewska JM, Robinson P, Williams IG. Severe oral ulceration in patients with HIV infection: a case series. Oral Dis 1997; 3 Suppl. 1: S194–6

    Google Scholar 

  75. Flaitz CM, Nichols CM, Hicks MJ. Herpesviridae-associated persistent mucocutaneous ulcers in acquired immunodeficiency syndrome: a clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81 (4): 433–41

    Article  PubMed  CAS  Google Scholar 

  76. Mattingly G, Rodu B. Differential diagnosis of oral mucosal ulcerations. Compendium 1993; 14 (2): 136, 138, 140

    PubMed  CAS  Google Scholar 

  77. Fenton SJ, Unkel JH. Viral infections of the oral mucosa in children: a clinical review. Pract Periodontics Aesthet Dent 1997; 9 (6): 683–90

    PubMed  CAS  Google Scholar 

  78. Jones AC, Gulley ML, Freedman PD. Necrotizing ulcerative stomatitis in human immunodeficiency virus-seropositive individuals: a review of the histopathologic, immunohistochemical, and virologic characteristics of 18 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89 (3): 323–32

    Article  PubMed  CAS  Google Scholar 

  79. Porter SR, Kingsmill V, Scully C. Audit of diagnosis and investigations in patients with recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1993; 76 (4): 449–52

    Article  PubMed  CAS  Google Scholar 

  80. Rogers III RS, Hutton KP. Screening for haematinic deficiencies in patients with recurrent aphthous stomatitis. Australas J Dermatol 1986; 27 (3): 98–103

    Article  PubMed  Google Scholar 

  81. Challacombe SJ, Barkhan P, Lehner T. Haematological features and differentiation of recurrent oral ulceration. Br J Oral Surg 1977; 15 (1): 37–48

    Article  PubMed  CAS  Google Scholar 

  82. Field EA, Rotter E, Speechley JA, et al. Clinical and haematological assessment of children with recurrent aphthous ulceration. Br Dent J 1987; 163 (1): 19–22

    Article  PubMed  CAS  Google Scholar 

  83. Ricer RE. Sucralfate vs placebo for the treatment of aphthous ulcers: a double-blinded prospective clinical trial. Fam Pract Res J 1989; 9 (1): 33–41

    PubMed  CAS  Google Scholar 

  84. Scott JD, Bender B. Treatment of recurrent aphthous ulcers with a corticosteroid inhaler in patients with HIV disease. AIDS Patient Care STDS 1996; 10 (3): 152–3

    Article  PubMed  CAS  Google Scholar 

  85. Greenspan D, Shirlaw PJ. Management of the oral mucosal lesions seen in association with HIV infection. Oral Dis 1997; 3 Suppl. 1: S229–34

    Google Scholar 

  86. Glick M, Muzyka BC. Alternative therapies for major aphthous ulcers in AIDS patients. J Am Dent Assoc 1992; 123 (7): 61–5

    PubMed  CAS  Google Scholar 

  87. Gordon SM, Dionne RA, Picco C, et al. Dose finding study: topical thalidomide for aphthous ulcers [abstract]. J Dental Research 2003; 82 (Sp. issue S): 28

    Google Scholar 

  88. Gordon SM, Wahl SM, Picco C, et al. Safety and tolerability and absorption of topical thalidomide [abstract]. Clin Pharmacol Ther 2003; 73 (2 Sp. issue S): 55

    Article  Google Scholar 

  89. MacPhail L. Topical and systemic therapy for recurrent aphthous stomatitis. Semin Cutan Med Surg 1997; 16 (4): 301–7

    Article  PubMed  CAS  Google Scholar 

  90. Lozada-Nur F, Huang MZ, Zhou GA. Open preliminary clinical trial of clobetasol propionate ointment in adhesive paste for treatment of chronic oral vesiculoerosive diseases. Oral Surg Oral Med Oral Pathol 1991; 71 (3): 283–7

    Article  PubMed  CAS  Google Scholar 

  91. Kay LW. Corticosteroids in diseases of the oral mucosa. Int Dent J 1976; 26 (4): 405–10

    PubMed  CAS  Google Scholar 

  92. Wolverton SE. Glucocorticosteroids. In: Wolverton SE, Wilkin JK, editors. Systemic drugs for skin diseases. Philadelphia (PA): WB Saunders Company, 1991: 86–124

    Google Scholar 

  93. Helfer EL, Rose LI. Corticosteroids and adrenal suppression: characterising and avoiding the problem. Drugs 1989; 38 (5): 838–45

    Article  PubMed  CAS  Google Scholar 

  94. Lozada F, Silverman SJ, Migliorati C. Adverse side effects associated with prednisone in the treatment of patients with oral inflammatory ulcerative diseases. J Am Dent Assoc 1984; 109 (2): 269–70

    PubMed  CAS  Google Scholar 

  95. Khandwala A, Van Inwegen RG, Alfano MC. 5% amlexanox oral paste, a new treatment for recurrent minor aphthous ulcers: I. Clinical demonstration of acceleration of healing and resolution of pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83 (2): 222–30

    Article  PubMed  CAS  Google Scholar 

  96. Khandwala A, Van Inwegen RG, Charney MR, et al. 5% amlexanox oral paste, a new treatment for recurrent minor aphthous ulcers: II. Pharmacokinetics and demonstration of clinical safety. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83 (2): 231–8

    Article  PubMed  CAS  Google Scholar 

  97. Binnie WH, Curro FA, Khandwala A, et al. Amlexanox oral paste: a novel treatment that accelerates the healing of aphthous ulcers. Compend Contin Educ Dent 1997; 18 (11): 1116–8

    PubMed  CAS  Google Scholar 

  98. Greer ROJ, Lindenmuth JE, Juarez T, et al. A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers. J Oral Maxillofac Surg 1993; 51 (3): 243–8

    Article  PubMed  Google Scholar 

  99. Taylor LJ, Walker DM, Bagg J. A clinical trial of prostaglandin E2 in recurrent aphthous ulceration. Br Dent J 1993; 175 (4): 125–9

    Article  PubMed  CAS  Google Scholar 

  100. Hutchinson VA, Angenend JL, Mok WL, et al. Chronic recurrent aphthous stomatitis: oral treatment with low-dose interferon alpha. Mol Biother 1990; 2 (3): 160–4

    PubMed  CAS  Google Scholar 

  101. Ylikontiola L, Sorsa T, Hayrinen-Immonen R, et al. Doxymycine-cyanoacrylate treatment of recurrent aphthous ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83 (3): 329–33

    Article  PubMed  CAS  Google Scholar 

  102. Adeoti AG, Vega KJ, Dajani EZ, et al. Idiopathic esophageal ulceration in acquired immunodeficiency syndrome: successful treatment with misoprostol and viscous lidocaine. Am J Gastroenterol 1998; 93 (11): 2069–74

    Article  PubMed  CAS  Google Scholar 

  103. Friedman M, Brenski A, Taylor L. Treatment of aphthous ulcers in AIDS patients. Laryngoscope 1994; 104 (5 Pt 1): 566–70

    Article  PubMed  CAS  Google Scholar 

  104. Silverman Jr S, Gallo J, Stites DP. Prednisone management of HIV-associated recurrent oral aphthous ulcerations. J Acquir Immune Defic Syndr 1992; 5 (9): 952–3

    PubMed  Google Scholar 

  105. Reyes-Teran G, Ramirez-Amador V, De la Rosa E, et al. Major recurrent oral ulcers in AIDS: report of three cases. J Oral Pathol Med 1992; 21 (9): 409–11

    Article  PubMed  CAS  Google Scholar 

  106. de Asis ML, Bernstein LJ, Schliozberg J. Treatment of resistant oral aphthous ulcers in children with acquired immunodeficiency syndrome. J Pediatr 1995; 127 (4): 663–5

    Article  PubMed  CAS  Google Scholar 

  107. Vega KJ, Bollu J, Dajani EZ, et al. Idiopathic esophageal ulceration in patients infected with human immunodeficiency virus. J Assoc Acad Minor Phys 1996; 7 (4): 93–8

    PubMed  CAS  Google Scholar 

  108. Kotler DP, Reka S, Orenstein JM, et al. Chronic idiopathic esophageal ulceration in the acquired immunodeficiency syndrome: characterization and treatment with corticosteroids. J Clin Gastroenterol 1992; 15 (4): 284–90

    Article  PubMed  CAS  Google Scholar 

  109. Wilcox CM, Schwartz DA. Comparison of two corticosteroid regimens for the treatment of HIV-associated idiopathic esophageal ulcer. Am J Gastroenterol 1994; 89 (12): 2163–7

    PubMed  CAS  Google Scholar 

  110. Mascaro JM, Lecha M, Torras H. Thalidomide in the treatment of recurrent, necrotic, and giant mucocutaneous aphthae and aphthosis. Arch Dermatol 1979; 115 (5): 636–7

    Article  PubMed  CAS  Google Scholar 

  111. Jenkins JS, Powell RJ, Allen BR, et al. Thalidomide in severe orogenital ulceration. Lancet 1984; II (8417–18): 1424–6

    Article  Google Scholar 

  112. Bowers PW, Powell RJ. Effect of thalidomide on orogenital ulceration. Br Med J (Clin Res Ed) 1983; 287 (6395): 799–800

    Article  CAS  Google Scholar 

  113. Kurkcuoglu N, Atakan N, Eksioglu M. Thalidomide in the treatment of recurrent necrotic mucocutaneous aphthae [letter]. Br J Dermatol 1985; 112 (5): 632

    Article  PubMed  CAS  Google Scholar 

  114. Grinspan D. Significant response of oral aphthosis to thalidomide treatment. J Am Acad Dermatol 1985; 12 (1 Pt 1): 85–90

    Article  PubMed  CAS  Google Scholar 

  115. Revuz J, Guillaume JC, Janier M, et al. Crossover study of thalidomide vs placebo in severe recurrent aphthous stomatitis. Arch Dermatol 1990; 126 (7): 923–7

    Article  PubMed  CAS  Google Scholar 

  116. Radeff B, Kuffer R, Samson J. Recurrent aphthous ulcer in patient infected with human immunodeficiency virus: successful treatment with thalidomide. J Am Acad Dermatol 1990; 23 (3 Pt 1): 523–5

    Article  PubMed  CAS  Google Scholar 

  117. Strazzi S, Lebbe C, Geoffray C, et al. Aphthous ulcers in HIV-infected patients: treatment with thalidomide. Genitourin Med 1992; 68 (6): 424–5

    PubMed  CAS  Google Scholar 

  118. Youle M, Clarbour J, Farthing C, et al. Treatment of resistant aphthous ulceration with thalidomide in patients positive for HIV antibody. BMJ 1989; 298 (6671): 432

    Article  PubMed  CAS  Google Scholar 

  119. Nicolau DP, West TE. Thalidomide: treatment of severe recurrent aphthous stomatitis in patients with AIDS. DICP 1990; 24 (11): 1054–6

    PubMed  CAS  Google Scholar 

  120. Gorin I, Vilette B, Gehanno P, et al. Thalidomide in hyperalgic pharyngeal ulceration of AIDS [letter]. Lancet 1990; 335 (8701): 1343

    Article  PubMed  CAS  Google Scholar 

  121. DeVincenzo JP, Burchet SK. Prolonged thalidomide therapy for human immunodeficiency virus-associated recurrent severe esophageal and oral aphthous ulcers. Pediatr Inf Dis J 1996; 15 (5): 465–7

    Article  CAS  Google Scholar 

  122. Georghiou PR, Kemp RJ. HIV-associated oesophageal ulcers treated with thalidomide. Med J Aust 1990; 152 (7): 382–3

    PubMed  CAS  Google Scholar 

  123. Bellomo A, Schorr-Lesnick B. Thalidomide treatment for idiopathic esophageal ulcers in patients with HIV. Gastrointest Endosc 1996; 44 (6): 729–31

    Article  PubMed  CAS  Google Scholar 

  124. Alexander LN, Wilcox CM. A prospective trial of thalidomide for the treatment of HIV-associated idiopathic esophageal ulcers. AIDS Res Hum Retroviruses 1997; 13 (4): 301–4

    Article  PubMed  CAS  Google Scholar 

  125. Jibaly RM, Moallem H, Fikrig SM, et al. Steroid-resistant idiopathic esophageal ulcer in a child with AIDS. J Pediatr Gastroenterol Nutr 1998; 27 (1): 97–101

    Article  PubMed  CAS  Google Scholar 

  126. Georghiou PR, Allworth AM. Thalidomide in painful AIDS-associated proctitis. J Infect Dis 1992; 166 (4): 939–40

    Article  PubMed  CAS  Google Scholar 

  127. Paterson DL, Georghiou PR, Allworth AM, et al. Thalidomide as treatment of refractory aphthous ulceration related to human immunodeficiency virus infection. Clin Infect Dis 1995; 20 (2): 250–4

    Article  PubMed  CAS  Google Scholar 

  128. Jacobson JM, Spritzler J, Fox L, et al. Thalidomide for the treatment of esophageal aphthous ulcers in patients with human immunodeficiency virus infection. National Institute of Allergy and Infectious Disease AIDS Clinical Trials Group. J Infect Dis 1999; 180 (1): 61–7

    Article  PubMed  CAS  Google Scholar 

  129. Ramirez-Amador VA, Esquivel-Pedraza L, Ponce-de-Leon S, et al. Thalidomide as therapy for human immunodeficiency virus-related oral ulcers: a double-blind placebo-controlled clinical trial. Clin Infect Dis 1999; 28 (4): 892–4

    Article  PubMed  CAS  Google Scholar 

  130. Birnkrant D. Thalidomide for aphthous ulcers in HIV infection. N Engl J Med 1997; 337 (15): 1086–7

    Article  PubMed  CAS  Google Scholar 

  131. Jacobson JM, Greenspan JS, Spritzler J, et al. Thalidomide in low intermittent doses does not prevent recurrence of human immunodeficiency virus-associated aphthous ulcers. J Infect Dis 2001; 183 (2): 343–6

    Article  PubMed  CAS  Google Scholar 

  132. US Food and Drug Administration. Thalidomide Information [online]. Center for Drug Evaluation and Research 2000. Available from URL: http://www.fda.gov/cder/news/thalinfo [Accessed 2003 Aug 11]

  133. Celgene Corporation. THALOMID® (thalidomide) [online]. Celgene Corporation 2003. Available from URL: http://www.celgene.com/thalidomid/index/htm [Accessed 2003 Aug 11 ]

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  1. Department of Oral Medicine, New York University College of Dentistry, 345 East 24th Street, New York, New York, 10010-4086, USA

    A. Ross Kerr &  Jonathan A. Ship

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  1. A. Ross Kerr
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Kerr, A.R., Ship, J.A. Management Strategies for HIV-Associated Aphthous Stomatitis. Am J Clin Dermatol 4, 669–680 (2003). https://doi.org/10.2165/00128071-200304100-00002

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