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RECURRENT APHTHOUS STOMATITIS (RAS): GUIDELINE FOR
DIFFERENTIAL DIAGNOSIS AND MANAGEMENT
Teshayeva Nozigul Ҳамидулло қизи
Bukhara State Medical Institute named after Abu Ali Ibn Sino
Tel : +998911329697
ABSTRACT
.
Aim Recurrent aphthous stomatitis (RAS) is a painful and
common ulcerative form that can pose a diagnostic challenge. In fact, similar oral
ulcers can appear secondary to a variety of welldefined pathological conditions.
Thus, the purpose of this work was to update the current knowledge about RAS
Methods A narrative review is presented aiming to clarify the extensive differential
diagnosis of RAS and its management. Results Clinically, RAS ulcers need to be
differentiated from Behçet’s disease, nutritional deficiencies, Crohn’s disease and
ulcerative colitis, PFAPA, MAGIC, HIV and xerostomia-related oral ulcers. A
thorough medical history and review of symptoms, in addition to a careful evaluation
of any oral feature, will help the clinician understand whether the ulcers are related
to a systemic disorder or can be defined as idiopathic. The management of RAS is
also challenging and currently there is not a defined treatment for controlling the
symptoms. Conclusion As a first aid in relieving the pain, topical applications of
corticosteroids, antibiotics, and analgesics are highly recommended, while systemic
therapy of RAS should be used in the case of multiple painful ulcerations
compromising the quality of life of the patient. Also, natural anti-inflammatory
substances from medicinal herbs, in the form of essential oils and extracts are
promising agents in the management of RAS.
Introduction
. Idiopathic recurrent aphthous stomatitis, also referred to as
recurrent aphthous stomatitis (RAS), is a common ulcerative disease of the oral
mucosa with a prevalence of 2–10% [Altengurg et al., 2014]. The cause of aphthous
ulcers is still unknown, even if many factors are thought to be involved in the disease
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[Riera Matute and Alonso, 2011]. Ulcers occur in healthy individuals in childhood,
adolescence, or in subjects under 30 years of age, and have the tendency to decrease
in severity and frequency over time [Riera Matute and Alonso, 2011]. RAS starts with
a typical burning sensation asting from 2 to 48 hours until an ulcer is formed
[Akintoye and Greenberg, 2014]. Typically, RAS is localised on the buccal and labial
oral mucosa (Fig. 1, 2), and on the surface of the tongue. It is characterised by the
development of painful round shallow ulcers [Edgard et al., 2017]. The necrotic centre
of the ulceration is covered by a yellowish-grey pseudo-membrane and surrounded
by a reddish edge (Fig. 3). Ulcers have a centrifugal growth and healing is achieved
usually within 7–14 days by re-epithelialisation, which starts from the margins
[Tarakji et al., 2015; Cui et al., 2016].
Conclusion
. New pharmacological molecules differently acting from
chemicals, able to reduce the inflammation process without side effects to the host,
while promoting the wound healing processes are strongly needed. Natural anti-
inflammatory substances from medicinal herbs, as in the form of essential oils as well
as extracts, can be worthwhile in the management of RAS [Li et al., 2016]. The
biological activity of essential oils and polyphenols from plants and herbs is related
to the presence of different chemical classes. In this regard, terpenes and terpenoids
in essential oils are promising agents in the prevention and treatment of inflammatory
and autoimmunity disorders suggesting them as potential chemopreventive and
therapeutic agents. Further interesting capabilities have been ascribed to polyphenols
from extracts, which molecules include tannins, flavonoids and lignin-carbohydrate
complexes strongly associated to anti-inflammatory, antioxidant and antimicrobial
properties [Milia et al., 2020; Milia et al., 2021]. The hopeful use of nanotechnology
should be a strategy to increase the activity of bioactive natural molecules in the
releasing of beneficial and safe substances to threat RAS [Manconi et al., 2018; Pinna
et al., 2019]. Although the large evidence of biocompatibility in oral cell lines,
adequate clinical trials are still necessary to validate the use of medicinal herbs in
humans [Porter and Scully, 2002].
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