Afty

[dziwne-losy]

Witam; czy ktoś ma sposób na pozbycie się aft? Znowu mnie dopadły, smarowanie
fioletem za bardzo nie pomaga :(

[Gość: Miki]

Po prostu spróbuj Aftinem.

[Gość: sopelek]

Masz obniżoną odpornoś.Proponuję Carident maśc.Dośc skuteczne.

[Gość: Afciarz]

Polecam płyt do płukania ust : CORSODYL

znasz angielski?

[Gość: onkolog]

Aphthous ulcers

Spyridon Marinopoulos, M.D.
10-19-2004
PATHOGENS

* None (idiopathic).
* See DDx below for other conditions causing oral ulcers.

CLINICAL

* Common oral lesions classified by size and duration into minor, major and
herpetiform.
* Minor: Small (<5 mm) single or multiple tender ulcerations, persist x7-14
d. Exam: superficial erosions w/ fibrinous covering often surrounded by red
halo. Involve mobile mucosa (tongue, floor of mouth, soft palate and
buccal/labial mucosa).
* Major: larger painful ulcerations, persist for up to 6 wks, eventually
heal w/ scar formation.
* Herpetiform: crops of small ulcers that eventually coalesce; may be
mistaken for HSV by appearance.
* In HIV-infected individuals, tend to occur more frequently, last longer
and may be more painful. Can significantly effect nutritional health in an
already at risk population.
* DDx: viral (HSV, CMV, Coxsackie), fungal (Histoplasma, Cryptococcus,
Cryptosporidium, Mucor), bacterial (TB, syphilis), neoplasm (NHL, KS, SCC),
Behcet's disease, Reiter's syndrome, SLE, bullous pemphigoid, pemphigus
vulgaris, dermatitis herpetiformis, Crohn's disease, pernicious anemia, Sweet
syndrome.
* Predisposing factors: Stress (emotional/physical), iron or vitamin
deficiencies (folic acid, vitamin B), allergies, hormonal changes, diet/food
hypersensitivity, trauma, immune dysfunction, cyclic neutropenia, sodium lauryl
sulfate (toothpaste detergent), celiac sprue, inflammatory bowel disease,
pernicious anemia, drugs (NSAIDs, alendronate, nicorandil, ddC).

DIAGNOSIS

* Clinical presentation & lesion appearance important. Initial Rx trial w/
topical agents helpful diagnostically. Bx +/- Cx for persistent, atypical
appearing ulcerations.
* Oral mucosal biopsy required for atypical or non-healing ulcers to exclude
possibility of deep fungal infection, viral infection and neoplasms.
* CBC, Fe studies, RBC folate, vitamin B12, serum
antiendomysial/transglutaminase antibody.
* Consider other etiologies (infectious): HSV: Tzank smear w/
inclusion-bearing giant cells; CMV: multinucleated giant cells; Syphilis:
+RPR/FTA; Cryptosporidiosis mucormycosis, histoplasmosis: +Bx/Cx.
* Consider other etiologies (noninfectious): Behcet's syndrome: genital
ulcers, uveitis, retinitis. Reiter's syndrome: uveitis, conjunctivitis,
arthritis, HLA B27+. Crohn's: bloody diarrhea, mucus, GI ulcerations. SLE: malar
rash, +ANA. Cyclic neutropenia: periodic fever & neutropenia. Squamous cell CA:
+Bx, +LN. Bullous pemphigoid/pemphigus vulgaris: diffuse skin involvement.

TREATMENT
TOPICAL

* Topical treatments below apply to idiopathic aphthous ulcers only. If
underlying condition detected, must treat underlying condition.
* Topical corticosteroids: 1st line Rx. Multiple agents can be used:
Betamethasone, fluocinonide, fluocinolone, fluticasone, and clobetasol more
effective than hydrocortisone & triamcinolone, but higher risk for
adrenocortical suppression & predisposition to candidiasis.
* Triamcinolone dental paste (Kenalog in Orabase) or fluocinonide dental
paste (Lidex in Orabase): apply to ulcer bid-tid x 5d or clobetasol propionate
mouthwash 10 cc x 5 min swish & spit tid.
* Dexamethasone elixir: 0.5 mg/5 cc swish & spit tid.
* Amlexanox (aphthasol 5%) paste: apply 1/4 inch (0.5 cm) topically to ulcer
qid. Apply following oral hygiene and as soon as possible after noticing symptoms.
* Chlorhexidine 15 cc oral rinse 0.12% swish & spit x 30 sec bid: increases
# of ulcer-free days and interval between ulcer development but does not affect
incidence/severity of ulceration.
* Tetracycline 250 mg capsule, dissolve in 180 cc water, s/s qid.
* Viscous lidocaine 2%, apply to ulcer w/ cotton swab qid PRN.
* Triamcinolone injection may be useful for persistent isolated lesions.
* Mile's solution: 60 mg hydrocortisone, 20 cc mycostatin, 2 gm
tetracycline, and 120 cc viscous lidocaine (swish & spit). The 2 active
ingredients are HC and TCN, but clinical trials have used more potent topical
steroids.

SYSTEMIC

* Systemic treatments below apply to idiopathic aphthous ulcers only. If
underlying condition detected, must Rx underlying condition.
* Severe cases only: Prednisone 60 mg PO qd x 5-7d, then D/C. Rx >7d
requires slow taper. Avoid if possible in immunocompromised pts, including HIV.
* Thalidomide 200 mg PO qd x 4 wk effective in 2/3 of pts w/ resistant
aphthous ulcers. Some pts may require thalidomide maintenance dose (200 mg twice
a wk).

MISCELLANEOUS

* Brush atraumatically (use small-headed, soft toothbrush). Avoid hard/sharp
foods/trauma to oral mucosa.
* Correct Fe & vitamin deficiencies.
* Exclude potentially offending foods.
* Consider allergy (patch) testing.
* Suppress ovulation if menses/OCP association.
* D/C potentially causal medications

Medyczne podejscie do aft (ang.)

[Gość: onkolog]

www.aafp.org/afp/20000701/149.html
Az szkoda, ze nie ma podobnych tekstow po PL.

[Gość: gosc]

Generalna zasada jest taka (niestety;( )): afty wyskakuja i niestety same
znikna, nie ma srodkow przyspieszajacych "gojenie", sa jedynie łagodzace objawy:
np.wspomniany wczesniej carident-lecz konsystencja jest kiepska,najlepszy to
Solocoseryl.