Aphthous Stomatitis Differential Diagnoses

Updated: Sep 25, 2020
  • Author: Ginat W Mirowski, MD, DMD; Chief Editor: William D James, MD  more...
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Diagnostic Considerations

Also consider the following:

  • Local, traumatic ulceration
  • Environmental triggers: Food (eg, figs, cheese, tomato, tomato sauce, vinegar, lemon, pineapple, milk, wheat flour) [62] ; sodium lauryl sulfate, a detergent used as an emulsifier and surface cleanser and found in many toothpastes and oral rinses [63, 64]
  • Drugs (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], [65] chemotherapies and cytotoxic drugs, Nicorandil, gold) [66]
  • Hematinic deficiencies (up to 20%) (iron, folic acid, vitamin B-12; rarely vitamin B-1 and B-6) [16]
  • Deep fungal disease (major aphthae) [67]
  • Rheumatologic diseases, including systemic lupus erythematous and reactive arthritis [68]
  • GI diseases (3%) (eg, Crohn disease, ulcerative colitis, celiac disease or gluten sensitive enteropathy [HLA –DRW 10 and DQW1], malabsorption, pernicious anemia) [69]
  • Sweet syndrome [70]
  • Causes of systemic neutropenia, including cyclic neutropenia and benign familial neutropenia [71]
  • PFAPA syndrome (periodic fever, pharyngitis, adenitis, and oral ulceration) [72, 73]
  • MAGIC (mouth and genital ulcers with inflamed cartilage) [74]
  • Primary and secondary immunodeficiencies, including HIV infection [75]
  • Trisomy 8, myelodysplasia [76]
  • Behçet disease [77, 78]  (For information on diagnostic criteria for Behçet disease, see the Medscape article Behçet disease.)


Differential Diagnoses