Aphthous Ulcers Workup

Updated: Jan 20, 2017
  • Author: Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC); Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Laboratory Studies

See the list below:

  • Systemic disorders should particularly be suspected in the presence of features that may suggest a systemic background.
  • Diagnosis of recurrent aphthous stomatitis (RAS) is based on history and clinical features. No specific tests are available; however, to exclude systemic disorders discussed above, the following tests may be helpful:
    • Complete blood cell count
    • Hemoglobin test
    • White blood cell count with differential
    • Red blood cell indices
    • Iron studies (usually an assay of serum ferritin levels)
    • Red blood cell folate assay
    • Serum vitamin B-12 measurements
    • Serum antiendomysium antibody and transglutaminase assay (positive in celiac disease)
  • Rarely, biopsy may be indicated in cases in which a different diagnosis is suspected. Occasionally, for example, pemphigus may mimic RAS. Occasional RAS can mimic a neoplasm, necrotizing sialometaplasia, or TUGSE (traumatic ulcerative granuloma with stromal eosinophilia).
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Histologic Findings

The histology of RAS is nonspecific. The ulcer is depressed well below the surface, and the inflammation extends deeply. The surface of the ulcer is covered by a fibrinous exudate infiltrated by polymorphs. Beneath is a layer of granulation tissue with dilated capillaries and edema. Deeper still is a repair reaction, with fibroblasts in the surrounding connective tissue laying down fibrous tissue.

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