Aphthous-like lesions are erosive or ulcerative lesions with erythematous margins and a fibrinous surface. They occur as single or multiple lesions, recurring cyclically and they are particularly painful and burning in nature, above all when coming into contact with food or irritating substances. If a diagnosis of primary aphthous stomatitis is excluded, the lesion/s may correlate with other pathologies, whose initial clinical symptom is a/are lesion/s of this type. These pathologies include:
- PAFPA syndrome (Periodic Fever, Aphthae, Pharyngitis and cervical Adenopathies)
PAFPA syndrome generally occurs in children under 5, being characterized by a high and sudden fever, lasting from 3 – 6 days, recurring approximately every 3 – 8 weeks. In addition to the febrile state, other signs and symptoms are present, including the presence of aphthous-like lesions, latero-cervical lympho-adenopathy, pharyngitis and tonsillitis, in the absence of respiratory infections. Such symptoms need not be present contemporaneously in the patient. The patient is totally asymptomatic and in good health between episodes of PAFPA syndrome. From a diagnostic point of view, there is a moderate increase in inflammation on haemato-chemical analysis, variable haemochromic leukocytosis and a slight raise in VES and PCR levels. Patients with PAFPA syndrome usually grow out of this condition spontaneously; treatment is usually with corticosteroids. - MAGIC syndrome (Mouth and Genital Ulcers with Inflamed Cartilage)
MAGIC syndrome is characterised by aphthous-like lesions, which appear on the oral and genital mucosa with an inflammation of the cartilage; its aetiology is still unknown and it is recurring. The cartilaginous tissue most affected are the nose, the ears, the trachea and the bronchi. Specific anti-collagen anti-bodies, which account for the destruction of the cartilaginous tissue, have been identified. MAGIC syndrome shares many features with Behçet’s syndrome, from which it is sometimes barely distinguishable; it can be treated with prednisone or immunosuppressive drugs. - Behҫet’s syndrome
Behçet’s syndrome is inflammatory and chronic, it has an autoimmune aetiology and is characterised by recurring, aphthous-like lesions on the oral and genital mucosa, also occurring in the eye (uveitis, retinal thrombosis, and glaucoma). It frequently involves also the dermis, the joints, central nervous system and gastro-intestinal tract. Its pathogenesis is still unknown even if an association with the HLA-B51 antigen has been proposed. This pathology is rare, occurring mainly in patients between 20 and 30 years of age, not gender specific, but apparently less severe in females. The development of Behçet’s syndrome is chronic in nature and diagnosis can be confirmed by the presence of oral, genital, skin and ocular lesions. The presence of the HLA-B51 antigen is considered diagnostically relevant only in the absence of the aforementioned lesions. Treatment is with corticosteroids or immunosuppressive drugs.
