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Differential diagnosis

Differential diagnosis of recurrent aphthous stomatitis

Differential diagnosis

Oral signs

Other signs and symptoms

Recurrent aphthous stomatitis
(Clinical pictures)


·  Single or multiple ulcers on unattached mucosa

·  May be associated with oropharyngeal or gastrointestinal ulcers

Herpes simplex virus

·  Single or multiple ulcers on attached mucosa

·  Diffuse gingival erythema

·  Preceding fever and mucosal vesicles

Varicella zoster virus

·  Extraoral and intraoral ulcers

·  Unilateral distribution

·  Prodrome of pain and burning

·  May cause scarring and neuralgia


·  Multiple ulcers in hard palate, soft palate, and oropharynx

·  Fever and malaise

Hand-foot-and-mouth disease

·  Ulcers preceded by vesicles

·  Skin lesions, low-grade fever, and malaise

Erythema multiforme

·  Lesions on attacthed and unattached mucosa; lip crusting

·  May be preceded by herpes infection

·  Sudden onset of skin macules and papules

·  Target lesions on skin

Oral lichen planus

·  Erosive and reticular lesions on buccal mucosa, gingiva, palate, and tongue

·  White (Wickham's) striae

·  May be asymptomatic

·  Lesions may occur on skin

Cicatricial pemphigoid

·  Vesiculobullous lesions on attached and unattached mucosa

·  Positive Nikolsky's sign

·  Can affect eyes and genitalia

·  Lesions can occur on skin

Pemphigus vulgaris

·  Vesiculobullous lesions on attached and unattached mucosa

·  Positive Nikolsky's sign

·  Lesions can occur on skin


The 3 classic forms of RAS are minor, major, and herpetiform. Minor RAS appears as recurrent, round, closely defined, small painful ulcers with shallow necrotic centers, raised margins and erythematous halos in the labial, buccal and floor of the mouth mucosa. Major RAS is similar to the minor but is larger, deeper, often scars and can last for weeks to months. Herpetiform RAS are the least common and appears as small and numerous ulcers.

Source: Ship AJ, Chavez EM, Doerr PA, Bradley SH and Sarmadi M. Recurrent aphthous stomatitis, Quintessence Int, 2000; 31 : 95-112

Last updated by Gisela Ladda Tayanin