# Recurrent Aphthous Stomatitis

> Recurrent aphthous stomatitis for NEET-PG Dermatology covers minor, major and herpetiform ulcers, systemic links such as Behcet disease and treatment options.

- Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/recurrent-aphthous-stomatitis
- Exam / course: NEET-PG · Subject: Dermatology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-15
- Last updated: 2026-10-15
- Reference basis: Fitzpatrick's Dermatology; Rook's Textbook of Dermatology; Burket's Oral Medicine
- How to cite: "Recurrent Aphthous Stomatitis", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/recurrent-aphthous-stomatitis

## Direct answer

Recurrent aphthous stomatitis is a common condition of recurrent, painful, round oral ulcers with a yellow-grey base and a red halo, occurring in otherwise healthy people. It is classified as minor, major or herpetiform, and minor ulcers are the commonest type. Its main importance lies in screening for systemic associations such as Behcet disease, coeliac disease and nutritional deficiency, while topical corticosteroids form the usual first-line treatment.

## What you must remember

- **Minor ulcers:** usually 1 to 5 mm, healing within one to two weeks without scarring, and the commonest form.
- **Major ulcers:** larger than 10 mm and deep, painful and slow to heal, often leaving a scar.
- **Herpetiform ulcers:** clusters of many tiny ulcers, typically 10 to 100, each about 1 to 3 mm, and not caused by herpes simplex virus.
- **Behcet disease:** recurrent oral ulcers together with genital ulcers, uveitis and skin lesions, with a positive pathergy test, must be excluded.
- **Intestinal disease:** coeliac disease and inflammatory bowel disease are associated with recurrent ulcers and should be considered in persistent cases.
- **Deficiencies:** iron, vitamin B12 and folate deficiencies are associated with ulcers and should be checked when they persist.
- **Triggers:** stress, minor trauma, sodium lauryl sulfate in toothpaste and certain foods are reported triggers.
- **Smoking:** smokers have fewer ulcers, and quitting may unmask disease in some patients.

## Comparing minor, major and herpetiform ulcers

The three types differ mainly in size, number and healing, which is why a careful description of the ulcer guides both the diagnosis and the treatment. The table summarises the differences most often tested.

| Feature | Minor | Major | Herpetiform |
|---|---|---|---|
| Size | Under 10 mm, usually 1 to 5 mm | Over 10 mm | About 1 to 3 mm each |
| Number | Few, usually one to five at a time | Few | Clusters of 10 to 100 |
| Healing | About one to two weeks | Several weeks | About one to two weeks |
| Scarring | None | Common | None |
| Typical treatment | Topical corticosteroids and anaesthetics | Systemic corticosteroids in severe disease | Topical corticosteroids |

Minor disease is far more common and is usually managed with topical measures alone. Major disease raises the question of a systemic association, while any persistent ulcer in any type needs the screening listed above.

Ulcers are assessed by their number, timing and relation to meals, since a clear pattern helps the clinician spot triggers and plan prevention. Diaries of flares are useful, because recurrence is common and treatment is often needed for flares rather than continuously.

## Where the exam tries to catch you

Stems on oral ulcers test whether you spot the systemic clue that changes management, rather than treating every ulcer as the same disease.

- **Trap:** labelling every oral ulcer as aphthous without asking about genital ulcers, eye symptoms or skin lesions. **Correct:** recurrent oral and genital ulcers with uveitis point to Behcet disease, which needs specialist evaluation.
- **Trap:** treating herpetiform ulcers as herpes simplex. **Correct:** herpetiform describes a clustered pattern and is not caused by herpes simplex virus, so a viral test is needed only when vesicles or a primary herpetic picture is present.
- **Trap:** ignoring coeliac disease or iron deficiency in persistent ulcers. **Correct:** haemoglobin, ferritin, vitamin B12, folate and coeliac serology are checked when ulcers recur frequently.

## Frequently asked questions

### What distinguishes minor from major recurrent aphthous stomatitis?

Minor recurrent aphthous stomatitis produces ulcers under 10 mm that heal within about two weeks without scarring, whereas major disease produces deep ulcers over 10 mm that heal slowly and can scar. Minor disease is far more common and is usually managed with topical therapy alone.

### Which systemic disease must be excluded in recurrent oral ulcers?

Behcet disease must be excluded in recurrent oral ulcers, particularly when genital ulcers, skin lesions or uveitis are present. A pathergy test and an eye examination help in the evaluation, and a specialist review is needed if the pattern is typical.

### Which blood tests are useful in recurrent aphthous stomatitis?

Haemoglobin, ferritin, vitamin B12 and folate are useful blood tests in recurrent aphthous stomatitis, along with coeliac serology when intestinal symptoms are present. These tests identify deficiencies and coeliac disease, which are treatable associations.

### How are severe recurrent aphthous ulcers treated?

Severe or frequent ulcers are treated first with topical corticosteroids, followed by short courses of systemic corticosteroids in severe disease. Other systemic agents are reserved for refractory cases under specialist supervision, because they carry significant side effects.