What is causing the 2-day sore on her inner lip?

This 36-year-old female presents with a sore on the inner lip of 2 days duration. She thinks she had 1 years ago. She has been under a lot of stress, but has no medication exposure. She is otherwise healthy. 

What could be the cause? 

A. Aphtous stomatitis.

B. Herpes simplex.

C. Coxsackie A16.

D. Pemphigus vulgaris.

E. Trauma.

(Answer and discussion on next page)

Answer: Aphtous stomatitis

The 3 main clinical types of recurrent aphthous stomatitis (RAS) are:

• Minor aphthous ulcers (MiAUs, 80% of all RAS).

• Major aphthous ulcers (MjAUs).

• Herpetiform ulcers.

This patient had minor aphthous stomatitis. Most relevant studies have found hematinic (eg, iron, folic acid, vitamin B12) deficiencies in as many as 20% of patients with recurrent ulcers. In addition, deficiencies of vitamins B1, B2, and B6 have been noted in some patient cohorts. Workup for a hematinic deficiency is warranted if the lesions are frequent or if they have major subtype. 

Treatment is typically with a topical corticosteroid when there is a limited or minor disease, such as in this sitaution.