title: Complex aphthosis: a large case series with evaluation algorithm and therapeutic ladder from topicals to thalidomide.
abstract: BACKGROUND
  Recurrent aphthous stomatitis is a common problem with 20% to 50% of the population having experienced simple aphthous lesions (ie, canker sores). Complex aphthosis is the diagnosis given to patients with almost constant >3 oral aphthae or recurrent oral and genital aphthae in the absence of Behcet's disease.
  
  
  METHODS
  Eighty-one patients were referred to the Wake Forest University School of Medicine, Department of Dermatology from 1995 to 2001 with the diagnosis of presumptive Behcet's disease. After exclusion of patients with simple recurrent aphthous stomatitis or non-aphthous oral disease, 64 patients remained. Ten of the patients met criteria for Behcet's disease. The remaining 54 patients were evaluated and treated as patients with the diagnosis of complex aphthosis.
  
  
  RESULTS
  The 54 patients with complex aphthosis became the subject of this study. Twelve patients had secondary complex aphthosis with 10/12 having inflammatory bowel disease. The remaining 42 patients had primary (ie, idiopathic) complex aphthosis. The therapeutic ladder for these patients ranged from topical therapy through oral colchicine and combination oral colchicine and oral dapsone therapy to oral thalidomide therapy.
  
  
  CONCLUSIONS
  Complex aphthosis is an important condition to distinguish from Behcet's disease. Appropriate patient evaluation algorithms and treatment therapeutic ladders are proposed.
authors.affiliation: Department of Dermatology at University of California, San Fransico, CA 94118, USA. letsingerj@derm.ucsf.edu
authors.forename: Julie Anne
authors.initials: JA
authors.lastname: Letsinger
authors.forename: Martha Ann
authors.initials: MA
authors.lastname: McCarty
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Jorizzo
mesh_terms: D000328:Adult; D000465:Algorithms; D001528:Behcet Syndrome / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D013281:Stomatitis, Aphthous / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D013792:Thalidomide / Q000627:therapeutic use
chemical_list: D013792:Thalidomide