Aphthous Stomatitis
Signs and symptoms

Minor aphthous ulcer on the labial mucosa (lower lip is retracted). Note erythematous "halo" surrounding ulcer.

An aphthous ulcer usually begins as a round yellowish elevated spot surrounded by a red halo. This then breaks down into a punched-out ulcer, which is covered with a loosely attached yellow-grey fibrinous membrane that can be scraped away. Surrounding tissue is healthy and unaffected.

People may experience single or multiple ulcers. Multiple ulcers tend to be widely distributed throughout a person's mouth.

There are three types of aphthous ulceration:

• Recurrent minor aphthous ulceration (80% of cases). Ulcers are less than 5 mm in diameter. They heal within 1–2 weeks.
• Major aphthous ulceration. Ulcers are large (often more than 10 mm) and take weeks or months to heal. They can leave a scar.
• Herpetiform ulcers, which are multiple pinpoint ulcers that heal within a month. These are most commonly on the tongue.

People with aphthous stomatitis have no detectable systemic symptoms or signs other than oral. Generally, symptoms may include prodromal sensations such as burning, itching, or stinging, which may precede the appearance of any lesion by some hours; and pain, which is often out of proportion to the extent of the ulceration and is worsened by physical contact, especially with certain foods and drinks (e.g., if they are acidic or abrasive).

Ulceration episodes usually occur about 3–6 times per year. However, severe disease is characterized by virtually constant ulceration (new lesions developing before old ones have healed) and may cause debilitating chronic pain and interfere with comfortable eating. In severe cases, this prevents adequate nutrient intake leading to malnutrition and weight loss.