Abstract and Introduction
Abstract
Recurrent aphthous stomatitis is the most common oral mucosal lesion found in childhood. It is a painful inflammatory process of the oral mucosa. Although the exact etiology of recurrent aphthous stomatitis is unknown, different hematinic, a nutrient required for the formation of blood cells, deficiencies have been proposed. This case study describes iron deficiency anemia in an 8-year-old female who suffered from severe herpetiform recurrent aphthous stomatitis, a rare clinical form in pediatric patients. A complete history and physical examination to rule out systemic disease is vital for an accurate diagnosis and care plan. Replacement therapy with oral ferrous fumarate led to improvement of the lesions in this patient. Clinicians, including pediatric nurses, should always consider recurrent aphthous stomatitis in a pediatric patient as a manifestation of an underlying health disorder.
Introduction
Recurrent aphthous stomatitis is an oral lesion that usually occurs first in childhood and affects up to 25% of the general population (Stoopler & Musbah, 2013). There are three manifestations of recurrent aphthous stomatitis: minor recurrent aphthous stomatitis (less than 70% to 85% of cases), major recurrent aphthous stomatitis (10% to 15% of cases), and herpetiform recurrent aphthous stomatitis (5% to 10% of cases) (Edgar et al., 2017). Minor recurrent aphthous stomatitis consists of ulcers less than one centimeter in diameter and usually heals within two weeks without scarring. Major form is specified as ulcers greater than one centimeter that persist for more than two weeks and heal with scarring (Stoopler & Musbah, 2013). The third type is herpetiform recurrent aphthous stomatitis. Despite the name 'herpetiform,' lesions are not associated with herpes simplex virus (Akintoye & Greenberg, 2014). Herpetiform recurrent aphthous stomatitis presents as multiple small clusters of pinpoint lesions that sometimes coalesce to form large irregular ulcers and improve within two weeks (Tarakji et al., 2015). Clinically, lesions are typically de tected on non keratinized oral mucosa as round ulcers covered by a white or yellow pseudomembrane with an erythematous halo (Stoopler & Musbah, 2013).
Etiopathogenesis of recurrent aphthous stomatitis is uncertain and often multifactorial (Stoopler & Musbah, 2013). Factors that predispose patients to recurrent aphthous stomatitis include hormonal changes, stressors, infections, traumas, dryness, irritants, toxin agents, genetic factors, hypersensitivities, and auto immune conditions (Akintoye & Greenberg, 2014). Systemic diseases can present with recurrent aphthous stomatitis. Conditions include human immunodeficiency virus (HIV) infection, Crohn's disease, Bechet's disease, Reiter's syndrome, and gluten-sensitive enteropathy (Volkov et al., 2005). Recurrent aphthous stomatitis can also result from a hematinic deficiency, especially lack of iron, folic acid, and vitamin B12 (Saikaly et al., 2018).
Treatment of recurrent aphthous stomatitis depends upon the frequency, distribution, and severity of the lesions (Stoopler & Musbah, 2013). Therapy aims to decrease symptoms, reduce ulcer number and size, promote healing, increase disease-free periods, and reduce recurrence frequency (Akintoye & Greenberg, 2014). Drug therapy is considered for patients who experience multiple episodes of recurrent aphthous stomatitis and present with symptoms of severe pain and difficulty eating. Health care providers should determine if possible hematinic deficiencies cause the onset of disease before initiating the medications for recurrent aphthous stomatitis (Chiang et al., 2019; Tarakji et al., 2015). Conventional treatment for recurrent aphthous stomatitis is glucocorticoids and antimicrobial therapy. Medications may be applied as topical agents, mouthwashes, or intralesional injections, or systemically by the oral route. A topical anesthetic, such as 2% viscous lidocaine, is used to decrease pain (Tarakji et al., 2015). Sucralfate applied to the lesions may also alleviate pain (Alpsoy et al., 1999).
Pediatr Nurs. 2022;48(2):94-96. © 2022 Jannetti Publications, Inc.
