Paediatric mouth ulcers



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PAEDIATRIC MOUTH ULCERS


ILLNESS

AGENT

SEVERITY

LESIONS

LOCATION

OTHER

HFMD







Papules, vesicles, ulcers on erythematous base

Usually 2-6mm



Gingiva, buccal mucosa, tongue, pharynx

Lesions on hands, feet, buttocks

Low grade fever



Herpangina

Coxsackie A/B

Enterovirus

Echovirus


Mod-severe

Papules, vesicles, ulcers on erythematous base

Usually 2-4mm



Post oral cavity

Tonsils, soft palate, uvula



Temp generally high

HSV Gigivostomatitis

HSV-1

Mod-severe

Vesicles

Ulcerations



Ant oral cavity, lips, gingiva, buccal mucosa

Temp usually high

Lymphadenopathy



Aphthous Stomatitis

Unknown

Mild-severe

Ulcers larger than viral exanthems

Lips, buccal mucosa, tongue, generally not diffuse

Afebrile

May be recurrent



Stevens-Johnsons

Immune

Mod-severe

Coalescent vesicles

which then ulcerate



Lips, gingiva, buccal mucosa, tongue, pharynx

Target lesions on skin

Diffuse mucus memb

involvement


Treatment = symptomatic

Topical xylocaine viscus

Difflam mouth wash

Chlorhexidine mouthwash

Painstop (Panadol/Nurofen usually insufficient)

Consider investigation (swab, bloods, LP) if:

Focal neurology (ie CNS involvement)



Immunosuppressed


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