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Modified Diagnostic Tree of Scully et al for a Patient with Recurrent Oral Ulcerations

Purpose: To evaluate a patient with recurrent oral ulcerations.

Description

Scully et al used a diagnostic tree to evaluate a patient with recurrent oral ulcerations. This can be expanded to include more diagnoses. The authors are from the University of London, Tel Aviv University and the University of California in San Francisco.


Patient selection: recurrent ulcerations

 

Parameters:

(1) systemic lesions

(2) fever

 

Systemic Lesions

Fever

Diagnosis

Yes

NA

Behcet's syndrome or neutropenia

No

No

recurrent aphthous stomatitis

No

Yes

PFAPA

 

where:

• PFAPA = periodic fever, aphthae, pharyngitis, adenitis

 

Additional factors that can be included:

(1) absolute neutrophil count (neutropenia)

(2) gluten intolerance (celiac disease, gluten sensitive enteropathy)

(3) recurrent infections (immunodeficiency state)

(4) gastrointestinal symptoms (idiopathic inflammatory bowel disease)


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Specialty

Objective

ICD-10