RECURRENT APHTHOUS STOMATITIS (RAS): LITERATURE REVIEW AND A CASE REPORT OF 2 CHALLENGING PAEDIATRIC CASES

Recurrent aphthous stomatitis (RAS) is a chronic con­dition of the oral mucosa, which typically first mani­fests during childhood or adolescence. Recurrent flare ups of solitary or multiple painful, erythematous mouth ulcers that hinder mastication and speech, and signifi­cantly diminish the short- and long-term quality of life and well-being of its sufferers, are the hallmark feature of this disease. The disorder is categorised into three clinical types: minor, major and herpetiform, with the minor variant occurring most frequently among paedi­atric patients, but the major variant proving considera­bly more debilitating. While the diagnosis of RAS relies upon well-defined clinical features and patient history, its underlying cause remains poorly defined and unders­tood. Nonetheless, several predisposing factors have been identified, with evidence suggesting that the pathological mechanism involves an underlying immunological dis­turbance. This immunological component explains why RAS tends to respond favourably to treatment with to­pical or systemic corticosteroids, especially in the acute phases of more severe cases. However, given the more restricted use of immunomodulatory drugs in children, the mainstay approach to managing RAS still centres on identifying and addressing potential predisposing factors, preventing infections and offering supportive care, with a wide range of local anaesthetics and antiseptics availa­ble to protect and treat active ulcers, as well as alleviate pain and discomfort. Regrettably, despite the existence of a varied therapeutic arsenal, no pharmacological in­tervention has been fully curative for RAS, as the pat­hogenic process persists unabated once the formation of lesions has occurred. In this article, we will report and discuss two cases of recalcitrant RAS in one female and one male teenage patient treated with oral prednisolone.