Aphthous ulcer classifications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Aphthous ulcers are classified according to the diameter of the lesion.

Recurrent Aphthous Stomatitis

Recurrent Aphthous Stomatitis is a T-cell mediated localized destruction of oral mucosa associated with an increased relative ratio of CD8+ T-cells to CD4+ T-cells.

Large aphthous ulcer on the inner side of the lower lip: 10 mm (1 cm) length and 5 mm width.

Minor aphthous ulcerations

This is the most common and least severe form of the disease. Aphthous ulcers develop in childhood and adolescence, and continue sporadically throughout life. Aphthous ulcers occur exclusively on non-keratinized, moveable mucosa, such as buccal (cheeks) and lingual mucosa, the floor of the mouth, and the soft palate. It is characterized as a yellow-gray ulcer surrounded by an erythematous halo less than 10 mm in diameter. They tend to heal without scarring in 7–10 days. Typical treatment is with topical steroids, although treatment is not necessary for healing to occur.

Major aphthous ulcerations

Major aphthous ulcers have the same appearance as minor ulcerations, but are greater than 10 mm in diameter and are extremely painful. They usually take more than a month to heal, and frequently leave a scar. These typically develop after puberty with frequent recurrences. They occur on moveable non-keratinizing oral surfaces, but the ulcer borders may extend onto keratinized surfaces. The lesions heal with scarring and cause severe pain and discomfort.

Major aphthous ulcer in the back of the mouth

Herpetiform aphthous ulcerations

This is the most severe form. It occurs more frequently in females, and onset is often in adulthood. It is characterized by small, numerous, 1–3 mm lesions that form clusters. They typically heal in less than a month without scarring. Palliative treatment is almost always necessary.[1]


  1. Bruce A, Rogers R (2003). "Acute oral ulcers". Dermatol Clin. 21 (1): 1–15. PMID 12622264.

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