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Canker sores, Acyclovir ineffective, now has cold sore type lesions on cheek and scalp. Want to consult viral specialist

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My husband has had canker sores for many years. They are debilitating at times and progressively worsening No one has any answers for him except "magic mouth wash. He has tried a short coarse of Acyclovir without help. He now has a few small "cold sore" type lesions on his cheek and scalp. I would like a consult with a viral specialist but do not know how to go about it
Posted Fri, 13 Apr 2012 in Infections
Answered by Dr. Mahesh Koregol 2 hours later

Thank you for the query.

An aphthous ulcer, also known as a canker sore, is a type of mouth ulcer that presents as a painful open sore inside the mouth or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious. The condition is also known as aphthous stomatitis (stomatitis is inflammation of the mucous lining), and alternatively as Sutton's Disease, especially in the case of major, multiple, or recurring ulcers.

Recurrent aphthous stomatitis is one of the most common oral conditions. At least 10% of the population has it.

The exact cause of many aphthous ulcers is unknown but citrus fruits (e.g., oranges and lemons), physical trauma, stress, lack of sleep, sudden weight loss, food allergies, immune system reactions,and deficiencies in vitamin B12, iron, and folic acid may contribute to their development.

Regular use of non-alcoholic mouthwash may help prevent or reduce the frequency of sores. Informal studies suggest that mouthwash may help to temporarily relieve pain.

In some cases, switching toothpastes can prevent aphthous ulcers from occurring,

Dental braces are a common physical trauma that can lead to aphthous ulcers and the dental bracket can be covered with wax to reduce abrasion of the mucosa. Avoidance of other types of physical and chemical trauma will prevent some ulcers, but, since such trauma is usually accidental, this type of prevention is not usually practical.
- in your husband's case it could be excess number of medications which could be causing stress and leading to canker sors for long time. There could be associated vitamin deficiency which needs to betreated by taking multivitamin tablets.

Nutrition: Zinc deficiency has been reported in people with recurrent aphthous ulcers.The few small studies looking into the role of zinc supplementation have reported mostly positive results, in particular for those people with zinc deficiency

- Taking antiviral medication like acyclovir is not recommended without confirming the diagnosis. If the lesions are enlarging in size, please visit a dentist and get biopsy of the lesion to rule out carcinoma in the mouth. Since you are mentioning the cold sore lesions on cheek and scalp, the spreading lesions are not good news. Please get biopsy of lesion to confirm diagnosis.

- Consult a dentist rather than viral medicine specialist.

Hope I have answered your query. Please write back if you any more queries.

Please do accept this answer if you have no more concerns.

Wishing you a speedy recovery.

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