key: cord-0858644-8fyk51gz
authors: Riad, Abanoub; Kassem, Islam; Stanek, Jan; Badrah, Mai; Klugarova, Jitka; Klugar, Miloslav
title: Aphthous stomatitis in COVID‐19 patients: Case‐series and literature review
date: 2021-01-10
journal: Dermatol Ther
DOI: 10.1111/dth.14735
sha: 051f14e3d6055eedca2827b60ab4289f0ad818cc
doc_id: 858644
cord_uid: 8fyk51gz

nan

A retrospective analysis of our hospital records for COVID-19 patients during the period of April-September 2020 revealed that out of 1237 patients tested positive by our screening clinic, 21 patients (1.7%) complained of intra-oral pain related to aphthous stomatitis.

The patients had undertaken polymerase chain reaction (PCR) testing of SARS-COV-2 due to various purposes including pre-travel (14.3%) and post-travel (9.5%) screening, direct (9.5%) and indirect (4.8%) contact with an infected case, presenting with mild (42.9%), and moderate (19%) respiratory symptoms (Table 1) .

Their mean age was 31.57 ± 11.01 (16-56) years old, and 17 patients (81%) were females. While the vast majority were nonsmokers, only two patients (9.5%) were smokers. The PCR test confirmed their infection with a mean cycle threshold (Ct) value of 25.76 ± 6.21 palate (9.5%), gingiva (9.5%) and both of palate and gingiva (4.8%).

The mean size of the ulcers was 2 ± 0.86 (1-4) mm, and they caused pain with a mean intensity of 5.38 ± 1.5 (3) (4) (5) (6) (7) (8) which was measured by means of an 11-item numerical rating scale (NRS) when with "0" denoting "no pain" and "10" denoting "pain as bad as you can imagine". 4 The patients were asked whether they had experienced similar ulcerative lesions previously and based on their negative answer, the recurrent aphthous stomatitis (RAS) was ruled out. To manage their .125, respectively. Gender and age were not associated with any of the aphthous characteristics; however, tobacco smoking was the only risk factor significantly associated with pain intensity, the onset of aphthous stomatitis, anosmia, and ageusia P = .032, 0.042, .006, and ≤.001, respectively.

On reviewing the currently growing evidence on aphthous stomatitis of COVID-19 patients, we have found 22 cases reported in 8 publications (7 case reports, 1 prevalence study). [5] [6] [7] [8] [9] [10] [11] [12] Fourteen cases (63.6%) were from Americas, five (22.7%) from Europe, two (9%) from the Middle East, and one (4.5%) from Asia-Pacific (Table 2 ). The aphthous lesions were equally distributed across gender; however, female predominance was noticed in the prevalence study of Florida, which is similar to our series. 11 Seventeen patients (77.3%) were below 40 years old; similarly, the majority of our series (80.1%) was below 40 years old. The onset of aphthous lesions was reported in 10 patients only; it was estimated using the latency period since COVID-19 symptoms emergence which ranged between 0 and 10 days with two patients experienced aphthous stomatitis concurrently with COVID-19 symptoms onset. The most common sites were tongue, lower and upper lip; this pattern was in agreement with what we had found in our patients except for buccal mucosa which was affected only in one patient although it was the first site in our series.

To conclude, the current epidemiologic evidence does not seem to be different from the typical characteristics of aphthous stomatitis in terms of female predominance and young age affinity. 13 pathophysiology and prevalence of this lesion positively associated with immuno-compromised population.

Oral manifestations of COVID-19 disease: a review article

The CARE guidelines: consensus-based clinical case reporting guideline development

Guidelines for the clinical care of people with COVID-19. Australian Clinical Practice Guidelines. Published 2020

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The authors declare no potential conflict of interest. 

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.