What is the Difference Between Aphthous Ulcers and Herpetic Ulcers

The key difference between aphthous ulcers and herpetic ulcers is that aphthous ulcers (or canker sores) occur on the non-keratinized tissues in the mouth, while herpetic ulcers (or cold sores) occur on the keratinized tissues in the mouth.

Aphthous ulcers and herpetic ulcers are two different types of oral ulcers or lesions. They are both recurrent, painful, superficial oral lesions. They persist for 14 days and normally heal spontaneously without leaving any scars. Moreover, aphthous ulcers are known as canker sores, while herpetic ulcers are known as cold sores.

CONTENTS

1. Overview and Key Difference
2. What are Aphthous Ulcers  
3. What are Herpetic Ulcers
4. Similarities – Aphthous Ulcers and Herpetic Ulcers
5. Aphthous Ulcers vs Herpetic Ulcers in Tabular Form
6. Summary – Aphthous Ulcers vs Herpetic Ulcers

What are Aphthous Ulcers?

Aphthous ulcers occur on the non-keratinized tissues in the mouth. These non-keratinized tissues include buccal mucosa, mucobuccal fold, the floor of the mouth, under and on the sides of the tongue, and on the soft palate. These ulcers are usually limited to a few numbers in the mouth. The center of the area where aphthous ulcers occur is ulcerated with a yellow or gray pseudomembrane, and it is encircled by a thin red rim or halo. The actual cause of aphthous ulcers is not known. However, it is the most common oral lesion.

Aphthous ulcers normally are considered bacterial, but this is not because they are caused by bacteria. When these lesions occur, bacteria are attracted to the necrotic tissue. Scientists believe aphthous ulcers are caused by triggers of the immune system in concert with stress, nutritional deficiencies, oral trauma (from a toothbrush or crusty French bread), hormones, or certain diseases. Sometimes allergies to certain foods, dyes, or preservatives may also cause aphthous ulcers. Aphthous ulcers can be diagnosed through medical history, clinical presentation, and laboratory testing. Furthermore, treatment options for aphthous ulcers include antibiotics such as tetracycline or minocycline, anesthetics such as benzocaine, over-the-counter topical steroids (prednisone), and a prescription topical agent called Aphthosol®.

What are Herpetic Ulcers?

Herpetic ulcers occur on the keratinized tissues in the mouth, such as lips, hard palate, gingival and alveolar ridge. They are also known as cold sores. Herpetic ulcers are small vesicles that rupture and form a crust. They especially occur in the lip. Inside the mouth, several small lesions often occur together, which come together to form a single large lesion. Moreover, herpetic ulcers are caused due to infection of the herpes simplex virus (HSV).

Herpetic ulcers can be diagnosed through physical examination, culturing of the fluid from the sores, and blood tests. Herpetic ulcers can be treated with medicines such as acyclovir and valacyclovir given as pills, creams, or as a shot.

What are the Similarities Between Aphthous Ulcers and Herpetic Ulcers?

• Aphthous ulcers and herpetic ulcers are two different types of oral ulcers or lesions.
• Both ulcers are recurrent, painful, superficial oral lesions.
• Both ulcers normally heal spontaneously without leaving any scars.
• They can be diagnosed through physical examination.
• They are treated through oral and topical medications.

What is the Difference Between Aphthous Ulcers and Herpetic Ulcers?

Aphthous ulcers (or canker sores) occur on the non-keratinized tissues in the mouth, while herpetic ulcers (or cold sores) occur on the keratinized tissues in the mouth. Thus, this is the key difference between aphthous ulcers and herpetic ulcers. Furthermore, aphthous ulcers are more common oral ulcers.

The below infographic presents the differences between aphthous ulcers and herpetic ulcers in tabular form for side-by-side comparison.

Summary – Aphthous Ulcers vs Herpetic Ulcers

Aphthous ulcers and herpetic ulcers are two different types of oral ulcers or lesions. Both ulcers are recurrent, painful, superficial oral lesions. They normally persist for 7 to 14 days and heal spontaneously without leaving any scars. Aphthous ulcers occur on the non-keratinized tissues in the mouth, while herpetic ulcers occur on the keratinized tissues in the mouth. So, this is the key difference between aphthous ulcers and herpetic ulcers.

Reference:

1. Chiang, Yi-Ting, et al. “Differential Diagnosis between Herpetic Gingivostomatitis and Herpetiform Aphthous Ulcerations.” Journal of Dental Sciences, U.S. National Library of Medicine, Sept. 2020.
2.“Canker Sore.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 3 Apr. 2018.

Image Courtesy:

1. “Aphthous stomatitis on the labial mucosa” By Farhan 9909 – Own work (CC BY-SA 4.0) via Commons Wikimedia
2. “Herpes(PHIL 1573 lores)” (Public Domain) via Commons Wikimedia