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of the general population suffers at some point in their lives&#46; There is a familial aggregation and is more common in women&#46; It usually starts in childhood&#44; adolescence&#44; or young adults under 30&#44; tending to decrease over time&#44; both in severity and frequency&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pathogenesis</span><p id="par0020" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of ROA are unknown so far&#46; It is likely that in genetically predisposed individuals&#44; immune dysfunction linked to various triggers facilitates the development of aphtosis&#46; Local immunological dysfunction could be related to increased T-lymphocyte subpopulations &#40;CD4 and CD8&#41;&#44; and plays an important role in altered immune responses in which the initial stimulus is not known&#46; Changes in serum levels of immunoglobulins have also been described&#44; which may play a role in the pathogenesis of ulcers and alterations in cell adhesion molecules that are essential to maintain a stable structure of the oralepithelium have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Possible local and general factors have been implicated and may favor the development or worsening of ulcers<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Genetic&#46; There is a familial aggregation&#44; and some studies have correlated ROA to HLA<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> antigens&#46; The chance of developing aphthous lesions is 90&#37; in people with two parents who present them&#44; reduced to 20&#37; in those in which parents have never presented them&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Immune imbalance in relation to likely immune events triggered by transitory immunodeficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Infections probably mean little&#46; There is evidence of possible cross-reactivity between bacterial antigens and the oral mucosa&#46; Potential associations with infection by <span class="elsevierStyleItalic">Helicobacter pylori</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> as well as human herpes virus-6<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> have been seen&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Mechanical trauma<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> &#40;bites&#44; dentures&#44; toothbrushes&#44; etc&#46;&#41;&#44; thermal or chemical lesions&#46; ROA has been related to the local irritant action of sodium lauryl sulfate&#44; a surfactant used in many types of toothpaste&#44; which can influence people with ROA&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Smoking cessation&#46; In non-smokers there is decreased keratinization of the mucosa which is more sensitive&#44; though&#44; when lesions are present&#59; when smoking&#44; there is no effect on their severity&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Deficiency of vitamins and minerals like iron&#44; folic acid and vitamin B12 in patients with frequent ROA&#44; without significant differences while studying each element separately&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In other studies there is a significant association with vitamin A and B12<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and B1<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> vitamin deficiency&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Hypersensitivity to foods &#40;chocolate&#44; cheese&#44; citrus&#44; tomatoes&#44; seafood&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> Often allergy or food intolerance is associated with atopy&#44; and in patients with a family history of ROA&#44; a significant association with a history of atopy<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> has been seen&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Hormonal changes&#46; ROA has often been associated with the menstrual cycle&#44; but this relationship has not been established clearly&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Stress&#46; It may play a role as a triggering or modifying factor rather than causing ROA&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a></p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Manifestations</span><p id="par0075" class="elsevierStylePara elsevierViewall">The lesions are initiated by an inflammatory foci in the form of painful erythematous macules&#46; Within hours&#44; keratolysis mediated by cytokines leads to a shallow&#44; rounded or oval&#44; well-defined ulcer&#44; with a raised inflammatory halo in which microscopically one can observe a large numbers of neutrophils&#44; lymphocytes&#44; and monocytes&#46; The center is necrotic and covered by a yellowish&#8211;gray pseudomembrane &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; They present centrifugal growth and healing is achieved by re-epithelialization from the edges&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Their presence may hinder speech&#44; eating&#44; and swallowing&#46; Pain is similar to that resulting from a burn&#44; and increases with contact with hot foods and spices&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">There are three different forms of presentation of ulcers in ROA&#58; minor&#44; major&#44; and herpetiform&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Minor aphthosis is the most common&#46; It usually affects non-keratinized mucosa&#44; especially the lips&#44; cheeks&#44; and sides of the tongue&#46; It is characterized by single or few ulcers &#40;less than 5&#41; with a size of less than 1<span class="elsevierStyleHsp" style=""></span>cm&#46; They are usually concentrated in the front of the mouth&#44; and often occur 2&#8211;4 times a year&#46; They present spontaneous healing without scarring in 1&#8211;2 weeks&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Major aphthosis is less common&#46; It typically affects the keratinized and non-keratinized mucosa&#44; especially the soft palate&#46; It occurs in the form of single or few ulcers &#40;less than 5&#41; of a size equal to or greater than 1<span class="elsevierStyleHsp" style=""></span>cm&#46; They usually have a predilection for the back of the mouth&#46; They are deeper and more painful than minor aphthae&#46; It takes 2&#8211;12 weeks to heal and leave a scar&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Aphthosis herpetiformis is the least common&#46; It usually affects non-keratinized mucosa&#44; especially the floor of the mouth and ventral surface of the tongue&#46; It usually has a later onset than the two previous forms&#44; occurring in the second or third decade of life&#46; It manifests with a variable number of ulcers &#40;10&#8211;100&#41; with a size of 1&#8211;3<span class="elsevierStyleHsp" style=""></span>mm appearing simultaneously and can coalesce&#46; It takes 1&#8211;4 weeks to heal and may leave scars&#44; especially in the coalescing ulcers&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Differential Diagnosis</span><p id="par0105" class="elsevierStylePara elsevierViewall">The presentation of oral aphtae helps in the differential diagnosis&#46; According to it&#44; diagnosis can be guided according to whether it is a solitary ulcer&#44; recurrent episodes of one or more ulcers that heal spontaneously&#44; a single episode preceded by blisters&#44; ulcers affecting multiple oral locations&#44; or persistent oral aphthosis affecting different sites &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> With the emergence of recurrent episodes of one or more ulcers that heal spontaneously&#44; the differential diagnosis must be made between recurrent aphthous stomatitis&#44; Beh&#231;et&#39;s disease&#44; aphthous-like-ulcers due to systemic diseases or drugs and recurrent erythema multiforme&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In addition to the presentation of oral aphtae&#44; the severity of clinical manifestations of oral aphthosis also helps to make the differential diagnosis&#46; With this criterion they are classified as simple aphthosis and aphthosis complex &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#8211;36</span></a> Simple aphthosis presentation is more frequent&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It presents with recurrent oral lesions in any of the three ways &#40;minor&#44; major or herpetiformis&#41;&#44; usually with 3&#8211;6 episodes per year that are of short duration and resolve spontaneously&#44; allowing the diagnosis of ROA&#46; Aphthosis complex manifests prolonged outbreaks that are often continuous&#44; with three or more oral lesions and may be associated with genital or perianal ulcers&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Faced with a complex oral aphthosis&#44; the first step should be to rule out Beh&#231;et&#39;s disease&#46; Once the diagnosis has been excluded&#44; oral aphthosis complex can be classified as primary or secondary&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">To establish the diagnosis of primary complex aphthosis&#44; one must discard all the processes that can produce and that would classify it as secondary &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> but even so&#44; it should be noted that the diagnosis of Beh&#231;et&#39;s disease can be difficult in the early stages and may be delayed up to several years&#44; which justifies a careful follow-up of all patients diagnosed with complex primary aphthosis&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Secondary complex oral aphthosis may be a sign of many systemic processes that may present with episodes similar to recurrent oral aphthosis&#46; The most common is inflammatory bowel disease&#44; of which it may be its first manifestation&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In clinical rheumatology practice it is not uncommon to find ulcers secondary to certain drugs and some diseases with joint manifestations&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">As for drugs&#44; there have been many cases of oral ulceration in relation to them&#44; and among them&#44; several are commonly used in rheumatology&#44; even to treat systemic diseases&#44; which in turn can cause oral aphthosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;42</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">With regard to the systemic diseases that may have joint involvement &#40;arthritis or joint pain&#41;&#44; some include the presence of ulcers among their diagnostic criteria&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Lupus erythematosus&#58; oral or nasopharyngeal ulcers&#44; usually painless&#44; observed by a physcian&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a></p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2&#46;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Beh&#231;et&#39;s disease&#58; recurrent oral ulcers &#40;major&#44; minor or herpetiform aphthosis&#41; seen by a physician or patient and having occurred at least three times in a period of 12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Wegener&#39;s granulomatosis&#58; oral or nasal inflammation to the development of painful or painless oral ulcers or purulent or bloody nasal discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Crohn&#39;s disease&#58; multiple small aphthous ulcerations in the upper and lower digestive tract&#44; not necessarily with longitudinal organization&#44; for at least three months&#44; plus caseous granulomas&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">5&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">PFAPA syndrome &#40;&#8220;Periodic Fever&#44; aphthous stomatitis&#44; pharyngitis&#44; cervical adenitis&#8221;&#41;&#58; oral ulcers&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a></p></li></ul></p><p id="par0170" class="elsevierStylePara elsevierViewall">Other systemic diseases that have or may have joint involvement&#44; and sometimes present with oral ulcers&#44; but their presence is not included among diagnostic criteria&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">1&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Reactive arthritis may be present and typically are not painful&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a></p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">2&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Sj&#246;gren&#39;s syndrome&#58; a dry oral mucosa often present ulcers&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">3&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Sweet syndrome or acute neutrophilic febrile dermatosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a></p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">4&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Ulcerative colitis&#58; ulcers are more prevalent than those found in a control group of patients with functional disorders of intestinal motility&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> but are more persistent and tend to be larger&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a></p></li></ul></p><p id="par0195" class="elsevierStylePara elsevierViewall">Another syndrome that may be considered in the differential diagnosis of rheumatic diseases capable of producing an oral aphthosis complex is the MAGIC &#40;&#8220;mouth and genital ulcers with inflamed cartilage&#8221;&#41; syndrome&#44; which has no established diagnostic criteria&#44; but is manifested by an overlap between Beh&#231;et&#39;s syndrome in which recurrent ulcers are a diagnostic criterion and relapsing polychondritis&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Treatment</span><p id="par0200" class="elsevierStylePara elsevierViewall">Lack of knowledge regarding the cause of ROA makes it impossible to cure the disease&#46; Existing symptomatic treatments are directed at reducing pain&#44; shortening the healing of ulcers&#44; and increasing the length of asymptomatic periods between attacks&#46; When ulcers are small&#44; with few symptoms and infrequent&#44; topical treatment along with dietary measures such as avoiding foods that can worsen ulcers is sufficient&#44; including those that due to their hard texture could erode the oral mucosa&#46; If identified precipitating factors can be corrected&#44; and act on them&#46; If there is a basic process that explains the appearance of aphthosis&#44; treatment of it leads to improvement&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">A systematic review of the outcome of various topical treatments used in ROA reached the following conclusions as to their ability to decrease the incidence of ulcers and their analgesic power<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a>&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">1&#46;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Chlorhexidine<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">a&#46;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Incidence of ulcer&#46; Compared with placebo mouthwash may be more effective in reducing the severity&#44; incidence and duration of the ulcer &#40;very low quality evidence&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">b&#46;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Analgesia&#46; Compared with placebo gel may be more effective in reducing pain &#40;very low quality evidence&#41;&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">2&#46;</span><p id="par0225" class="elsevierStylePara elsevierViewall">Hexetedine<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">a&#46;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Incidence of ulcer&#46; Compared with placebo may not be more effective in reducing the severity&#44; incidence and duration of the ulcer &#40;very low quality evidence&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">b&#46;</span><p id="par0235" class="elsevierStylePara elsevierViewall">Analgesia&#46; Compared with placebo may not be more effective in reducing pain &#40;very low quality evidence&#41;&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">3&#46;</span><p id="par0240" class="elsevierStylePara elsevierViewall">Carbenoxolone gel or mouthwash<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">a&#46;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Incidence of ulcer&#46; Compared with placebo mouthwash may be more effective in reducing the number of ulcers &#40;very low quality evidence&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">b&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Analgesia&#46; Compared with placebo mouthwash may be more effective in reducing pain &#40;very low quality evidence&#41;&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">4&#46;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Topical corticosteroids<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">a&#46;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Incidence of ulcer&#46; Compared with placebo may be more effective in reducing the incidence of new ulcers and their duration &#40;very low quality evidence&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">b&#46;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Analgesia&#46; Compared with placebo may be quicker to reduce the amount and duration of pain without causing adverse local or systemic events &#40;very low quality evidence&#41;&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">5&#46;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Local anesthetic&#58; benzidamide mouthwash<ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">a&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Incidence of ulcer&#46; Compared with placebo may not be more effective in reducing the incidence of new ulcers &#40;very low quality evidence&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">b&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Analgesia&#46; Compared with placebo may not be more effective in reducing pain&#44; but may be preferred for its transient topical analgesic effect &#40;very low quality evidence&#41;&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">6&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Tetracycline mouthwash<ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">a&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Analgesia&#46; Compared with placebo may be more effective in reducing pain &#40;very low quality evidence&#41;&#46;</p></li></ul></p></li></ul></p><p id="par0295" class="elsevierStylePara elsevierViewall">Other topical treatments such as sucralphate<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> have also been proposed&#44; which act by forming a protective film on the bottom of the oral ulcers&#44; reducing pain and shortening healing time&#46; Amlexanox 5&#37; also leads to a rapid healing of ulcers when applied as oral ointment&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">Local cauterization by caustic solutions such as silver nitrate<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> has been employed&#46; Cryotherapy with liquid nitrogen has been used&#44; but has not shown greater analgesic effect than placebo&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> Laser treatment<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> has also been used&#44; as has low intensity ultrasound&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">If ROA presents with recalcitrant recurrent episodes several systemic treatments have been recommended with varying success&#44; including&#58; steroids&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a> pentoxiphylin&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a> levamisole&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> colchicine and dapsone&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> thalidomide&#44;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">66&#44;67</span></a> biologic drug<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a> treatment&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> clophazimine&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a> and others &#40;methotrexate&#44; azathioprine&#44; cyclosporine&#44; cyclophosphamide&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">71&#44;72</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0320" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recurrent aphthous stomatitis consists on recurring oral ulcers of unknown etiology&#46; Oral ulcers may be different in number and size depending on the clinical presentation&#44; which also determines the time needed for healing&#46; Moreover&#44; there are factors associated to outbreaks but not implicated in its etiopathogenesis&#46; When oral aphthosis has a known etiology&#44; it is not considered as recurrent aphthous stomatitis&#46; The severity and the clinical presentation helps in the differential diagnosis&#46; Treatment is symptomatic in recurrent aphthous stomatitis while&#44; if there is an underlying systemic disease&#44; the treatment of such disease is need in addition to topical treatment&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La aftosis oral recurrente consiste en la aparici&#243;n de episodios repetidos de &#250;lceras sin que exista una causa conocida&#46; Son &#250;lceras orales en n&#250;mero y tama&#241;o variable seg&#250;n la forma de presentaci&#243;n&#44; la cual tambi&#233;n condiciona el tiempo necesario para la curaci&#243;n&#46; Existen factores que favorecen su aparici&#243;n&#44; pero no son causales&#46;&#160;En determinados casos&#44; los brotes de aftosis tienen una causa conocida y entonces no se considera una aftosis oral recurrente&#46; La forma de presentaci&#243;n de las &#250;lceras y su gravedad son claves en el diagn&#243;stico diferencial&#46; El tratamiento es sintom&#225;tico en la aftosis oral recurrente&#44; mientras que si existe una causa sist&#233;mica de base el tratamiento ser&#225; el indicado en este caso adem&#225;s del t&#243;pico&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Riera Matute G&#44; Riera Alonso E&#46; La aftosis oral recurrente en Reumatolog&#237;a&#46; Reumatol Clin&#46; 2011&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.05.003">doi&#58;10&#46;1016&#47;j&#46;reuma&#46;2011&#46;05&#46;003</span>&#46;</p>"
      ]
    ]
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        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lesions start through an inflammatory foci in the form of erythematous painful macules&#46;</p>"
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      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; Modified from Letsinger al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm for ROA differential diagnosis&#46;</p>"
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      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; Modified from Scully et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>"
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Infectious disease</span><span class="elsevierStyleHsp" style=""></span>Herpetic stomatitis<span class="elsevierStyleHsp" style=""></span>Chicken pox<span class="elsevierStyleHsp" style=""></span>Herpes zoster<span class="elsevierStyleHsp" style=""></span>Coxsackie Virus &#40;hand-foot disease&#44; herpangina&#41;<span class="elsevierStyleHsp" style=""></span>Infectious Mononucleosis<span class="elsevierStyleHsp" style=""></span>HIV infection<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleHsp" style=""></span>Acute necrotizing gingivitis<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mycobacterium tuberculosis</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Treponema pallidum</span><span class="elsevierStyleHsp" style=""></span>Fungal infections<span class="elsevierStyleHsp" style=""></span>Protozoal infections &#40;leishmania&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Malignant tumors</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Blood diseases</span><span class="elsevierStyleHsp" style=""></span>Anemia<span class="elsevierStyleHsp" style=""></span>Leukemia<span class="elsevierStyleHsp" style=""></span>NeutropeniaWhite cell dyscrasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gartrointestinal diseases</span><span class="elsevierStyleHsp" style=""></span>Celiac disease<span class="elsevierStyleHsp" style=""></span>Crohn&#39;s diseaseUlcerous colitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Skin diseases</span><span class="elsevierStyleHsp" style=""></span>Lichen planus<span class="elsevierStyleHsp" style=""></span>Pemphigus<span class="elsevierStyleHsp" style=""></span>Penphigoid<span class="elsevierStyleHsp" style=""></span>Erithema multiformis<span class="elsevierStyleHsp" style=""></span>Herpetiform dermatitis<span class="elsevierStyleHsp" style=""></span>Lineal IgA disease<span class="elsevierStyleHsp" style=""></span>Ampule Epidermolysis<span class="elsevierStyleHsp" style=""></span>Chronic ulcerous stomatitis<span class="elsevierStyleHsp" style=""></span>Other dermatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Rheumatic diseases</span><span class="elsevierStyleHsp" style=""></span>Lupus erithematosus<span class="elsevierStyleHsp" style=""></span>Beh&#231;et&#39;s syndrome<span class="elsevierStyleHsp" style=""></span>MAGIC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> syndrome<span class="elsevierStyleHsp" style=""></span>Sweet syndrome<span class="elsevierStyleHsp" style=""></span>Reactive arthritis<span class="elsevierStyleHsp" style=""></span>Wegener¿s granulomatosisPFAPA<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Drugs</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Radiotherapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab212088.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara">Human immunodeficiency virus&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara">Mouth and Genital ulcers with inflamed cartilages&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara">Periodic fever&#44; aphthous stomatitis&#44; pharyngitis&#44; cervical Adenitis&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Main Causes of Oral Ulcers&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; Modified from Field et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Single ulcer</span><span class="elsevierStyleHsp" style=""></span>Trauma<span class="elsevierStyleHsp" style=""></span>Squamous carcinoma<span class="elsevierStyleHsp" style=""></span>Infections &#40;syphilis&#44; tuberculosis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Spontaneous episodes of one or more ulcers that heal spontaneously</span><span class="elsevierStyleHsp" style=""></span>Recurrent aphtous stomatitis<span class="elsevierStyleHsp" style=""></span>Beh&#231;et&#39;s disease<span class="elsevierStyleHsp" style=""></span>&#8220;<span class="elsevierStyleItalic">Aphthous-like-ulcers</span>&#8221; due to systemic disease or drugs<span class="elsevierStyleHsp" style=""></span>Recurrent erithema multiformis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Single episode of vesicle preceded ulcers which affect multiple oral localizations</span><span class="elsevierStyleHsp" style=""></span>Viral infections &#40;herpangina&#44; primary herpetic stomatitis&#41;<span class="elsevierStyleHsp" style=""></span>Erithema multiformis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Persistent oral ulcers affecting different localizations</span><span class="elsevierStyleHsp" style=""></span>Skin and mucosa &#40;oral lichen planus&#41;<span class="elsevierStyleHsp" style=""></span>Autoimmune ampules &#40;oral pemphigus&#41;<span class="elsevierStyleHsp" style=""></span>Gastrointestinal &#40;Crohn&#39;s disease&#41;<span class="elsevierStyleHsp" style=""></span>Hematological &#40;leukemia&#41;<span class="elsevierStyleHsp" style=""></span>Drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Main Causes of Oral Ulcers According to Their Presentation&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; Modified from Letsinger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Simple aphtosis&#58;</span> recurrent attacks of minor&#44; major or herpetiform ulcers&#44; with disease free periods&#44; mostly in young persons &#40;ROA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complex aphtosis&#58;</span> almost constant presence of &#8805;3 oral ulcers or recurrent oral and genital ulcers&#46; Excluding Beh&#231;et&#39;s disease&#44; it may be&#58;<span class="elsevierStyleHsp" style=""></span>Primary or idiopathic complex aphtosis<span class="elsevierStyleHsp" style=""></span>Complex secondary aphtosis&#58;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Intestinal inflammatory disease<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>HIV infection &#40;human immunodeficiency virus&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cyclic neutropenia<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PFAPA syndrome &#40;&#8220;<span class="elsevierStyleItalic">Periodic Fever&#44; Aphthous stomatitis&#44; Pharyngitis&#44; cervical Adenitis</span>&#8221;&#41;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Iron&#44; zinc&#44; folate or vitamin B<span class="elsevierStyleInf">1</span>&#44; B<span class="elsevierStyleInf">2</span>&#44; B<span class="elsevierStyleInf">6</span>&#44; B<span class="elsevierStyleInf">12</span> deficiency<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Gluten enteropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Beh&#231;et&#39;s disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAGIC syndrome &#40;&#8220;<span class="elsevierStyleItalic">Mouth And Genital ulcers with Inflamed Cartilages</span>&#8221;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Clinical Classification of Ulcers&#46;</p>"
        ]
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      5 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alendronate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diclofenac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Interpheron&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Penicillamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alprazolam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dideoxycytidine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Interleukin-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Penicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Allopurinol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dilthiazem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imipramine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Potassium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disopiramide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isoprenaline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proguanile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chloride&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atorvastatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Docetaxel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ketorolac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Promethazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aurothiomalate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxorrhubicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lamotrigin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Propanolol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azathioprine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emepronius-Bromide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leflunomide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Propilthyouracil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aztreonam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enalapril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Levamizole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quinidine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Barbiturates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythromicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lythium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ritonavir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bleomi&#161;ycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Everolimus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Losartan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sachinavir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Captopril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Phenilbutazone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melphan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SertralineStreptomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carbamazepine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Phenindione&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metamizole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sulphonamides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cyclosporine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Phenitoin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sulindac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cisplatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fluconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metronidazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Terbutaline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Citarabine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Flunisolide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mitomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tetracyclines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Claritromicina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fluoxetin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Molgramostim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vancomycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clonazepam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gancyclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Naproxen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vincristin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chloranphenicole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydralazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nicorandil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venlaphaxine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydroxiurea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Niphedipine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Warfarin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chloropromacine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ibuprofen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Olanzapine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zidovudin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Codeine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indomethacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pancreatine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab212085.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Drugs That Produce Oral Ulcers&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:72 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aphthous ulceration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Scully"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
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                        "volumen" => "355"
                        "paginaInicial" => "165"
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                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
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              "etiqueta" => "2"
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
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                            0 => "C&#46; Scully"
                            1 => "R&#46; Shotts"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
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                          ]
                        ]
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                  "host" => array:1 [
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                            "web" => "Medline"
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                        ]
                      ]
                    ]
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            3 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                          "etal" => false
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                          ]
                        ]
                      ]
                    ]
                  ]
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            4 => array:3 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;R&#46; Porter"
                            1 => "C&#46; Scully"
                            2 => "A&#46; Pedersen"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                    ]
                  ]
                ]
              ]
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            5 => array:3 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "C&#46; Scully"
                            1 => "M&#46; Gorsky"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                      ]
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            6 => array:3 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
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                            0 => "R&#46;S&#46; Rogers III"
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                  "host" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Factores inmunol&#243;gicos y microbiol&#243;gicos asociados con la etiolog&#237;a de la estomatitis aftosa recurrente"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Correnti"
                            1 => "R&#46; Guti&#233;rrez"
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                      "titulo" => "Expresi&#243;n de mol&#233;culas de adhesi&#243;n y subpoblaciones linfocitarias en lesiones de pacientes con estomatitis aftosa recurrente"
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                        0 => array:2 [
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                      "titulo" => "Determinaci&#243;n de subpoblaciones linfocitarias en lesiones de pacientes con estomatitis aftosa recurrente"
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                          "etal" => false
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                            3 => "A&#46; De Guglielmo"
                          ]
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                    ]
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              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagn&#243;stico diferencial de las &#250;lceras orales"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;P&#46; Ortiz Vega"
                            1 => "E&#46; Chimenos K&#252;stner"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Close association of HLA-B52 and HLA-B44 antigens in Israeli Arab adolescents with recurrent aphthous stomatitis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Jaber"
                            1 => "A&#46; Weinberger"
                            2 => "T&#46; Klein"
                            3 => "I&#46; Yaniv"
                            4 => "M&#46; Mukamel"
                          ]
                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Otolaryngol Head Neck Surg"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11177036"
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