Prednisone

A canker sore is a painful, open sore in the mouth. Canker sores are white or yellow and surrounded by a bright red area. They are benign (not cancer).

See also: Herpes, Fever blisters and Canker sores

Aphthous ulcer; Ulcer - aphthous

Canker sores are a common form of mouth ulcer. They occur in women more often than men. They may occur at any age, but usually first appear between the ages of 10 and 40.

Canker sores usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.

Canker sores can run in families. They may also be linked to problems with the body's immune (defense) system. The sores may occur after a mouth injury due to dental work, aggressive tooth cleaning, or biting the tongue or cheek.

Canker sores can be triggered by emotional stress, dietary deficiencies (especially iron, folic acid, or vitamin B-12), menstrual periods, hormonal changes, food allergies, and similar situations. They occur most commonly with viral infections. In some cases, the cause can not be identified.

The first symptom is usually a tingling or burning sensation that you feel before other symptoms develop.

The following symptoms may then occur:

• Painful, red spot or bump that develops into an open ulcer
  • Center is colored white or yellow
  • Usually small (under 1 cm) but occasionally larger
  • Single bump or group of bumps (crops)
• Sore may turn gray just before starting to heal

Less common symptoms include:

• Fever
• General discomfort or uneasiness (malaise)
• Swollen lymph nodes

Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks. Particularly large ulcers (greater than 1 cm in diameter) often take longer to heal (2 to 4 weeks). Occasionally, a severe occurrence may be accompanied by nonspecific symptoms of illness, such as fever. Canker sores often return.

Your health care provider can often make the diagnosis by looking at the sore. If canker sores persist or continue to return, tests should be done to rule out other causes, such as erythema multiforme, drug allergies, herpes infection, bullous lichen planus, and other disorders.

Canker sores are not cancer and do not cause cancer. There are types of cancer, however, that may first appear as a mouth ulcer that does not heal. See: Squamous cell carcinoma.

A biopsy may be used to distinguish a canker sore from other causes of mouth ulcers.

Treatment is usually not necessary. In most cases, the canker sores go away by themselves.

If you have a canker sore, you should not eat hot or spicy foods, which can cause pain. Mild, over-the-counter mouth washes or salt water may help. There are over-the-counter medicines that soothe the painful area. These medicines are applied directly to the sore area of the mouth.

The easiest home remedy is a mixture of half hydrogen peroxide and half water. Use a cotton swab to apply the mixture directly to the canker sore. Then, dab a small amount of Milk of Magnesia on the canker sore, three to four times a day. This is soothing and may also help it heal.

Another home remedy is to mix half Milk of Magnesia and half Benadryl liquid allergy medicine. Swish this mixture in your mouth for about 1 minutes, then spit it out.

Other treatments for more severe cases include applying fluocinonide gel (Lidex) or chlorhexidine gluconate mouthwash. Powerful anti-inflammatory medicines called corticosteroids are sometimes used.

To prevent bacterial infection, brush and floss your teeth regularly and visit the dentist for routine care.

Canker sores usually heal on their own. The pain usually decreases in a few days. Other symptoms disappear in 10 to 14 days.

Antibiotic treatment for canker sores may lead to oral thrush (a type of mouth infection) or other Candida infections. Rarely, bacterial infections such as cellulitis and Ludwig's angina may occur.

Canker sores are not cancer and don't lead to cancer. But if you have a mouth ulcer lasts more that 2 weeks, you should see your doctor to rule out possible cancer.

Apply home treatment and call your health care provider if symptoms of canker sores persist or worsen, or canker sores recur more often than 2 or 3 times per year.

Call your health care provider if symptoms are associated with other problems such as fever, diarrhea, headache, or skin rash.

Femiano F, Lanza A, Buonaiuto C, et al. Guidelines for diagnosis and management of aphthous stomatitis. Pediatr Infect Dis J. 2007;26:728-732.

Gonsalves WC, Chi AC, Neville BW. Common oral lesions: Part I. Superficial mucosal lesions. Am Fam Physician. 2007;75(4):501-507.

Cranial mononeuropathy VI is a nerve disorder that causes people to see two of the same image (double vision).

Abducens palsy; Lateral rectus palsy

Cranial mononeuropathy VI is damage to the sixth cranial (skull) nerve. This nerve, also called the abducens nerve, helps control eye movement.

Disorders of this nerve can occur with:

• Brain aneurysms
• Diabetic neuropathy
• Increased pressure in the skull (intracranial pressure)
• Infections (such as meningitis or sinusitis)
• Tissue damage from loss of blood flow (infarction)
• Trauma (caused by head injury or accidentally during surgery)
• Tumors

In some people, there is no obvious cause.

Because there are common nerve pathways through the skull, the disorder may affect other cranial nerves (such as the third or fourth cranial nerve).

Symptoms may include:

• Double visionwhen looking to one side (people who are blind in one eye cannot have double vision)
• Headaches
• Pain

Tests typically show that one eye has trouble looking to the side, while the other eye moves normally. An examination shows the eyes do not line up -- either at rest, or when looking in the direction of the weak eye.

Your health care provider will do a complete examination to determine the possible effect on other parts of the nervous system. Depending on the suspected cause, you may need:

• Blood tests
• Head imaging study (such as an MRI or CT scan)
• Spinal tap(lumbar puncture)

You may need to be referred to a doctor who specializes in visual problems related to the nervous system (neuro-ophthalmologist).

If the health care provider finds a cause, medications called corticosteroids can reduce swelling and relieve pressure on the nerve. Sometimes, the condition may disappear without treatment. People with diabetes may benefit from close control of blood sugar levels.

Until the nerve heals, wearing an eye patch may relieve double vision.

Treating the cause may improve the condition. Even if the cause is never found, the condition may improve.

Complications may include permanent vision changes.

Call your health care provider if you have double vision.

There is no way to prevent this condition. However, people with diabetes may reduce the risk by controlling their blood sugar.

Ovarian overproduction of androgens is a condition in which the female ovaries make too much testosterone. This leads to the development of male characteristics in a woman. Other hormones, called androgens, from other parts of the body can also cause the development of male characteristics in women.

In healthy women, the ovaries and adrenal glands produce about 40 - 50% of the body's testosterone. Both tumors of the ovaries and polycystic ovary syndrome (PCOS) can cause excess androgen production.

Cushing's disease, an abnormality in the pituitary gland, causes excess amounts of corticosteroids, which cause masculine body changes in women. Also, tumors in the adrenal glands can cause overproduction of androgens and lead to male body characteristics in women.

Hyperandrogenism:

• Acne
• Amenorrhea(absence of menstrual periods)
• Changes in female body contours
• Decrease in breast size
• Increase in body hair in a male pattern (hirsutism) such as on the face, chin, and abdomen
• Oily skin

Virilization:

• Clitoromegaly (enlargement of the clitoris)
• Deepening of the voice
• Increase in muscle mass
• Temporal balding (thinning hair and hair loss)

• 17-hydroxyprogesterone test
• ACTH test
• CT scan
• DHEA blood test
• Glucose test
• Insulin test
• Pelvic ultrasound
• Prolactin (if periods are infrequent or absent) test
• Testosterone test
• Total cholesterol test
• TSH test (if there is hair loss)

Treatment depends on the problem that is causing the increased androgen production. Medications can be given to decrease hair production in patients who have excess body hair (hirsutism) or to regulate menstrual cycles. In some cases, surgery may be necessary to remove an ovarian or adrenal tumor.

The success of the treatment depends on what caused the excess androgen production. If the condition is caused by an ovarian tumor, surgical removal of the tumor may correct the problem. Most ovarian tumors are not cancerous (benign), and will not come back after they've been removed.

In polycystic ovary syndrome, the following can reduce symptoms caused by increased androgen levels:

• Careful monitoring
• Dietary changes
• Medications
• Regular vigorous exercise

Infertility is a possible complication.

Women with polycystic ovary syndrome may be at increased risk for:

• Diabetes
• High blood pressure
• High cholesterol
• Obesity
• Uterine cancer

There is no known prevention. Maintaining a normal weight through healthy diet and regular exercise can reduce your chances of any long-term complications.

Lobo RA. Hyperandrogenism: physiology, etiology, differential diagnosis, management. In: Katz V, Lobo RA, Lentz G, Gershenson D, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 40.

Bulun SE, Adashi EY. The physiology and pathology of the female reproductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 16.

• problems with your vision;
• swelling, rapid weight gain, feeling short of breath;
• severe depression, unusual thoughts or behavior, seizure (convulsions);
• bloody or tarry stools, coughing up blood;
• pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate);
• low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or
• dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious prednisone side effects may include:

• sleep problems (insomnia), mood changes;
• acne, dry skin, thinning skin, bruising or discoloration;
• slow wound healing;
• increased sweating;
• headache, dizziness, spinning sensation;
• nausea, stomach pain, bloating; or
• changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088