102 THE PHARYNX AND NASOPHARYNX Aphthons ulcers are not associated with acute infection, and appear for no obvious reason. They take the form of small, shallow ulcers with a clean base and surrounding erythema, and may be found anywhere on the buccal mucosa, the pharyngeal mucosa and the tongue. They give rise to considerable pain. There is no specific treatment. Some help has been obtained by the treatment of any deficiency shown by a full blood examination—especially if there is reduced vitamin B12 or folic acid. Dental treatment to obviate rough edges of teeth may be required. Triamcinolone (Adcortyl) may be prescribed for its antibacterial and anti-immunosuppressive actions, or hydrocortisone may be applied locally as small pellets (Corlan). The local use of a salicylate gel (Bonjela) may be soothing. There are reports of success from the use of tranquillizers as many patients are of the highly emotional type. Behcet's Syndrome. This is most commonly found in eastern Mediterranean countries. The cause is unknown, but it may be due to virus infection or it may be an auto-immune response. The syndrome consists of ulcerations below the tongue or on the buccal mucosa accompanied by ulceration of the genitals. There are various ocular lesions, such as episcleritis, iridocyclitis and corneal ulceration. Steroid therapy combined with a wide-spectrum antibiotic is the most frequent treatment. Folic acid in doses of 5-20 mg daily may be useful. Virus infections show lesions in the mouth and pharynx. Measles may be diagnosed before the rash appears by the presence of white Koplik's spots on the buccal mucosa. Chicken pox may produce herpetiform lesions in the mouth. Herpes may rarely be met with in the throat when groups of small vesicles appear on the soft palate accompanying herpes zoster oticus or ophthalmic herpes. The palatal ulcers cause considerable discomfort and are usually confined to a specific nerve distribution. The virus concerned is Coxsackie A. Skin conditions may be accompanied by lesions of the buccal or pharyngeal mucosa. Lichen planus appears as white papules on the buccal mucosa, and these may coalesce to form larger symmetrical milky reticulate patches which do not give rise to pain, but do cause some discomfort. Treatment is sympto- matic by frequent gargles and aureomycin mouth washes, or even Corlan pellets or triamcinolone paste. Pemphigus vulgaris is a much more serious disease which affects the middle age group, and it may be fulminating and fatal. Large bullae containing haemorrhagic fluid may appear in the mouth and on the pharyngeal mucosa, and these leave shallow ulcers when they rupture. The diagnosis is confirmed by biopsy. The condition is treated by the corticosteroids or prednisolone in the usual dosage. Pemphigoid lesions may be found in the mouth of older patients, especially women. They begin as bullae which break down to cause wide ulceration. Topical steroid therapy is helpful. Erythema multiforme may affect the mouth in its serious form (Stevens- Johnson syndrome). The condition may be drug-induced or it may be a reaction to sepsis in the nose or throat. Large bullae form in the mouth, but they usually respond to the corticosteroids in large doses. Any other drugs which are being taken should be withheld. Polydysplastic epidermolysis buttosa is a rare, sometimes fatal, hereditary disease of infancy in which haemorrhagic bullae may appear on the skin and on mucosal surfaces giving rise to some degree of scarring in the pharynx. There is no specific treatment.