58-year-old man presents with the chief complaint of painful ulcers in his mouth for over a year

NKDA, Current medications include fluocinonide gel, magic mouthwash, tetracycline and diflucan with no resolution after several weeks of compliant use

PMH: HTN treated with atenolol, constipation, recurrent respiratory infections, occasional chest pain of indeterminate cause, alopecia, oral aphthae and thrush