Aphthous Ulcers Medication

  • Author: Crispian Scully, MD, PhD, MDS, CBE, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC), ; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 10, 2012
 

Medication Summary

TCs remain the mainstay of treatment for recurrent aphthous stomatitis (RAS). TCs reduce the number of ulcer days compared with controls, but they have no consistent effect on the frequency of ulceration. TCs may reduce the ulcer duration and pain. Amlexanox oral adhesive pellicles or oral adhesive tablets appear to reduce ulcer pain and duration.

Chlorhexidine gluconate mouth rinses reduce the severity and pain of ulceration but do not affect the frequency.

The range of systemic medications available is of variable or unproven efficacy or may have serious adverse effects; such agents include systemic corticosteroids, colchicine, clofazimine, and thalidomide (and many others).[3]

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Corticosteroids

Class Summary

A spectrum of different TCs can be used. All can reduce symptoms, and neither hydrocortisone nor triamcinolone preparations cause adrenal suppression. Ulcers still recur.

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Hydrocortisone topical (Cortaid, Dermacort, Westcort)

 

Decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.

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Triamcinolone topical (Aristocort, Flutex, Kenalog)

 

Decreases inflammation by suppressing migration of PMNs and reversing capillary permeability.

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Betamethasone topical (Alphatrex, Diprolene, Maxivate)

 

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of PMNs and reversing capillary permeability.

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Fluocinolone (Synalar, Fluonid)

 

High-potency topical corticosteroid that inhibits cell proliferation and is immunosuppressive, antiproliferative, and anti-inflammatory.

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Fluocinonide (Fluonex, Lidex)

 

High-potency topical corticosteroid that inhibits cell proliferation and is immunosuppressive and anti-inflammatory.

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Clobetasol (Temovate)

 

Class I superpotent topical steroid; suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction.

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Contributor Information and Disclosures
Author

Crispian Scully, MD, PhD, MDS, CBE, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC),  Professor of Oral Medicine, Bristol University; Co-Director of World Health Organization Collaborating Centre for Oral Health-General Health; Emeritus Professor of Oral Medicine and Special Care Dentistry, University College London; Professor, Oral Medicine, Pathology, and Microbiology, University of London; Visiting Professor at Universities of Athens,Edinburgh, Granada, Helsinki and Plymouth

Crispian Scully, MD, PhD, MDS, CBE, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC), is a member of the following medical societies: Academy of Medical Science, British Society for Oral Medicine, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, and International Association for Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Hassan H Ramadan, MD, MSc  Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Robert M Kellman, MD  Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society

Disclosure: Revent Medical Honoraria Review panel membership; Synthes Nursing Education Honoraria Other

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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  15. Lo Muzio L, della Valle A, Mignogna MD, et al. The treatment of oral aphthous ulceration or erosive lichen planus with topical clobetasol propionate in three preparations: a clinical and pilot study on 54 patients. J Oral Pathol Med. Nov 2001;30(10):611-7. [Medline].

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Traumatic ulcer on ventrum/lateral margin of tongue; these must be differentiated from aphthae.
Recurrent aphthae in floor of mouth, showing ovoid ulcer with inflammatory halo.
Typical aphthous ulcer in a common site, showing inflammatory halo surrounding a yellowish round ulcer.
 
 
 
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