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). [22]
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.
Hydrocortisone topical (Cortaid, Dermacort, Westcort)
Decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.
Triamcinolone topical (Aristocort, Flutex, Kenalog)
Decreases inflammation by suppressing migration of PMNs and reversing capillary permeability.
Betamethasone topical (Alphatrex, Diprolene, Maxivate)
For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of PMNs and reversing capillary permeability.
Fluocinolone (Synalar, Fluonid)
High-potency topical corticosteroid that inhibits cell proliferation and is immunosuppressive, antiproliferative, and anti-inflammatory.
Fluocinonide (Fluonex, Lidex)
High-potency topical corticosteroid that inhibits cell proliferation and is immunosuppressive and anti-inflammatory.
Clobetasol (Temovate)
Class I superpotent topical steroid; suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction.
Oral Rinses
Class Summary
Mucoadhesive action reduces pain by adhering to the mucosal surface of the mouth.
Bioadherent oral (Gelclair)
This agent adheres to the mucosal surface of mouth and forms a protective coating that shields exposed and overstimulated nerve endings. Ingredients include water, maltodextrin, propylene glycol, polyvinylpyrrolidone (PVP), sodium hyaluronate, potassium sorbate, sodium benzoate, hydroxy ethylcellulose, polyethylene glycol (PEG)–40, hydrogenated castor oil, disodium edetate, benzalkonium chloride, flavoring, saccharin sodium, and glycyrrhetinic acid.
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Traumatic ulcer on ventrum/lateral margin of tongue; these must be differentiated from aphthae.
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Recurrent aphthae in floor of mouth, showing ovoid ulcer with inflammatory halo.
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Typical aphthous ulcer in a common site, showing inflammatory halo surrounding a yellowish round ulcer.
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Recurrent aphthous ulcer with well-defined erythematous halo and central yellowish gray base, on left anterolateral tongue.
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Recurrent aphthous stomatitis with ulcers of varying sizes - large ulcers on the right buccal mucosa and a small ulcer on the anterior tongue.
