Treatment of Canker Sores (Aphthous Ulcers)
First-Line Treatment Approach
- The American College of Dermatology recommends betamethasone sodium phosphate 0.5 mg in 10 mL water as the cornerstone treatment, holding in mouth for 2-3 minutes, then spitting out, using 1-4 times daily 1, 2, 3
- For pain management, the British Journal of Dermatology suggests benzydamine hydrochloride oral rinse or spray every 3 hours, especially before eating 2, 3, 4
- The British Journal of Dermatology also recommends warm saline mouthwashes daily to reduce bacterial colonization 2, 3
- For oral hygiene, the British Journal of Dermatology advises 0.2% chlorhexidine digluconate mouthwash 10 mL twice daily, which can be diluted by 50% to reduce stinging 2, 3
Second-Line Treatment for Refractory Cases
- The American College of Dermatology recommends tacrolimus 0.1% ointment applied twice daily for 4 weeks for refractory cases 1, 2
- For severe cases, the American College of Dermatology suggests intralesional triamcinolone combined with topical clobetasol 0.05% 1, 2
Systemic Therapy for Severe or Recurrent Disease
- The American College of Dermatology recommends prednisone/prednisolone 30-60 mg daily for 1 week, followed by tapering over the second week for highly symptomatic or recurrent ulcers 1, 4
- For recurrent aphthous stomatitis, the Annals of the Rheumatic Diseases suggest colchicine, particularly when associated with Behçet disease 1, 5
- The Annals of the Rheumatic Diseases also recommend azathioprine 2.5 mg/kg/day for severe cases with frequent recurrences 1, 5
Treatment of Secondary Infections
- The British Journal of Dermatology recommends nystatin oral suspension 100,000 units four times daily for 1 week if candidal infection is suspected 2, 3
- The British Journal of Dermatology also suggests miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week as an alternative 2, 3