Treatment Options for Oral Aphthous Ulcers

First-Line Treatments

• The British Journal of Dermatology recommends betamethasone sodium phosphate 0.5 mg dissolved in 10 mL of water as a 2-3 minute rinse-and-spit solution one to four times daily for oral aphthous ulcers 1
• The British Journal of Dermatology suggests fluticasone propionate nasules diluted in 10 mL of water twice daily for oral aphthous ulcers 1
• The British Journal of Dermatology recommends clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly to localized lesions on dried mucosa for oral aphthous ulcers 2
• For highly symptomatic ulcers, the Annals of Oncology recommends considering high-potency topical corticosteroids first 3

Pain Management

• The Annals of Oncology recommends following the WHO pain management ladder for more severe pain in oral aphthous ulcers 3
• The British Journal of Dermatology suggests using barrier preparations such as Gengigel mouth rinse/gel or Gelclair for pain control in oral aphthous ulcers 1, 2

Second-Line Treatments

• The British Journal of Dermatology recommends tacrolimus 0.1% ointment applied twice daily for 4 weeks for recalcitrant oral aphthous ulcers 1, 2
• The Annals of Oncology suggests considering weekly intralesional triamcinolone (total dose 28 mg) in conjunction with topical clobetasol gel or ointment (0.05%) for ulcers that don't resolve with topical treatment 3

Systemic Therapy for Severe Cases

• The Annals of Oncology recommends considering systemic corticosteroids (high-dose pulse 30-60 mg or 1 mg/kg oral prednisone/prednisolone for 1 week followed by dose tapering over the second week) for highly symptomatic or recurrent ulcers 3

Common Pitfalls and Caveats

• The Praxis Medical Insights recommends treating patients with concurrent candidal infection with nystatin oral suspension or miconazole oral gel 4

Treatment of Recurrent Aphthous Stomatitis

Systemic Therapy for Severe or Recurrent Disease

• Colchicine is particularly effective for recurrent aphthous stomatitis, especially when associated with Behçet disease, as reported by the Annals of the Rheumatic Diseases 5
• Azathioprine 2.5 mg/kg/day is recommended for severe cases with frequent recurrences, according to the Annals of the Rheumatic Diseases 5
• Thalidomide is the most effective treatment for recurrent aphthous stomatitis but its use is limited by teratogenicity and peripheral neuropathy risks, as noted by the Annals of the Rheumatic Diseases 5
• Colchicine combined with topical treatments is recommended for recurrent aphthous stomatitis, as suggested by the Annals of the Rheumatic Diseases 5