From the Guidelines
Topical measures, such as local corticosteroids, should be the first line of treatment for aphthous ulcers. According to the EULAR recommendations for the management of Behçet disease 1, topical treatments are preferred for isolated oral and genital ulcers.
Treatment Options
- Topical corticosteroids, such as steroid preparations, can be used to manage oral ulcers.
- Lidocaine gel and chlorhexidine can also be used as topical measures to manage oral ulcers.
- Sucralfate suspension has been shown to be effective for oral and genital ulcers in an RCT 1.
Systemic Measures
For more resistant lesions, systemic measures such as colchicine, azathioprine, IFNa, and TNFa antagonists may be considered 1.
- Colchicine is widely used, although its efficacy is not well-established except in erythema nodosum lesions and genital ulcers among women.
- Minocycline has been shown to decrease the frequency of oral ulcers, erythema nodosum, and papulopustular lesions in an open study 1.
- Azathioprine, thalidomide, IFNa, and TNFa antagonists can be used in resistant cases, but their use is limited by potential side effects and cost 1.
Quality of Life
Treatment should be tailored according to how it affects the patient's quality of life, with oral hygiene being an important aspect of management 1.
From the Research
Treatment Options for Aphthous Ulcers
The treatment options for aphthous ulcers include:
- No treatment
- Treatment of associated systemic diseases or conditions (e.g., celiac sprue, vitamin deficiencies) 2
- Systemic medications
- Topical medications
- Conversion of the aphthous ulcer to a wound
- Palliative treatments 2
- Avoiding hard, acidic, and salty foods and toothpastes containing sodium lauryl sulfate, as well as alcohol and carbonated drinks 3
Topical Treatments
Topical treatments are preferred due to fewer associated side effects 2. Options include:
- Corticosteroids
- Topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac
- Local anesthetics such as lidocaine 3
- Topical anaesthetics, which have been shown to be effective in 49% of the population 4
Systemic Treatments
Systemic treatments may be necessary in severe cases, including:
- Colchicine
- Pentoxifylline
- Prednisolone 3
- Immunosuppressive agents, which should be given systemically only for refractory or particularly severe oral aphthous ulcers due to Adamantiades-Behçet disease 3
Multidisciplinary Approach
A multidisciplinary treatment approach may be necessary for major aphthous ulcers, which can be refractory and persistent 5. This approach may include a combination of topical and systemic treatments, as well as nutritional supplements 4.