What is the best way to treat an aphthous ulcer on the lip?

Treatment of Aphthous Ulcers on the Lip

Topical corticosteroids, such as 0.1% triamcinolone acetonide in orabase applied 2-4 times daily until healing, are the first-line treatment for aphthous ulcers on the lip. 1

First-Line Treatment Options

Topical Corticosteroids

• Apply 0.1% triamcinolone acetonide in orabase 2-4 times daily until healing (typically 7-14 days) 1
• Alternative topical corticosteroid options:
  • Clobetasol 0.05% ointment
  • Betamethasone sodium phosphate
  • Fluticasone propionate

Pain Management

• Topical anesthetics:
  • Lidocaine viscous 2% solution for immediate pain relief 1
• Barrier preparations:
  • Gengigel or Gelclair to manage pain and promote healing 1

Additional Topical Treatments

• Sucralfate suspension - forms a protective barrier over the ulcer 1
• Tacrolimus 0.1% ointment - particularly for resistant cases 1

Self-Care Measures

Oral Hygiene

• Use a soft toothbrush and mild non-foaming toothpaste 1
• Rinse with saline solution 4-6 times daily 1
• Use alcohol-free mouthwash 1

Dietary Modifications

• Avoid triggering foods:
  • Spicy foods
  • Acidic foods (citrus, tomatoes)
  • Hard or rough foods that may traumatize the ulcer
  • Foods containing sodium lauryl sulfate 1
• Stay well-hydrated 1

Treatment Algorithm for Aphthous Ulcers

1. Initial Presentation:

   • Apply topical corticosteroid (0.1% triamcinolone acetonide) 2-4 times daily
   • Use topical anesthetic for pain relief as needed
   • Implement self-care measures

2. If No Improvement After 7 Days:

   • Consider stronger topical corticosteroid (clobetasol 0.05%)
   • Add sucralfate suspension or tacrolimus 0.1% ointment 1

3. For Severe or Recurrent Cases:

   • Consider systemic medications:
     • Colchicine (particularly effective for recurrent cases) 1, 2
     • Pentoxifylline
     • Short course of systemic corticosteroids for major aphthous ulcers 1, 3
   • Thalidomide is most effective but limited by adverse effects 2

Important Considerations

Red Flags Requiring Immediate Evaluation

• Ulcer persisting beyond 2 weeks despite treatment 1
• Induration or fixation of the lesion
• Unexplained bleeding
• Cervical lymphadenopathy
• Growth despite treatment
• Persistent numbness or paresthesia

Differential Diagnosis

Aphthous ulcers must be distinguished from:

• Oral herpes simplex 3
• Pemphigus vulgaris
• Bullous pemphigoid
• Tuberculosis
• Fungal infections
• Crohn's disease 1
• Squamous cell carcinoma (any solitary chronic ulcer should be biopsied) 1, 2

Monitoring

• Regular monitoring is essential for persistent cases 1
• Follow-up every 3-6 months for recurrent symptomatic cases 1

Aphthous ulcers are extremely painful but typically self-limiting with appropriate treatment. The primary goals of therapy are pain relief, reduction of ulcer duration, and restoration of normal oral function 4. With proper management using topical corticosteroids and supportive care, most aphthous ulcers will heal within 7-14 days 1.