What is the treatment for aphthous ulcers?

Treatment of Aphthous Ulcers

Topical corticosteroids are the first-line treatment for aphthous ulcers, with 0.1% triamcinolone acetonide in orabase being the most effective option applied 2-4 times daily until healing occurs. 1

Clinical Characteristics

• Aphthous ulcers (canker sores) present as well-defined, round or oval lesions with:
  • White or yellow pseudomembrane
  • Red halo
  • Crateriform appearance due to epithelial defect
  • Typically painful

Treatment Algorithm

First-Line Therapy

1. Topical Corticosteroids

   • 0.1% Triamcinolone acetonide in orabase: Apply 2-4 times daily until healing (typically 7-14 days) 1, 2
   • Alternative corticosteroids: clobetasol 0.05% ointment, betamethasone sodium phosphate, or fluticasone propionate 1

2. Pain Management

   • Topical anesthetics: 20% benzocaine gel for immediate pain relief 2
   • Oral analgesics as needed for severe pain 1

Second-Line Therapy

1. Other Topical Agents
   • 5% Amlexanox: Apply 2-4 times daily (shown similar efficacy to triamcinolone) 2
   • Topical doxycycline: Mix 100mg doxycycline hyclate with denture adhesive and normal saline (20:2:1) 2

Supportive Measures

1. Oral Hygiene

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

2. Dietary Modifications

   • Avoid spicy, acidic, and rough foods
   • Stay hydrated
   • Avoid toothpastes containing sodium lauryl sulfate 1, 3

Special Considerations

• Any oral ulcer persisting beyond 2 weeks despite treatment requires further investigation to rule out malignancy or systemic disease 1
• For severe or recurrent aphthous stomatitis (RAS), defined as recurrence of oral aphthous ulcers at least 4 times per year, consider:
  • Evaluation for underlying conditions (celiac disease, inflammatory bowel diseases, nutritional deficiencies, immune disorders) 4
  • Systemic therapy with colchicine for recurrent cases 4, 3

Comparative Effectiveness

• A randomized, double-blind, placebo-controlled trial showed that 0.1% triamcinolone acetonide and 5% amlexanox were more effective in reducing size, number, pain, erythema, and exudate levels of aphthous ulcers compared to doxycycline, benzocaine gel, and placebo by day 8 2
• Triamcinolone acetonide ointment showed superior effectiveness (86.7% positive response) compared to phenytoin (53.3% positive response) in treating aphthous ulcers in patients with Behçet's syndrome 5

Follow-up

• Regular monitoring is essential, especially for persistent cases
• If ulcers do not respond to treatment within 2 weeks, refer for further evaluation 1
• For recurrent cases, follow-up every 3-6 months is recommended 1

Remember that while most aphthous ulcers are benign and self-limiting, proper treatment can significantly reduce pain and discomfort, improving the patient's quality of life during the healing process.