Is hydrocortisone (cortisol) effective for treating aphthous ulcers?

Hydrocortisone for Aphthous Ulcers

Topical hydrocortisone is effective for treating aphthous ulcers, but is generally considered a second-line treatment after topical betamethasone and clobetasol, which are more potent and preferred in clinical guidelines. 1, 2

First-Line Treatment Options

• Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL of water as a rinse-and-spit solution 1-4 times daily is recommended as a first-line topical steroid treatment for oral aphthous ulcers 1
• Clobetasol 0.05% ointment mixed in 50% Orabase applied twice weekly to localized lesions on dried mucosa is another preferred high-potency topical corticosteroid option 1
• For highly symptomatic ulcers, high-potency topical corticosteroids should be considered as first-line therapy 1

Hydrocortisone for Aphthous Ulcers

• Hydrocortisone is a lower-potency topical corticosteroid that has shown efficacy in treating aphthous ulcers, but with less potency than other corticosteroid options 3
• Hydrocortisone in-situ gel formulations can provide prolonged drug release for up to 8 hours, which may improve bioavailability and extend drug residence time on the ulcer 4
• Topical corticosteroids, including hydrocortisone, work by reducing inflammation and providing symptomatic relief of pain associated with aphthous ulcers 5

Treatment Algorithm for Aphthous Ulcers

1. Initial approach: Begin with topical treatments including steroids, barrier agents, and pain control measures 2

2. For localized ulcers:

   • First try: Clobetasol gel or ointment (0.05%) or betamethasone sodium phosphate rinse 1, 2
   • Alternative: Hydrocortisone preparation if higher potency steroids are not available or not tolerated 3

3. For widespread or difficult-to-reach ulcers:

   • Use dexamethasone mouth rinse (0.1 mg/ml) 2
   • Consider hydrocortisone preparations for less severe cases 3

4. For refractory cases:

   • Consider intralesional steroid injections (triamcinolone) 2
   • Progress to systemic corticosteroids for highly symptomatic or recurrent ulcers 2

Efficacy and Safety Considerations

• Dexamethasone ointment has demonstrated superior efficacy compared to placebo in reducing ulcer size (7.167 ± 6.3415 mm² vs. 4.346 ± 7.0666 mm²), pain levels, and improving healing ratios (83.33% vs. 54.70%) 3
• Topical corticosteroids like hydrocortisone are generally safe when used for short periods, with minimal systemic absorption 3
• No detectable serum levels of dexamethasone (<0.502 ng/mL) were found after topical application in one study, suggesting minimal systemic absorption with topical corticosteroids 3

Common Pitfalls and Caveats

• Avoid premature discontinuation of corticosteroid treatment before disease control is established 2
• For patients with concurrent candidal infection, combine treatment with nystatin oral suspension or miconazole oral gel 1
• Topical corticosteroids should be applied after meals and oral hygiene to maximize contact time with the ulcer 5
• Systemic absorption is minimal with topical application, but long-term use should be avoided due to potential local side effects 5, 3

Additional Supportive Measures

• Use topical anesthetic mouthwashes (viscous lidocaine 2%) before meals to reduce pain 2
• Apply mucoprotectant mouthwashes three times daily to create a protective barrier 2
• Clean the mouth daily with warm saline mouthwashes to maintain oral hygiene 2
• Avoid hard, acidic, and salty foods that may exacerbate ulcer pain 5