Is dexamethasone cream effective for treating aphthous ulcers?

Dexamethasone Cream for Aphthous Ulcers

Topical dexamethasone cream is effective for treating aphthous ulcers, with studies showing significantly reduced pain, faster healing time, and higher healing ratios compared to placebo. 1

First-Line Topical Treatments

• Topical corticosteroids, including dexamethasone, are recommended as first-line therapy for aphthous ulcers 2, 3
• For localized ulcers, apply dexamethasone ointment directly to the ulcer 3 times daily after meals for 5 days 1
• Alternative corticosteroid options include:
  • Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as a rinse-and-spit preparation four times daily 2, 3
  • Clobetasol 0.05% ointment mixed in 50% Orabase applied twice daily to dried mucosa 3
  • Fluticasone propionate nasules diluted in 10 mL of water twice daily 3

Mechanism and Efficacy

• Dexamethasone reduces inflammation and pain associated with aphthous ulcers 1, 4
• Clinical trials show dexamethasone ointment provides:
  • Significant reduction in ulcer size compared to placebo 1
  • Substantial pain relief 1
  • Higher healing ratio (83.33% vs 54.70% with placebo) 1
  • No detectable serum levels of dexamethasone (<0.502 ng/mL), indicating safety for topical oral use 1

Complementary Treatments

• For pain management:
  • Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 2, 3
  • Topical anesthetic preparations (viscous lidocaine 2%) applied 3-4 times daily for severe pain 3
• For oral hygiene:
  • Daily cleaning with warm saline mouthwashes to reduce bacterial colonization 3, 5
  • Antiseptic oral rinses (0.2% chlorhexidine digluconate) twice daily 5
• For mucosal protection:
  • Barrier preparations such as Gelclair or white soft paraffin ointment 5

Treatment Algorithm for Aphthous Ulcers

1. Start with topical dexamethasone cream applied 3 times daily after meals 1
2. Add pain management with benzydamine or lidocaine as needed 3
3. Implement oral hygiene measures with saline rinses and antiseptic mouthwashes 5
4. For ulcers that don't respond to topical treatment within 5-7 days:
   • Consider intralesional triamcinolone injections 2, 3
   • For severe or recurrent cases, consider systemic therapy with prednisone/prednisolone 30-60 mg daily for 1 week with tapering 2, 3

Special Considerations and Pitfalls

• Ensure proper diagnosis of aphthous ulcers before initiating treatment 5
• For ulcers lasting more than 2 weeks or not responding to 1-2 weeks of treatment, refer to a specialist 2
• Consider underlying systemic conditions (e.g., Behçet's syndrome) in patients with recurrent aphthous ulcers 5
• Avoid premature discontinuation of corticosteroid treatment before healing is established 2
• For recurrent aphthous stomatitis, colchicine can be considered as first-line systemic therapy, especially if accompanied by erythema nodosum or genital ulcers 2, 6