From the Guidelines
As a first-line treatment for an adult patient with aphthous ulcers, I would prescribe topical measures such as local corticosteroids, specifically steroid preparations, to be applied directly to the ulcer. This approach is based on the EULAR recommendations for the management of Behçet disease, which suggests that topical measures should be the first line of treatment for isolated oral and genital ulcers 1. The use of topical corticosteroids can help reduce inflammation and promote healing of the ulcers. Additionally, other topical treatments such as lidocaine gel and chlorhexidine can be used to manage oral ulcers and prevent secondary infection 1. It is also important for patients to maintain good oral hygiene and avoid spicy, acidic, or rough-textured foods during the healing process. Some key points to consider when treating aphthous ulcers include:
- Topical corticosteroids as the first line of treatment
- Use of lidocaine gel for pain management
- Chlorhexidine mouthwash to prevent secondary infection
- Maintenance of good oral hygiene
- Avoidance of irritating foods during healing. Systemic measures such as colchicine, azathioprine, and TNF-alpha antagonists may be considered in more resistant cases, but are not recommended as first-line treatment 1.
From the Research
First Line Treatment for Aphthous Ulcers
The first line treatment for aphthous ulcers typically involves topical medications, which are preferred due to their minimal side effects 2. The following are some of the commonly prescribed topical treatments:
- Topical anesthetics to relieve pain
- Topical corticosteroids to reduce inflammation
- Sucralfate to protect the ulcer and promote healing
- Topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac
- Local anesthetics such as lidocaine
Treatment Strategies
The treatment strategy for aphthous ulcers depends on the severity of the condition and the frequency of recurrences. For mild cases, topical treatments may be sufficient, while more severe cases may require a combination of topical and systemic medications 3, 4, 5. Some of the systemic medications that may be used to treat aphthous ulcers include:
- Colchicine
- Pentoxifylline
- Prednisolone
- Thalidomide (although its use is limited due to frequent adverse effects)
Comparative Evaluation of Treatments
A comparative study of low-level laser therapy and topical triamcinolone acetonide 0.1% found that both treatments were effective in reducing pain and ulcer size, and improving healing 6. However, the study found that low-level laser therapy was more effective in reducing pain and erythema, and improving ulcer healing, especially on days 3 and 5.