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, I would recommend oral hygiene measures such as lidocaine gel and chlorhexidine to manage oral ulcers and prevent secondary infection 1. It is also important to advise the patient to avoid irritants that could exacerbate the ulcers, such as spicy or acidic foods, and to maintain good oral hygiene through gentle brushing and flossing. If the ulcers are severe, recurrent, or do not respond to these treatments, further evaluation and consideration of systemic medications may be necessary. The goal of treatment is to reduce symptoms, promote healing, and improve the patient's quality of life, which is in line with the EULAR recommendations for managing mucocutaneous involvement in Behçet disease 1. Key points to consider in treatment include:
- Topical corticosteroids as first-line treatment for oral ulcers
- Oral hygiene measures to prevent secondary infection
- Avoidance of irritants to promote healing
- Consideration of systemic medications for severe or recurrent cases
- Focus on improving the patient's quality of life through effective management of symptoms.
From the Research
First-Line Treatment for Aphthous Ulcer
The first-line treatment for aphthous ulcer typically involves topical medications. The following are some of the commonly prescribed medicines:
- Topical corticosteroids, such as triamcinolone acetonide 2, 3
- Anti-inflammatory drugs, such as amlexanox 2
- Antibiotics, such as doxycycline 2
- Antiseptics, such as lidocaine 2, 4
- Topical antiseptic/anti-inflammatory agents, such as triclosan and diclofenac 4
Rationale for Topical Medications
Topical medications are preferred as the first line of treatment due to their minimal side effects 3. They can help reduce ulcer pain, stimulate ulcer healing, and prevent ulcer recurrence 2. In some cases, systemic medications may be necessary if the disease progresses or if local treatment is insufficient 2, 4.
Considerations for Treatment
The treatment of aphthous ulcers is symptomatic and tailored to the severity of the problem in the individual case 4. The frequency of ulcers, the intensity of pain, and the responsiveness of the lesions to treatment are all important considerations when selecting a treatment option 4.