From the Guidelines
As a second-line treatment for severe aphthous ulcers, I would prescribe azathioprine, as it has been shown to be effective in preventing mucocutaneous lesions, including oral ulcers, in patients with Behçet's disease 1. When considering second-line treatment options for severe aphthous ulcers, it's essential to weigh the potential benefits and risks of each medication.
- Azathioprine, an immunosuppressive medication, has been found to be effective in reducing the frequency and severity of oral ulcers in patients with Behçet's disease, as noted in the EULAR recommendations for the management of Behçet disease 1.
- Other options, such as thalidomide, IFNa, and TNFa antagonists, may also be considered for resistant cases, but their use is limited due to potential side effects and cost 1.
- Colchicine, which is widely used for erythema nodosum and genital ulcers, may not be the most effective option for oral ulcers, as its efficacy is not well-established for this specific condition 1.
- Minocycline, which has been shown to decrease the frequency of oral ulcers, erythema nodosum, and papulopustular lesions in an open study, may be considered as an alternative option 1. It's crucial to tailor treatment to the individual patient's needs and quality of life, taking into account the severity of symptoms, medical history, and potential interactions with other medications.
- Patients should be advised to maintain good oral hygiene, avoid spicy or acidic foods, and use topical anesthetics, such as benzocaine 20%, for pain relief.
- Regular follow-up appointments are necessary to monitor the patient's response to treatment and adjust the medication regimen as needed.
From the Research
Second Line Treatment for Severe Aphthous Ulcer
As a doctor, for an adult patient with a severe case of aphthous ulcer, the following medicines can be prescribed as a second line treatment:
- Topical corticosteroids, such as clobetasol propionate 2
- Systemic medications, including:
- Other immunosuppressive agents, such as levamisole or thalidomide, may be considered for refractory or particularly severe cases 5
Considerations for Treatment
When selecting a second line treatment, it is essential to consider the severity of the ulcer, the patient's medical history, and any potential interactions with other medications. The treatment should be tailored to the individual case, with the primary goals of relieving pain, reducing ulcer duration, and restoring normal oral function 5.
Treatment Options
The treatment options for severe aphthous ulcer may include:
- Topical application of corticosteroids, such as clobetasol propionate in an adhesive denture paste or oral analgesic base 2
- Systemic administration of corticosteroids, such as prednisolone, which can be effective in promoting ulcer healing 4
- Combination therapy, using a multidisciplinary approach, which may be effective in achieving a long-term disease-free state 6