From the Research
As a third-line treatment for severe aphthous ulcers in an adult patient, I would prescribe thalidomide at a dose of 100 mg/d for 10 days, then 50 mg/d for 10 days, and 25 mg/d for 10 days, as it has been shown to have a long-term effect of extending the recurrence interval of continuous RAU 1. This approach is reserved for patients who have failed first-line treatments (topical corticosteroids, antimicrobial mouthwashes) and second-line options (topical tetracycline, intralesional steroid injections).
- The patient should be advised to maintain good oral hygiene, avoid spicy or acidic foods, and return for follow-up within 2 weeks to assess treatment response and monitor for potential side effects of systemic therapy.
- Thalidomide requires strict monitoring due to its teratogenic effects and potential for peripheral neuropathy.
- Other options such as systemic corticosteroids, specifically prednisone, or immunomodulatory agents like colchicine or dapsone, may also be considered, but thalidomide is the preferred choice based on the most recent and highest quality study 1.
- The treatment goals are to relieve pain, reduce ulcer duration, and restore normal oral function, as well as to reduce the frequency and severity of recurrences and maintain remission 2.