Management of aphthous ulcer Comparison of Minor, Major and Herpetiform aphthous ulcer.
The management of RAS (Recurrent aphthous stomatitis) depends on the frequency and severity of the lesions. In many cases (especially for the minor form) treatment is not necessary as the pain is tolerable and does not interfere with the daily life activities of the patient
The main therapeutic goal for severe and painful cases is to reduce the frequency of the episodes and control the pain.
Patients who report one to two outbreaks a year may be instructed to use over-the-counter local anesthetics (such as 10% benzocaine), viscous lidocaine, or mucoadhesive agents such as polyvinylpyrrolidone sodium hyaluronate and methylcellulose paste (Orabase Paste®)
Amlexanox is a prescription medication with anti-inflammatory properties incorporated in a mucoadhesive agent that has shown some effectiveness. Reassurance and patient education on the condition are also indicated.
Patients with more frequent and severe episodes may be treated with topical corticosteroids and other immunosuppressive agents to shorten the duration and size of the ulcers.
High-potency topical steroids (betamethasone, clobetasol, or fluocinonide) are usually applied on the affected area two to three times daily after meals. Larger and recalcitrant ulcers (such as the ones observed in the major form) can be treated by intralesional therapy such as triamcinolone injections at 10 mg per cm2 of ulceration.
Systemic therapy for severe outbreaks that do not respond to topical measures can be managed with prednisone (usually at 1 mg/kg), pentoxifylline, dapsone, colchicine, azathioprine, or thalidomide. Due to possible side effects with these medications, patients should be carefully monitored long term
Management of aphthous ulcer
| Topical anesthetics for pain control | Instruction |
| Benzocaine 10% | Apply to the affected site, 3-4 times a day |
| Benzydamine hydrochloride 0.15% | Swish 5-15 mL and split out, 3-4 times a day |
| Dyclonine hydrochloride 1% | |
| Viscous lidocaine 2% | Viscous lidocaine may be mixed in equal volume with diphenhydramine, aluminium/magnesium, and bismuth subsalicylate |
| Topical anesthetics for pain control | Instructions |
| Triamcinolone 0.1% in methylcellulose paste Clobetasol 0.005% gel Betamethasone 0.05% gel Fluocinolone 0.05% gel | Apply to affected site 2-3 times daily; no drink or food intake for 20-30 min afterword |
| Dexamethasone elixer 0.5mg/5mL Clobestol 0.005% Solution (Compounded) | Dispense 300 mL; swish 5 mL for 3-4 min (timed) and spit out, 3-4 times a day; no drink or food intake for 20-30 min afterward |
| Steroid injection with triamicinolone (into the aphthous ulcer) | 5-10 mg triamicinolone per cm2 of ulceration |
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